“Mrs. Jenkins says she refuses to see anyone but Dr. Patel,” the receptionist whispers to the administrator. “She insists, ‘I’m paying to see a doctor.’” 

The schedule has Dr. Patel booked solid for six weeks; the nurse practitioner (NP) who was set to see Mrs. Jenkins had three same-day openings.

This is the daily dilemma for many practice leaders: physician schedules burst at the seams while advanced practice providers (APPs) — NPs and physician assistants (PAs) — carry plenty of unused capacity when patients insist on “the doctor.” Clinicians worry about scope of practice, quality, and liability, while administrators and finance leaders see access and margin at risk if you don’t leverage APPs more effectively.

While some private practices opt not to use APPs, many others are working to reframe the question around how to do so in a way that patients accept, clinicians trust, and the business can sustain.

Not just a scheduling problem: APP utilization is a strategic issue

Across ambulatory care, practices are steadily adding APPs to meet demand. Recent MGMA Stat polling found that nearly half of practices increased their APP-to-physician ratio compared to the prior year. Prior to that, another MGMA poll found that more than six in 10 medical groups planned to add new APP roles, with very few cutting back.

The practice administrator’s dilemma centers on design and communication: how to build the care team model, how you talk about it, and how consistently the team reinforces it. Drawing on MGMA Member Community discussions and broader ambulatory care research, here are practical strategies to move beyond the “I only want the doctor” standoff.