Dr. Sophia Thomas: Let NPs be allies as healthcare faces physician shortage

For Sophia Thomas, DNP, an unlikely spark lit her passion for nursing: a severe case of appendicitis at age 13.

Dr. Thomas, the immediate past president of the American Association of Nurse Practitioners, credits the nurses who went above and beyond to take care of her at the hospital for inspiring her career path. 

Dr. Thomas ended her two-year term as AANP's president July 1, handing the reins to April Kapu, DNP. Alongside her advocacy work, she continues to practice as a family and pediatric nurse practitioner at the DePaul Community Health Center in New Orleans.

Here, Dr. Thomas reflects on her last two years as AANP's president and outlines how she'd like to see the nurse practitioner role — and healthcare — change. 

Editor's note: Responses have been lightly edited for length and clarity. 

Question: What piqued your interest in the nursing or healthcare profession?

Dr. Sophia Thomas: When I was 13, I got appendicitis. I was very, very sick, and when I finally made it to the hospital, my appendix was ruptured. I had to have emergency surgery, developed peritonitis and was in the hospital for about a week with a drain and everything. This was back in the early 1980s when parents couldn't stay with you in the hospital. So I had the nurses taking care of me and being surrogate mothers to me. They left such an impression on me. I had no exposure to nursing before that time and didn't really understand what a nurse was. From that moment, I knew I wanted to help others just like they helped me. It was truly life-changing, and from then on, my path was set.

Q: What's the biggest lesson you've learned over the last two years as AANP's president?

ST: When I first became a nurse practitioner 26 years ago, we learned that the populations most at risk for high blood pressure, asthma, diabetes, kidney disease and heart disease were communities of color, and those statistics have not changed in the entire time I've been a nurse practitioner. Couple that with the fact that the U.S. will face a shortage of up to 90,000 physicians by the year 2025. In addition, more than 84 million people live in health professional shortage areas, and an estimated 122 million Americans live in a mental health professional shortage area.

It's really clear we're facing significant challenges to combat future pandemics, address chronic disease and strengthen healthcare outcomes for underserved communities. The pandemic has really shone a bright light on these challenges. We've learned that we have to reimagine our healthcare system. The way we've been providing healthcare in this country hasn't been working. 

I think we've learned we need all healthcare providers practicing at the top of their education and training without any regulatory restrictions. We know that lifting regulatory restrictions does improve healthcare access. We know that when healthcare providers, health systems, hospitals, pharmaceutical companies and policymakers all come together, we can accomplish anything. Take the development of the COVID-19 vaccine. We had a public-private partnership supporting the effort, and we miraculously came to the vaccine in such a short period of time. If we can do that to battle COVID-19, we really should be able to do that for any disease or disorder.

Q: If you fast forward 10 years, what do you hope the NP profession looks like or has achieved?

ST: The most important thing is full practice authority for nurse practitioners in all 50 states. More than three-quarters of nurse practitioners are trained in primary care. Today, about half of U.S. states grant patients full and direct access to nurse practitioners providing care, allowing nurse practitioners to practice at the top of their education and training without any regulatory restrictions. But in the remaining states, they are just lagging behind on outdated licensure laws, making nurse practitioners be tied to a specific physician to be able to practice. They are required to sign collaborative practice agreements that really do nothing to improve healthcare access or outcomes. There is no evidence to support that those collaborative practice agreements are even necessary to provide healthcare. Those are really outdated practice laws that we need to modernize. 

Certainly I would also expect nurse practitioners to continue to advocate for policies and laws that improve patient access and outcomes. That's something that is so important to us as we look at our holistic approach to providing patient care. At the end of the day, once we have a healthier community — by using a community-based model, reimagining public health and utilizing all of our healthcare providers — we'll have a healthier country. 

Q: Many hospitals are grappling with serious nursing workforce shortages right now. What actions are needed to remedy this issue, whether on a hospital or national level?

ST: Within hospitals, credentialing nurse practitioners for admission privileges to improve access for patients is critical. Again, utilizing nurse practitioners to the top of their education and training is also important. There are some hospital-based clinics that are using nurse practitioners almost as assistants to physicians. They're really not utilizing them to their full potential. When we talk about the financial impact, you could have other healthcare providers who are already employed providing care. Because we know that outcomes from nurse practitioner-provided care are equal to physician outcomes. So utilizing nurse practitioners to the top of their education, training and national certification would be ideal. 

Q: What was your proudest accomplishment as AANP's president?

ST: You know, I've had so many. The thing I'm probably most proud of is the resiliency of nurse practitioners in this country really stepping up to the plate to be on the front lines and fight COVID-19 head on. Whether they were in hospitals and clinics or in their community volunteering for testing, 60 percent of nurse practitioners were actively testing and treating patients in their practices this year. Now on the front lines of providing the vaccine, we've had so many nurse practitioners doing home visits to vaccinate people, drive-thru vaccine clinics, etc. The resiliency of the profession is just amazing. Certainly at AANP we worked hard to provide education and support to our nurse practitioner colleagues around the country, but at the end of the day I'm most proud of them. 

Q: Any other thoughts you'd like to share? 

ST: It's so important that we address healthcare disparities in this country. Certainly the nurse practitioner profession is doubling down on our awareness of cultural issues, and we are advocating for our patients, and we realize the challenges they face. Hopefully as we finish the remainder of this year and look toward next year, we can all come together as a healthcare community and country to really make a change in access to healthcare.

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