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Maximizing Their Scope of Practice (SOP)

Date: 12/07/2024
American Headache Society Practice Tips
  1. “You recognize a good physician by the way he takes care of a patient who has headaches” (William Osler). It is a common goal between Headache Medicine (HM) practices and the APPs for the latter to work at the top of their scope of practice (SOP). Bringing value and being valued is critical for successful integration of non-physician care providers into a team-based approach.
     
  2. A good onboarding process, mutually agreed between the supervisor and the new APP hire, may set the tone for a long collaboration and a successful HM provider. This should involve tailored shadowing duration, gradually increasing clinical responsibility, developing safe and efficient procedural skills, ongoing learning, communicating optimally with patients and colleagues.
     
  3. The scope of practice (SOP) for the onboarded APP is expected to be highly variable, depending on the individual practice needs, which may change over time, as well as state and federal regulations. Upfront and ongoing discussions between the supervising provider and the new APP on expected responsibilities and goals, collaborative practice with colleagues and staff, ethical and legal considerations, billing/coding and other specific matters may provide enhanced team integration and practice retention.
     
  4. Various sources of education are recommended,  including books, journal articles, online materials, e.g. AHS Education On Demand, participation to local, regional, national conferences; practices are recommended to provide support (time and financial) for APPs to attend such relevant educational opportunities. Use International Classification of Headache Disorders (ICHD) as the main resource for differential diagnosis and keep an open eye for non-headache neurological diagnoses.
     
  5. Periodic formal self-assessments, some available online, and formative evaluations by the supervisors can help build true confidence.  Need to be assertive and develop competencies in taking the history, performing the neurological exam, doing patient education and counseling, pharmacologic and non-pharmacologic management, clinical documentation, and performing procedures. Strive to learn laboratory tests and especially imaging (including shadowing in the Neuroradiology reading room).
     
  6. Staying connected with peers, networking and learning from authorities in the field helps at both professional and personal levels. Becoming a member in professional organizations: e.g. AHS, AAN, AANP (American association of nurse practitioners), AAPA (American Academy of Physician Assistants). Practicing APPs in HM are well positioned to educate others (like APP students, APP peers, nurses, clinic staff and even medical students, residents and fellows) on headache management, including procedures.
     
  7. APPs are encouraged to actively participate in any practice/department activities as desired and applicable, including case presentations, weekly meetings, grand rounds, practice management, wellness projects, quality improvements, as well as to explore education and research opportunities.
     
  8. Diversify the roles the APP fulfills in the practice as much as possible, including return and new patients, procedures, in-basket optimizations, group visits, infusion clinic, inpatient care. Autonomy is one of the main factors driving job satisfaction and retention; it needs to be well balanced with availability of appropriate support to prevent excessive workload and burnout.
     
  9. Be an upstander, for yourself, patients, peers, practice. Ask for and provide feedback as often as necessary. Seek active mentorship and mentor others. Leadership or co-leadership roles may be available in a more or less competitive fashion. Getting involved in advocacy will increase the sense of purpose and is often therapeutic.
     
  10. Academic development is encouraged. Consider applying for formal certification, like Added Qualification in Headache medicine (AQH). Doctor of Nursing Practice (DNP for NPs) may help answer research questions the APP might be interested in. Applying for and getting promotion within the practice or department is becoming more common for APPs and is recommended to become familiar early with promotion criteria and building portfolios.

About the Author

Dr. Marius Birlea, MD, FAHS, FAAN is the Chief of the Headache section in the department of Neurology at the University of Colorado Anschutz Medical Campus. He is the co-chair of the Advanced Practice Providers working group of the AHS Practice Management committee. He has closely collaborated with many Advanced Practice Providers in the last 10 years and appreciates the exceptional value they bring to Headache Medicine patient care and not only. Dr. Birlea has authored and co-authored multiple publications on Headache Medicine, given numerous presentations and has also been involved in various advocacy endeavors.