APPs are the key to healthcare access. Our leadership models haven’t caught up.
By Anita Opdycke, DNP, APRN, RN, PMHNP-BC, NP-C, SVP/Partner, Press Ganey Consulting and Advisory Services
The advanced practice provider (APP) workforce is expanding at a pace healthcare has never seen before. Nurse practitioners and physician assistants are projected to grow by as much as 45% over the next decade, far outpacing physician workforce growth.
At the same time, access to the availability of care remains one of the most urgent and persistent challenges facing healthcare systems today.
These two realities are not separate as often assumed but deeply connected.
APPs are no longer a supplemental workforce. They are central to how health systems expand access, improve throughput, and deliver team-based care. Every day, APPs are absorbing demand, extending capacity, and helping organizations respond to workforce shortages alongside rising patient needs.
And yet, most organizations aren’t structured to support them.
The leadership gap behind the access gap
Despite their growing role, many APPs continue to operate in structural ambiguity. Governance is inconsistent. Leadership is fragmented. Career pathways are unclear. But the data makes it crystal clear that these aren’t anecdotal cases.
Press Ganey is leading the way in continuous listening for the APP workforce, with national benchmarking data reflecting trends over the past two years. And the data tells a nuanced story. On one hand, APP engagement, alignment, and resilience are improving, alongside gains in safety culture. On the other, persistent challenges remain.
Across nearly 16,000 APP comments from 181 healthcare organizations, the most common themes that surface are strikingly consistent:
- Compensation and benefits
- Staffing and retention
- Collaboration and communication
At the same time, the strongest drivers of engagement are equally clear:
- Confidence in senior leadership
These aren’t solely operational issues but leadership ones. If access is increasingly dependent on APPs, then it’s also increasingly dependent on how well we lead them.
A system not designed for the workforce it now depends on
Most health systems were built around two primary clinical structures: physicians and nursing. APPs were added over time, often without a corresponding evolution in governance.
The result is a workforce that spans service lines but lacks centralized leadership and accountability, which leads to predictable consequences: inconsistent role utilization
- Fragmented professional identity
- Limited influence on care model design
- Under-realized return on workforce investment
These are system performance issues, and when APP governance is unclear, organizations unintentionally constrain their own capacity. Decisions about APP deployment are made at the department level rather than through enterprise strategy. Variability increases. Efficiency declines. Access remains limited, even when the workforce exists to expand it.
What leading organizations are doing differently
Forward-thinking health systems are beginning to recognize that APPs are not an operational resource but a strategic asset.
These organizations are establishing enterprise-level APP leadership, often through system advanced practice executive roles, to:
- Align workforce planning across the organization
- Standardize practice models
- Optimize scope of practice
- Elevate the APP voice in executive decision-making
It’s not a hierarchical shift but one of accountability.
When APP governance is clearly defined:
- Role clarity improves
- Engagement becomes more durable
- Workforce utilization becomes consistent and scalable
- Care models evolve more effectively
- Access expands in a sustainable way
Organizations move from reactive staffing solutions to intentional workforce strategy.
The policy imperative
Healthcare cannot solve its access challenges without addressing how it leads and governs APPs. As demand continues to rise and workforce shortages persist, the ability to scale access will depend not only on how many APPs we have, but on how effectively we enable them to practice.
This requires:
- System-level APP leadership structures
- Standardized governance models
- Investment in APP well-being and professional development
- Intentional integration of APPs into care model design
It also requires a shift in mindset. APPs are not an extension of existing structures. They are a foundational component of the future care delivery model.
A personal perspective
As both a family psychiatric nurse practitioner and primary care nurse practitioner, I have seen firsthand the impact APPs can have on access, continuity, and patient outcomes. I have also seen the frustration that comes when talented, highly trained clinicians are placed in systems that were not designed for them to thrive.
What is most striking is that the solution is not elusive:
- We know what drives engagement.
- We know what enables performance.
- We know what expands access.
The question is whether we are willing to redesign leadership structures to match the workforce we now depend on.
The future of healthcare access will not be determined by whether we have enough APPs. It will be determined by whether we built the leadership systems to enable them to succeed.
Explore how structured APP governance, leadership, and continuous listening can help your organization expand access, strengthen engagement, and deliver care at scale. Connect with Press Ganey Consulting to start the conversation.
