Advanced practitioners in nephrology show diverse integration
Click Here to Manage Email Alerts
The National Kidney Foundation’s Council of Advanced Practitioners conducts an online survey every 2 years to assess the workplace and functions of today’s nephrology advanced practitioners, known as APs.
Topics include work setting, demographics, duties and responsibilities, along with pay and benefits. The 15-minute survey is open to all APs working in nephrology, regardless of their membership in the council.
Demographics
There were 322 participants who responded to the 2020 survey, which was higher than previous years. While the APs who responded were predominantly female and white (6% each for the next highest categories of Asian American participants and African American participants), there was diversity in ages as was also seen in the 2018 survey.
Among respondents, 25.5% were aged 20 to 30 years old, 31% were aged 30 to 40 years old, and 22.7% were aged 40 to 50 years old.
Nearly half of the respondents said they had been in their current position for 5 years or less, and roughly a third reported 5 years or less as an AP (see Figures 1 and 2). This trend toward newer APs could reflect the declining fellowship numbers and increasing need for nephrology support from APs, as well as an expanding labor force overall.
Nurse practitioners (NPs) still make up most of the AP workforce, followed by physician assistants (PAs) and clinical nurse specialists (CNS). In the survey, 86% of all APs reported their highest degree obtained was at a master’s level.
All but three states were represented in the data (Delaware, Rhode Island and North Dakota), and the largest numbers of APs practice in the South and Midwest regions of the United States. The highest reporting states, with 20 or more AP respondents, were Illinois, Michigan, Missouri and Texas.
Four APs did report working outside the United States.
Workplace setting
Physician practice size where APs and PAs work varied widely, with anywhere from one to 60 nephrologists per practice. However, the average size reported in the survey was 10 physicians, four NPs and one PA.
Full-time employment (92.5%) vastly outnumbered the few part-time employees (7.5%). One-fifth of all APs were in a single-specialty physician group, according to the survey results.
At 82%, dialysis remained the largest setting for APs. That included outpatient clinic/office (66%), hospital inpatient coverage (37%) and ICU/critical care management (21%).
Hospital duties covered the standard range of provider needs, such as history and physicals, new consults and progress notes, discharges and call coverage. Office clinics consisted largely of chronic kidney disease and hospital follow-up visits.
Most APs (60%) took call for dialysis during the week, with 25% also taking call after hours and/or on weekends. About one-third took call for office clinic, but this was primarily during standard business hours.
While APs remained well involved in dialysis and other clinical duties, research and education activities have slightly declined since the 2018 survey. Fifteen percent of APs surveyed were involved in research, with one to two studies at any given time. This number has continued to decline in recent years.
While most of APs acted as sub-investigator, 17% acted as the primary investigator. Only 4% and 5% of APs surveyed were involved in pediatric nephrology or interventional nephrology, respectively, with procedures largely including central lines or supporting with catheters, discharges or first assistance. Regarding education duties, 28% of APs were involved in both mentoring AP students and new AP employees. Less than 20% of APs taught kidney disease education classes, a decrease from the 2018 report of 33%.
Dialysis duties
In-center hemodialysis still dominates AP time with little work on home therapies (maximum 18% work in peritoneal dialysis). Transplant duties were also minimal and mainly involved immunosuppressive management or transplant education.
The average number of patients on dialysis cared for by APs varied significantly based on the study results, but most APs saw 76 to 100 patients per week, a slight increase from 2018 (see Figure 3). While most APs rounded weekly (55% of APs complete three out of four monthly capitated visits), 46% reported responsibility for the monthly comprehensive visit, 43% for care plans, 40% for clerical duties, such as medication lists, and 35% with paperwork, such as insurance, disability or transport forms.
Salary and benefits
Slightly more than half of the respondents reported practicing under a written contract. More than half of these contracts included a non-compete clause and 12% included automatic salary increases. More than 50% of APs received a raise in the past year, usually within the range of 1% to 3% and based on productivity, merit/performance and/or to maintain a competitive range.
Most survey respondents reported a salary range of $101,000 to $110,000, and more than half of survey participants reported a salary between $96,000 and $120,000. The overall average was $109,800, with NPs receiving an average of $109,200 (see Figure 4) and PAs $113,100.
The overall average salary has steadily increased by $2,000 to $3,000 annually since 2016. Pay for call coverage was predominantly for after hours (79%). Nearly 30% of APs participated in profit sharing, mostly at a 1% to 3% rate.
Other benefits included continued education (CME), with a $1,725 annual budget on average and 4 to 5 days of paid time off for CME. Total paid time off averaged 26 days, with 20 days of vacation. Most received health care insurance with varying premium coverage, and roughly a third reported vision and/or dental coverage. Employer-based malpractice coverage was reported by a vast number of respondents at 93%.
Conclusion
The National Kidney Foundation Council of Advanced Practitioners’ biennial survey allows for a regular snapshot of the AP in nephrology. The workforce was most strongly represented in regions with a high percentage of kidney disease as one might expect, and newer APs in the profession may represent an increasing demand for providers in nephrology. Bread-and-butter duties continue to constitute most of the AP’s daily duties, such as office management of CKD and patients on dialysis. That being said, APs have integrated themselves into every aspect of nephrology and maintained this diverse coverage in the last few years.
Acknowledgements
The NKF Council of Advanced Practitioners helped with the survey and Kim Zuber, PA-C, provided guidance on this manuscript.
- For more information:
- Amy Mosman, MMS, PA-C, is a nephrology physician assistant and advanced practitioner leader for Saint Louis University and can be reached at amy.mosman@health.slu.edu.
Collapse
Read more about
Click Here to Manage Email Alerts