Emily Izzo, U of U Health.
Building a Career Progression Framework for Advanced Practice Clinicians
By the year 2032, two-thirds of the provider workforce will be advanced practice clinicians (APC). Charity Coe and Julie O’Brien, APCs and seasoned leaders passionate about improving their discipline, are charting a course for the success of future practitioners.

dvanced practice clinicians (APCs) are a relatively new discipline in the field of medicine, first introduced in the 1960s. Today APCs—physician assistants (PAs) and nurse practitioners (NPs)—perform many of the services that were once the sole responsibility of a physician. We play an integral role within any care team, especially as the U.S. health care system continues to move toward value-based care and population health programs that require greater access, choice, and cost efficiency in treating patients. 

APCs have grown as the number of physicians have declined, especially primary care doctors and those in rural and low-income communities. The Association of American Medical Colleges (AAMC) released a 2020 report predicting a shortage of 54,000 to 139,000 physicians, both primary and specialty care, by 2033. PAs and NPs increase access where there are not enough physicians to meet patient demand. They can also work in numerous clinical settings, from rural and underserved community clinics to specialty clinics, urgent care centers, acute care facilities, and more.

Growing Pains for APCs

Today there are more than 123,000 PAs and 290,000 NPs working in primary and specialty care clinics throughout the U.S., and by the year 2032 APCs are projected to make up around two-thirds of the health care provider workforce.1 Even with this growth, many organizations are struggling to figure out how to help these professionals advance in their careers. Most organizations do not have specific career progression tracks in place like they do for physicians.

"Most organizations do not have specific career progression tracks in place like they do for physicians."

We both navigated our way into our current leadership roles, advancing professionally as University of Utah Health recognized the need for more formalized oversight and leadership with the growing number of APCs in our department. 

In our roles as APC directors in the surgery department, we saw a need for more support on the professional side. In addition to helping PAs and NPs understand their clinical role and how they can enhance a practice, we wanted to create an infrastructure that supports them in a long-term career path based on their own interests and strengths. In the absence of these support systems, APCs who want to advance often decide to move on to different positions or different organizations, which isn’t in the best interest of patients, providers, and our organization. 

Create opportunity: APCs as integrated clinical AND academic partners

As we explored ways to improve APC career progression, we decided to start somewhere that is already familiar: University of Utah Health’s Faculty Appointment, Retention and Advancement (FARA). 

It was a practical decision in the sense that we didn’t need to reinvent the wheel and could use some of the same common language that the organization already uses for professional development. It was also a strategic decision. For years, APCs have been working to become integrated, not only as clinical partners, but as academic partners as well. Our PAs and NPs work alongside some of the best educators in academic medicine, and it’s important that they are recognized for their clinical skills as well as their academic and research skills.  

The program itself is in its early stages, but we hope to make it the gold standard for APC career advancement and progression, providing a path that allows them to stay long-term like our faculty do. 

Build community through learning

University of Utah Health has a robust community of APCs in a variety of departments. We all have requirements to maintain our licenses, and previously would piggyback on what the faculty physicians were doing—attending grand rounds and choosing from conferences that meet our needs. 

With rapid changes in health care, it became clear to us that we needed a formal setting where APCs could share their knowledge and experience, so we created an annual Education Day. It’s on-site and provides eight hours of CME without any travel, and is the ideal setting to share best practices and network with other APCs, especially those in other departments. 

The day is catered specifically to the questions, concerns, and challenges of nurse practitioners and physician assistants so they don’t have to find what’s relevant to them from a conference directed at physicians. It also has another professional development benefit: an opportunity for those who want to build their communication skills to volunteer as presenters.

While COVID-19 has thrown a wrench in our ability to gather in person, we’re looking for new and innovative ways to continue events and professional development virtually. 

Commitment to continued growth

The process to create a brand new professional development and career progression program for our advanced practice clinicians is in the early stages. While we’ve started from scratch, it’s been valuable to identify what our APCs need to build a lasting professional development community. 

With a physician shortage that is projected to increase, advanced practice clinicians will continue to be integral to expanding access and improving care in primary and specialty medicine. We’re committed to becoming the premier destination nationally for APC excellence, helping our nurse practitioners and physician assistants achieve their career goals while furthering our mission to provide exceptional patient care.


1. Auerbach, David I, Staiger, Douglas O, & Buerhaus, Peter I. (2018). Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce. The New England Journal of Medicine, 378(25), 2358-2360.

Originally posted August 2020


Charity Coe

APC Director, Clinical Operations, Department of Surgery, University of Utah Health

Julie O'Brien

APC Director of Education and Recruitment, Department of Surgery, University of Utah Health

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