In the June 4 issue of the Connect, we referenced an article by Cook and Schwartz in JAMA Neurology,
Advanced Practice Clinicians – Neurology’s Underused Resource.” 

JAMA Neurology’s Editors chose to publish extremely negative, non-evidence-based letters authored by physicians that berated the role of advanced practice clinicians (APC) such as nurse practitioners, clinical nurse specialists, and physician assistants, calling these APCs unsafe, poorly trained, dangerous practitioners. In response to this, the ANVC Board of Directors approved submission of our own Letter to the Editors to counter these highly inappropriate physician comments. Unfortunately, the JAMA Neurology editorial team deemed our response (presented below) “too low a priority” and therefore it was not accepted for publication.

ANVC believes that our letter and the values that support it are not only consistent with the Vision and Mission of our organization, but also critically important to all of our neurovascular practices worldwide. We also believe that sentiments such as those in the published letters are not unknown to any of us, but instead represent beliefs that are growing less common as our professional contributions become better understood. Because there is power in knowledge, the ANVC Board encourages all of our members to take a few minutes to become familiar with these letters and our response below so that all of us are prepared to project a united front that positively communicates the value of collaborative interdisciplinary services that include APCs to support our highly vulnerable patients and their families.

We read with great interest the Viewpoint article by Cook and Schwartz in JAMA Neurology, “Advanced Practice Clinicians – Neurology’s Underused Resource.”1  Multiple professional neurologic societies including the American Academy of Neurology (AAN), the Society of Vascular and Interventional Neurology (SVIN), and the Society of Neurointerventional Surgery (SNIS) have integrated advanced practice clinicians (APCs) into their membership structures; these organizations fully acknowledge the interdisciplinary advantages of creating and promoting healthcare teams represented by complimentary disciplines. Successful interdisciplinary practice integration requires a mature organizational culture that recognizes the value that diverse professions bring to the clinical management of patients with neurologic illness. In environments with limited numbers of practicing neurologists, utilization of complimentary manpower such as APCs makes sense and should not be viewed as a threat, but instead an enhancement of the patient experience, especially when supported by APCs possessing specialty-specific neurologic education and certification to demonstrate mastery of knowledge.

The Association of Neurovascular Clinicians (ANVC) was formed in 2010 to address the critical need for standardized acute stroke education and certification of nurses, stroke coordinators and APCs.2 Since 2013, the ANVC has offered post-Masters resources to support attainment of advanced acute stroke clinical practice knowledge and skills that culminate in credentialing via the Advanced Neurovascular Practitioner (ANVP) board examination. Board certified ANVP APCs provide evidence-based clinical care that supports a number of advanced roles on mobile stroke units, in telemedicine programs, and within emergency settings in environments where they are valued and fully supported by their vascular neurologist and vascular neurosurgeon colleagues.

While we acknowledge the reality of challenges that may be associated with APCs integration, especially among practitioners that are naïve to working with these non-physician providers, perceiving APCs as a threat to physician practice or patient safety is not supported by the literature when adequate education, clinical skills training, and supervision is afforded by physician partners. APCs are not physicians, nor do they want to masquerade as such; they bring complimentary expertise from a variety of backgrounds including Nursing, and the competent, proficient and expert APC is well aware of what he/she knows as well as when to immediately ask for assistance and guidance from his/her physician colleague. We applaud the authors in publishing this viewpoint and hope that it moves the practice of Neurology toward a professional and organizational culture that recognizes the value that each provider is capable of bringing to the clinical practice setting for our often challenging and disability burdened patients and their families. Frankly, our patients deserve nothing less.

Respectfully Submitted,

The Association for Neurovascular Clinicians (ANVC)

1.         Cook C, Schwartz H. Advanced Practice Clinicians - Neurology’s Underused Resource JAMA Neurology. 2021.

2.         Association of Neurovascular Clinicians. Association of Neurovascular Clinicians Published 2021. Accessed 6/5/21.


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