“We Need APPs” - A Physician’s Take on Advanced Practice Providers - PMD Alliance

“I was born in Egypt, in Cairo,” Mohamed Elkasaby, MD, told me, describing his international journey in pursuit of a broad perspective on medical training. He completed medical school in his native Egypt, moved to Germany for his neurology residency, and then to Cleveland, Ohio, first for his movement disorders fellowship and then for a cognitive neurology fellowship, which he is in the midst of completing.

This international experience, he says, “added a lot to my understanding of the patient’s needs,” because the approach to patients, navigating the insurance systems, and the available resources are different everywhere. “What I’ve learned, and am trying to do to help, is create a more patient-centered approach.” Dr. Elkasaby insists high-quality care is not just about ordering medications; “it’s a journey,” he says, that includes a full and wholistic view of each person.


An ATMRD “Aha” Moment

Dr. Elkasaby attended our inaugural Advanced Therapeutics in Movement & Related Disorders™ (ATMRD) Congress in June in Washington, DC. He appreciated the exposure he received to emerging advanced treatments and clinical science and believes what’s on the horizon in movement disorders is exciting. But, for him, the most valuable experience was the APProviders™ Conference day, a full-day, pre-Congress course created for and by advanced practice providers (APPs)—nurse practitioners and physician assistants. APPs, he believes, have their pulse on their patients, and have a meaningful view of each person’s physical and emotional needs.

“When I say care is a journey with different aspects,” he explained, “I mean that a patient needs to control his symptoms, but it’s not only motor symptoms. A patient may have anxiety or maybe needs more safety in his home. Maybe he needs to build a support network or his caregiver needs help. We, as providers, need to have a broader view in order to deliver comprehensive care.”

For Dr. Elkasaby, delivering comprehensive care is not something physicians can do alone: “The relationship between the physician and nurse practitioner or physician assistant is so important.”

Multidisciplinary Care is the Future

When Dr. Elkasaby was completing his residency in Germany, he experienced a team approach that would impact his thinking about patient-centered care. “We had a multidisciplinary approach,” he said, “what we called Parkinson complex management. It included a physician, nurse practitioner, social worker, physiotherapist, occupational therapist, and speech therapist—all working together.”

The key, he insists, was their regular communication. They would meet weekly, sit together, and discuss progress. They’d explore their approaches to patient medication, devices, and therapy. For example, if a physician refers a patient to therapy in a more isolated model of care, they may never get real feedback on how it went. In this integrated model, they received feedback weekly. “It was a high standard of care because we were working in harmony.”

APPs Deserve Professional Development

ATMRD solidified Dr. Elkasaby’s view. “What I felt during the APP day of the congress was that APPs’ voices need to be heard.” He saw their expertise on display in lectures and panel discussions, and he knows what they bring is unique and valuable. In fact, he believes it’s critical that APPs receive continued professional development and training, helping them deepen their expertise and garner the respect they deserve, just as he has done through his two fellowships.

“APPs are doing a lot of good things. They’re doing DBS programming and seeing patients for regular, full visits. I see them in practice communicating with each other when they have questions, putting their heads together to improve care.” This is valuable. It’s also why Dr. Elkasaby shares our vision for further educational opportunities for APPs, and even an association or fellowship for APPs in movement disorders to certify their skills and expose them to even more of the specialized knowledge and challenging cases they crave. Furthering APP development, he says, “would really create a high level of expertise and contribute to even higher levels of care.”


Closing Gaps in Care

APPs can also help solve another problem. Disparities in access to health care are real, especially with a limited number of movement disorder specialists across the country. “I remember I saw a patient with dystonia who drove about three hours because he didn’t have access to the movement disorder care he needed locally.”

Once again, this is why Dr. Elkasaby sees APP professional development as critical: with continuing access to further specialized education, APPs can support patients in rural areas who don’t have a movement disorder specialist in town. Everyone wins when APPs are supported.

The Heart of Care

At the end of our conversation, I asked Dr. Elkasaby what he has learned from his patients. He smiled: “A lot.”

He has learned to listen and see each patient in their wholeness, including all of their home-life circumstances. Not everyone has the same access to care or resources and support, and he’s learned to hear their needs and do his best to meet them where they are. He’s also learned that there is no aspect of patient care that is too small.

There are moments, he explains, where, as a physician, you can have a pile of phone messages from patients and it can feel overwhelming to answer all of them. But he’s learned that having that sense of certainty and safety by hearing from their doctor matters, to his patients and their care partners, so he always takes the time.

“I remember I had a patient who was really advanced in her Parkinson’s, and her husband would call almost every two weeks with a question. We were addressing his concerns and changing her medication. And then, suddenly, the calls stopped for two months. When he finally called, again, he said, ‘I want to thank you.’
I said, ‘You’re welcome. What happened?’

‘My wife passed, but I feel very grateful for all the help you offered.’

“I felt like it was too much for me to receive. His wife passed and he was calling to say thank you. I felt very mixed emotions. But he was so grateful because he felt like he had the support he asked for. I think this is why we, as healthcare providers, do our jobs. Hearing this, it takes away all the stress and the all the tiredness and all the long days. So I think this is the best thing I have learned from my patients: to just make them happy and address their concerns. That’s it.”

The heart of care comes back to this simple truth: we all want to be seen and heard.


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