Across the U.S., health systems are turning to Advanced Practice Providers (APPs) to solve the escalating crisis in specialty care access. It’s a necessary and logical solution. Yet, as a recent investigative series from Bloomberg documented, this rapid expansion has exposed persistent gaps in training and oversight, leaving many to wonder if we are setting this critical workforce up for success.
This is not a training issue, but a design problem. The real risk to patient care isn’t the APP model itself, but the outdated clinical architecture it’s forced to operate in. Health systems have asked APPs to expand capacity without fundamentally redesigning the supervision models to make their work safe, effective, and sustainable. Simply inserting a new provider into a workflow built for a different era isn’t a strategy, it’s an improvisation that prioritizes coverage over clarity, introducing risk and undermining trust.
As a practicing gastroenterologist and a leader at the American Gastroenterological Association, I’ve seen this challenge firsthand. The need is particularly urgent in gastroenterology, where provider shortages and increasing complexity are straining traditional models. In both my clinical and leadership roles, I’ve learned that the success of APP-led care hinges not on who delivers the care, but on how that care is structured, supported, and supervised.
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A scalable model doesn’t just insert an APP into a physician’s place. True scalability requires reengineering the system around APPs, not just inserting them into legacy workflows. That includes:
- Clear protocols for common presentations, based on specialty-specific guidelines
- Real-time escalation pathways for out-of-scope cases
- Continuous supervision that’s proactive, not reactive
- Structured peer networks where APPs can consult and collaborate
- Feedback loops for quality, safety, and ongoing clinical education
Supervision is often treated as a compliance function or a legal safeguard. But in reality, it’s a core driver of care quality. When built into daily workflows, it accelerates clinical growth, builds trust, and reduces variability.
The ideal model is one where supervision happens in real time, deviations from protocol are surfaced immediately, and supervising physicians can step in when needed. It’s a model where APPs can confidently practice at the top of their license, knowing support is close by. This kind of system doesn’t just protect patients. It protects providers, the organization, and the integrity of care delivery overall.
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In this kind of model, everyone has clarity. APPs know their boundaries and escalation paths. Physicians are freed to focus where they’re most needed. And patients experience a system that feels coordinated, not pieced together.
Supervision at scale: Where AI actually delivers
Much of the attention around AI in healthcare has focused on tasks like documentation, diagnosis, or patient engagement. But one of its most valuable and overlooked applications is in supervision.
With the right design, AI can track adherence to protocols, surface edge cases, and flag inconsistencies in real time. It helps ensure that supervising physicians are not reviewing every chart but focusing where their judgment matters most. It supports APPs by identifying patterns and deviations early, enabling faster feedback and better decisions.
This isn’t just another layer of tech. It’s a way to scale mentorship and safety without slowing things down. It strengthens the entire system by improving the quality of oversight, without adding unnecessary complexity.
APP-led care has often been seen as narrower in scope than physician-led care due to differences in training. But the real risk isn’t in the role itself, it’s in the system around it. With the right structure (clear expectations, strong oversight, and technology that enhances clinical judgment) APPs can safely and effectively manage a broader range of care. Tech-enabled platforms are helping close historical gaps and expand what’s possible.
Many of today’s systems weren’t built for speed, supervision, or scale, and they can’t support the level of intelligence or flexibility that modern care delivery demands. The solution isn’t to retreat from APPs. It’s to invest in models that make their work safe, effective, and scalable. We already know how to do this. In aviation, junior pilots don’t fly solo. They’re embedded in multi-crew environments with defined escalation points and simulation training. In surgery, attendings don’t disappear when residents take the lead. They supervise, debrief, and refine.
Why should specialty care be any different?
A smarter future is still possible
We are at a crossroads in gastroenterology and across specialty care. Patient demand continues to rise. Physician shortages will not resolve anytime soon. APPs are here to stay, and rightly so. They are a critical part of the solution, but the system around them must evolve.
Scaling care does not begin with technology alone. It begins with structure and supervision that is thoughtful, consistent, and supported by tools that reinforce clinical judgment rather than replace it. That is how we build a smarter, safer, and more sustainable future for specialty care.
Photo: Panya Mingthaisong, Getty Images
Russ Arjal, MD, AGAF serves as Co-founder and Chief Medical Officer of WovenX, a tech enabled cloud clinic that partners with existing brick-and-mortar centers to offer a turnkey channel for GI care using a national network of GI trained Advanced Practice Providers (APPs). Launched in 2022, WovenX Health operates in multiple markets. Russ is also a practicing gastroenterologist with interests in cognitive GI, AI, and digital health. He serves on the Governing Board of the American Gastroenterological Association as the Development & Growth Councillor.
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