Dear editor,
As members of the Society for Vascular Nursing (SVN) Board of Directors, the Society for Vascular Surgery (SVS) Advanced Practice Provider (APP) Section, and representatives of our broader membership, we feel compelled to respond to Dr. Arthur Palamara’s recent opinion piece published online April 29. While Dr. Palamara rightly identifies concerns about physician shortages and systemic challenges in healthcare, his characterization of advanced practice providers (APPs) warrants a more nuanced discussion based on current evidence.
The value of APPs in vascular care extends far beyond the mere “substitution” of physicians. Multiple studies demonstrate that APPs improve healthcare delivery through collaborative practice models. A systematic review published in the Journal for Nurse Practitioners found consistent evidence supporting the quality of care provided by nurse practitioners across various settings.1 This directly contradicts the assertion that APPs provide “negligible success” in healthcare delivery. Comprehensive analysis shows that when properly integrated into care teams, APPs contribute significantly to positive patient outcomes, enhanced access to care and cost-effectiveness.2 The statement by Dr. Palamara that APPs are “utterly unqualified to diagnose and treat patients” misrepresents our training and expertise. In a 2023 study, APP utilization in a single specialty surgical practice was found to reduce complications, decrease postoperative readmissions, and improve physician accessibility to see new and more complex patients.3 Another recent study published in the Journal of Trauma Surgery and Acute Care showed that APP utilization can improve healthcare costs, length of stay, time to consultation and treatment, overall mortality, and patient satisfaction.4
Regarding the Hattiesburg Clinic study referenced by Dr. Palamara, it’s important to note this study evaluated APPs functioning with separate patient panels rather than in collaborative team-based models that characterize modern vascular care. This distinction is crucial, as research shows optimal results occur when APPs practice within their scope as part of integrated care teams. A systematic review and meta-analysis demonstrated that nurse practitioner-led care in patients with cardiovascular disease was associated with positive outcomes comparable to physician-led care.5 Additionally, a comprehensive review concluded that outcomes for patients under the care of nurse practitioners were comparable and, in some ways, superior to those of physicians alone.6
Our collective experience in vascular care demonstrates that APPs facilitate smooth transitions across care settings, enhance patient education, improve adherence to follow-up protocols and allow surgeons to focus on complex surgical cases where their specialized training is most needed. Multiple studies have documented that APPs in surgical specialties contribute to shorter hospital stays, reduced readmission rates, improved patient satisfaction and more efficient use of healthcare resources. Vascular surgery hospitalist programs have demonstrated improved surgeon satisfaction, resource utilization, timeliness of patient care, and enhanced communication among referring physicians and staff.7 Research specific to vascular surgery has shown that integrating nurse practitioners into outpatient vascular clinics significantly increased patient satisfaction scores, with substantial improvements in metrics such as “likelihood to recommend” and perceptions of staff collaboration.8
The future of vascular care depends on collaborative models that leverage the complementary skills of all team members. Rather than promoting divisive rhetoric, we should focus on optimizing team-based care where physicians and APPs work together to address the complex needs of vascular patients. The evidence overwhelmingly supports that APPs enhance, not diminish, the quality of care when properly integrated into specialty practices. As we face growing demands for vascular services amid physician shortages, we must move beyond outdated paradigms to embrace collaborative solutions that serve our patients’ best interests while supporting the well-being of all healthcare providers.
Respectfully submitted,
The SVN Board of Directors and the SVS APP Section
References
- Stanik-Hutt J et al (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492-500. https://doi.org/10.1016/j.nurpra.2013.07.004
- Swan M et al (2015). Quality of primary care by advanced practice nurses: A systematic review. International Journal for Quality in Health Care, 27(5), 396-404. https://doi.org/10.1093/intqhc/mzv054
- Hollenbeck BK et al. Effects of advanced practice providers on single-specialty surgical practice. Ann Surg. 2023 Jan 1;277(1):e40-e45. doi: 10.1097/SLA.0000000000004846. Epub 2021 Mar 3. PMID: 33914476; PMCID: PMC8989058
- Lasinski AM et al. Advancing the practice of trauma: utilizing advanced practice providers to improve patient outcomes through a collaborative team approach. Trauma Surg Acute Care Open. 2024 Aug 21;9(1):e001281. doi: 10.1136/tsaco-2023-001281. PMID: 39175840; PMCID: PMC11340716
- Smigorowsky MJ et al (2020). Outcomes of nurse practitioner‐led care in patients with cardiovascular disease: A systematic review and meta‐analysis. Journal of Advanced Nursing, 76(1), 81-95. https://doi.org/10.1111/jan.14229
- Newhouse, RP et al (2011). Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economics, 29(5), 230-250.
- Cull, DL et al (2013). The influence of a vascular surgery hospitalist program on physician and patient satisfaction, resident education, and resource utilization. Journal of Vascular Surgery, 58(4), 1123-1128. https://doi.org/10.1016/j.jvs.2013.04.052
- Dunlap E, Fitzpatrick S, Nagarsheth K (2022). Collaboration with advanced practice registered nurses to improve patient satisfaction in outpatient clinic. The Journal for Nurse Practitioners, 18(9), 1009-1012. https://doi.org/10.1016/j.nurpra.2022.06.012
