This includes innovative strategies to recruit, retain and motivate employees, including mid-level providers (advanced practice nurses and physician assistants).
To maintain a competitive edge, hospitals need to increase patient access and transform care delivery models to provide clinical services in the most efficient and cost-effective manner. Care team skill mix will be closely scrutinized as hospitals transition to creating value by delivering the right care, at the right time, by the right provider. Hospitals have begun and will continue to rely more heavily on advanced practice nurses (APNs) and physician assistants (PAs) to close the talent gap created by a widening physician shortage in the United States.
As a result, the ability of hospitals, health systems and general health care providers to recruit, retain and effectively utilize the APN and PA workforce segments has become a strategic priority.
THE ISSUE
As care delivery models evolve, APNs and PAs are moving toward top-of-license practice and greater role diversity. Top-of-license practice refers to the concept that anyone with clinical skills should use them effectively and efficiently, with routine, simpler tasks completed by someone with fewer skills at a lower cost. Accordingly, there is a growing trend to differentiate APN and PA compensation based on clinical skill level, scope of practice, and overall level of patient care responsibility rather than traditional measures such as setting (hospital versus clinic), practice area (surgical versus medical versus primary care) or tenure (years of experience).
Given the rapid pace of change, hospitals are struggling to ensure competitive pay levels while aligning APN and PA compensation with factors reflecting complexity, scope of practice and specialty/subspecialty — a task further complicated by a lack of comparative and robust market data that captures these distinctions. For example, we know anecdotally that pay can vary substantially across specialties and within certain specialties (e.g., ED, NICU, surgical specialties), warranting premiums due to necessary skill sets; however, it can be challenging to support differentiation based on market data.
AN INNOVATIVE APPROACH
While our specific approach to building a visual guide for understanding how comparative market benchmarks relate to the functional complexity of APN/PA roles is customized to meet each health care provider’s unique profile and circumstances, below is a general summary of the typical five-step process.
1. Determine organization context
The process begins by having in-depth conversations to better understand the health care provider’s unique circumstances, strategic priorities and any APN/PA attraction/retention issues.
2. Map benchmark APN/PA roles to surveys
The APN/PA roles are mapped to market benchmarks across credible compensation surveys. Available benchmarks vary by survey and the availability of APN/PA benchmarks is not as robust as physician benchmarks.
3. Review market data
Relevant APN and PA market total cash compensation data are compiled for the applicable benchmarks/specialties, and findings as well as any relevant scoping parameters are reviewed.
4. Stratify by specialty
The benchmarks/specialties are stratified into comparable levels based on natural breakpoints in the market value of the roles. Based on our knowledge of the market and the workforce segment, logical inferences are drawn regarding how the stratified levels relate to job skill, complexity and compensable factors.
5. Build grid framework
Composite benchmarks are developed for each level in a grid format that includes practice type, market descriptors and organization-specific APN/PA leveling.
The approach can be further customized with a visual guide to reflect the evolving scope and complexity of roles within any organization. Customization typically involves reducing or expanding levels based on each organization’s unique circumstances, or re-slotting roles based on internal value placed on the job. APN/PA roles are mapped to level benchmarks based on the descriptors, and comparisons are prepared showing client pay levels relative to market benchmarks. Once the mid-level roles are mapped, a market-competitive pay structure can be developed at each level to support stated compensation philosophy and staffing objectives.
The development of a visual guide, or market-based complexity grid, is a crucial step toward recognizing, supporting and leveraging the value of mid-level providers.
Contact Betsy Field, senior executive compensation consultant and co-leader of Willis Towers Watson’s Not-for-Profit Industry Team at betsy.field@willistowerswatson.com or Vincent Poplaski, executive compensation consultant and member of Willis Towers Watson’s Not-for-Profit Industry Team at vincent.poplaski@willistowerswatson.com for more information.
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