Category: Uncategorized

Four years ago, Denis Karchebnyi was Chief of Orthopedic Surgery and the Head of Technology at a leading hospital in Moscow, Russia. Today, he is Manager of Clinical Services at AP Health.

“I graduated at the top of my class and was trained at one of the best research institutes in Moscow,” Denis says. “I had a nice job, but I decided to come to America to do what was best for my family. I didn’t have time to take all the exams to be licensed as a doctor in the U.S.; however, it turned out that surgical assisting was the perfect match for me to continue my career in the medical field over here in the states.”

After several visits to America; Denis, his wife, their three children and their dog came to the U.S. for good in 2019. He started working as a surgical assistant to an OB/GYN surgeon and later joined AP Health in 2020. He quickly became a popular assistant to surgeons in a variety of specialties, including labor and delivery, plastics, OB/GYN and orthopedics.

Building Strong Relationships with Surgeons

“I understand what it’s like to be a surgeon,” Denis explains. “Like everyone, surgeons can have very different personalities and different ways they like to work. You must understand that, but also realize that whoever the surgeon is, your role is to make their jobs easier and make them more successful.”

AP Health has been implementing what Denis does intuitively into its Surgeon Relationship Management (SRM) program. As part of the SRM program, the company has been gathering information on the preferences of the surgeons it works with and then provides that information to all of its practitioners. As a result, all AP Health practitioners are armed with information that enables them to better serve the surgeons and build stronger relationships with them.

For Denis, building those stronger relationships includes staying on top of the latest technologies and tools. Recently, when a robotics vendor was coming to the hospital to introduce some new robotic surgery equipment, Denis researched it ahead of time and gave the surgeon he works with an overview of the advances. As a result, the surgeon learned about the technology more quickly and was able to be more efficient in the operating room. He also knew that he could rely on Denis to know how to use it.

One of the surgeons Denis assists most is Dr. Daniel Chan, Chief of Orthopedic Surgery at Memorial Healthcare System. They have performed some marathon surgical sessions together. Recently, they completed 10 hip and knee replacement surgeries in one day. Dr. Chan recalls, “I appreciate my awesome surgical assistant Denis for helping me close 10 hip and knee replacements that day. Teamwork makes the dream work.”

Promoted to Manager of Clinical Services

While Denis is a popular surgical assistant, he was recently promoted to Manager of Clinical Services. In this role, he helps manage the day-to-day operations at Memorial Regional Hospital, Memorial South, and Cypress Creek Surgery Center. That includes scheduling nearly 20 surgical assistants and matching them to the right surgeon and surgery across multiple facilities each day.

Mentoring, Developing Employees

While managing surgical assignments and working in the OR make up the bulk of his new job, Denis enjoys helping surgical assistants develop their skills and advance their careers. He exemplifies the AP Way, which is a commitment to looking beyond the job at hand and working to make improvements to the team and to the value it provides to surgeons and company as a whole.

“I was working with one practitioner who wanted to learn more about orthopedic surgery,” Denis explains. I taught him some things and directed him to some resources where he could learn more. He made great progress, so I assigned him to an orthopedic surgery. At first the surgeon was resistant, thinking the practitioner was too inexperienced. I told the surgeon to just try him out and let me know afterwards. He called me later and said, ‘You were right. He was great.’ I am very proud of him.

“I love the company and I love my team,” Denis says. “I get excited by surgical assistants who want to learn new things. I enjoy helping them, whether it’s showing them a particular kind of suture or providing resources to help advance their knowledge in a particular specialty.”

“We have a lot of great talent here,” Denis says. “I’m happy to be doing what I can to make us even better.”

When a new, full-time employee joins AP Health, they are given stock option grants in the company. This sets the tone from the beginning that we want our employees to think of AP Health as their company, too. We also give annual grants, 5-year bonus grants, and occasionally additional grants based on merit for exceptional performance. I believe employee ownership is an important part of our company culture, and of our success. Here’s why:

Ownership enhances teamwork and performance. I believe owners think differently than employees with no stake in the company’s future. They are more committed to the success of their fellow employees and to the company as a whole. I’ve always been impressed by other businesses where employees are also owners such as Costco and Publix, and how much pride they take in their jobs; it’s because they have skin in the game.

Growth is good – for everyone. AP Health is a company committed to growth. It is how we fund pay increases and benefit improvements. For employees without ownership, growth could seem like an abstract concept or simply “more work.” For owners, it is not just about working for the company’s future, but also working for their individual financial futures.

Ownership helps recruitment and promotes retention. Ownership differentiates AP Health as an employer and helps us attract high-performing and goal-oriented professionals. It also helps us retain employees for the long term who want to accumulate more stock over time and build their financial nest eggs.

It holds me accountable – to employees. Employee ownership means that employees have a stake in the business decisions we make. I owe my fellow owners explanations for business decisions and our plans for the future. Ownership promotes transparency in the way we run the company and requires open communication.

Everyone should benefit from what we are building together. Most Advanced Practice Providers work for physicians and help create value for the physician practices. At the end of 15-20 years, they have nothing to show for it. I may spend a good part of my day trying to grow AP Health, but I know it is our employees’ dedication, professionalism and hard work that fuels our success. If there is ultimately a sale or recapitalization of the company, we should all benefit financially from that.

I believe that employee ownership of AP Health is central to our growth and success.

Hospitals are being squeezed by the dual forces of soaring costs and limited revenue growth, resulting in extreme pressures on margins. For the first three months of the year, median hospital margins were negative, according to Kaufman Hall. This is being felt at both nonprofit and for-profit operators. With limited opportunities to increase revenue, hospitals need to take an innovative approach to cutting costs and increasing efficiencies in order to restore margins.

Inflation hit the hospital industry early, and hard. This was primarily driven by labor costs, which are up  by more than a third from pre-pandemic levels and much of this comes from the increased use of contract labor to make up for staff shortages and departures. Contract labor grew fivefold as a percentage of total hospital labor costs during the pandemic. During the pandemic, hospitals were forced to use staffing agencies to fill vacant positions. Many of the contract labor staff were “travelers,” earning on average three times the amount of in-house staff. As a result, hospitals also increased hourly rates and pay bonuses to staff nurses in order to fill shifts.

Faced with these increased costs, hospitals are looking for ways to boost revenue from all sources. They will not find much help from the federal government, the biggest payor for healthcare services. The pandemic funds benefitting hospitals have ended and the Centers for Medicare & Medicaid Services (CMS) is unlikely to increase its fee schedules significantly. That leaves commercial insurers. According to the Wall Street Journal, hospitals are asking insurers for price increases of 7.5-15 percent – a big jump from the 4-6 percent increase requested in a “typical” year. Insurers are balking, and negotiations will likely be heated going forward with no windfall for hospitals highly likely.

With cost pressures and limited revenue growth opportunities, hospitals will need to get creative to restore margins.

Surgical Staffing Provides an Opportunity for Innovation

Surgeries are one of a hospitals’ primary sources of profitable revenue, so it may not be one of the first areas examined for cost savings. However, innovative approaches to staffing these surgeries offer an opportunity to not only lower costs, but also increase revenue by making the OR more efficient and productive.

At AP Health, we provide Advanced Practice Providers to assist in surgeries for dozens of hospitals and surgery centers. Our model, which has been proven over the past eight years, reduces hospitals’ administrative and labor costs while improving OR productivity, which increases operating revenue.

When a hospital contracts with AP Health for surgical assist staffing, we assume the responsibility to handle all the recruiting, credentialling, scheduling, management, and billing of surgical assistants. This relieves hospitals of many administrative duties, which in turn lower their costs. Because surgical assistant staffing is the focus of our business, we perform these duties more efficiently than those managing a variety of staff positions. We typically provide this service to hospitals at a cost well below what the hospital would incur with in-house staff. 

Some hospitals have been reluctant to consider outsourcing surgical staff, mistakenly believing that it provides less stability in the operating suite. The truth is that OR volumes fluctuate significantly from week to week, which often means there are either too many or too few surgical staff for the cases of the day. If the OR is overstaffed, overhead negatively impacts margins. If it is understaffed, the providers suffer burnout and leave. AP Health assigns staff based on the surgical volume, ensuring the OR is optimally staffed.

Outsourcing surgical staffing may not be the final solution to the financial pressures hospitals face today; however, I can assure you that we save our hospital clients an average of 25-50 percent of what they had been spending previously on employing/managing Advanced Practice Providers. As a result, I believe that outsourcing surgical staff can be an injection of innovation for hospitals to help them recover profit margins.

When asked to describe what she was looking for in a new PA job, Kristen says, “the biggest thing for me is the ability to leave work at work.”

Before joining AP Health in August 2021, Kristen was a PA with a physician group for two years. She spent her time in clinic from 8 to 5 each day, often with hospital rounds, surgery and office procedures. She was also on call on the weekends frequently.

“I felt like I could never put my phone down. It just got to be too much. Now, I can take the dogs for beach walks and relax. I am able leave my phone in the car and not have anxiety about it.”

At AP Health, Kristen works at Jupiter Medical Center, assisting in labor and delivery surgeries and as well as helping out in the main OR. She likes the learning opportunities through assisting in different kinds of surgeries, but labor and delivery remains her favorite.

“I love C-sections,” she says. “They’re unique in the sense that the patient is awake, so I still get to have that patient interaction which is nice. “

Kristen typically gets in around 7 a.m. to set up the OR for a 7:30 C-section. Then there are additional surgeries at 9:30 and 12:30, with her heading home around 3 p.m.

“Things can definitely move around a bit,” Kristen explains. “And if it’s busy, we may add a C-section in the afternoon. You can’t always predict with babies.”

“There’s a really good work-life balance here, which is nice,” Kristen explains. “I like the focus on being a valued part of the surgical team. There are times when I may get called in after-hours or help out on my days off, but when I do work extra, there’s direct compensation, along with gratitude.”

Helping AP Health Grow

In addition to her work in the labor and delivery OR, Kristen has been instrumental in helping AP learn about opportunities for the company to grow in other areas of the hospital. The company already provided staff for the cardiac unit, but not the main OR.

“Labor and Delivery has its own suite on the third floor, but I knew AP Health wanted to provide staff for the main OR,” she explains. “When I had time, I’d go down the main OR on the second floor and just tell them that I was available if they needed help. Or if there was an interesting case that I’d love to scrub in.”

As a result, Kristen has scrubbed in on orthopedic and plastic surgeries as well.

“I’ve also done some OB-GYN surgeries, since I am now very familiar with the anatomy,” she explains. “And I really enjoy suturing.”

Kristen’s initiative and ability to build relationships helped AP Health identify opportunities in the main OR, which it now helps staff.

“The surgeons here, especially in the OB department, are really awesome to work with,” Kristen says. “While my weekends are mine for the most part, if they need me, I try to make myself available to lend a helping hand. But I’ve only been called a handful of times on the weekends since I started, which is great because it shows that my time is respected.”

Kristen says. “AP Health has been like a breath of fresh air.”

Nashville, TN – February 8th,2022

AP Health is proud to be Certified™ by Great Place to Work® for the 2nd year in a row. The prestigious award is based entirely on what current employees say about their experience working at AP Health. This year, 84% of employees said it’s a great place to work- 25% higher than the average U.S. company.

Great Place to Work® is the global authority on workplace culture, employee experience, and the leadership behaviors proven to deliver market-leading revenue, employee retention and increased innovation.

“Great Place to Work Certification™ isn’t something that comes easily- it takes ongoing dedication to the employee experience,” said Sarah Lewis-Kulin, Vice President of Global Recognition at Great Place to Work®.  says “It’s the only official recognition determined by employees’ real time reports of their company culture. Earning this designation means that AP Health is one of the best companies to work for in the country.” 

“We make employee experience a priority every day and it means a lot that our employees have reported a consistently positive experience with their coworkers, their leaders, and with their jobs. This is important to us because we know that when our employees have a high-trust experience every day, they are more productive, drive better business results and make a difference to our customers, ” says J. Toby Gray, CEO of AP Health.

According to Great Place to Work research, job seekers are 4.5 times more likely to find a great boss at a Certified great workplace. Additionally, employees at certified workplaces are 93% more likely to look forward to coming to work, are twice as likely to be paid fairly, earn a fair share of the company’s profits and have a fair chance at promotion.

WE’RE HIRING!

Looking to grow your career at a company that puts its people first? Visit our careers page on LinkedIn HERE

Great Place to Work® is the global authority on workplace culture. Since 1992, they have surveyed more than 100 million employees around the world and used those deep insights to define what makes a great workplace: trust. Great Place to Work helps organizations quantify their culture and produce better business results by creating a high-trust work experience for all employees. Emprising®, their culture management platform, empowers leaders with the surveys, real-time reporting, and insights they need to make data-driven people decisions. Their unparalleled benchmark data is used to recognize Great Place to Work-Certified™ companies and the Best Workplaces™ in the US and more than 60 countries, including the 100 Best Companies to Work For® and World’s Best list published annually in Fortune. Everything they do is driven by the mission to build a better world by helping every organization become a Great Place to Work For All™.

For more information on AP Health, check out their Great Place to Work® profile at:

Working at AP Health | Great Place to Work®

Recruiting and retaining employees is challenging in any industry – probably none more so than healthcare. This only gets more difficult the more specialized the healthcare professional. To succeed, you need to have an ongoing recruitment and retention program. That’s one of the main reasons hospitals and surgeons value their partnership with AP Health.

At AP Health, we recruit advanced practitioners – typically Nurse Practitioners and Physician Associates – to serve as surgical assistants for our hospital and surgeon customers. It’s our focus as a company and as a result, we have a successful ongoing recruitment program. On any given day, we’re actively recruiting for five positions – I’m currently recruiting for eight. When hospitals try to hire for similar positions in-house, they only do so when there is a need. It’s inefficient and fraught with delays because they hire for a variety of positions throughout the hospital and are not laser-focused on advanced practitioners like we are. We recruit surgical staff every day and have systems in place to get them credentialed and working in the OR quickly.

We hire for a variety of surgical specialties, including orthopedics, ob/gyn and cardiothoracic. In some situations, we hire recent graduates and train them ourselves. For others, we hire practitioners with more than 10 years of experience in the OR. Our recruitment efforts include typical outreach opportunities through associations and social channels like LinkedIn. We also have an employee referral program which offers bonuses to employees who refer someone who we end up hiring.

Our hospital and surgeon customers appreciate that we take on all aspects of surgical staffing – not just recruiting, but also credentialing, schedule management, billing and retention. This frees them of administrative and management duties and allows us to provide surgeons with qualified surgical staff wherever they operate. If they are operating one day in a hospital and two others at an ambulatory surgery center, we can provide them with a consistent staff who knows their style and surgical preferences.

Our business is based on our providing highly qualified, efficient and consistent staffing for the OR, so retention is critical. That’s one of the reasons we are an employee-owned company. We also support practitioners who want to add or change surgical specialties with training programs. I think the biggest factor driving our retention is our focus on work-life balance. If someone has a surgical case that runs late, we’ll work to flex them out the following day. Or if they have a family obligation come up, we’ll work with them to find someone to fill in for them. We can do this because we have a deep bench of practitioners and can move them around to address not just our customers’ changing needs, but our employees’ needs, as well. If that same practitioner worked on staff at a hospital, they’d still have to come in and work their schedule or take call because there’s no one else to take their place.

In the end, I think to be successful at recruiting and retention – particularly in a field like ours, it has to be a program that you focus on every day. You can’t turn it on and off when the need arises. We’ve been successful recruiting and retaining staff in a highly specialized area of healthcare because that’s our focus. And that’s why hospitals hire us and why doctors want to bring us along when they start operating in new ORs.

I became a PA in 1998 because it was a profession that was not only growing in numbers, but also in importance. I saw it as a great way for me to make a more impactful contribution to the delivery of quality healthcare. Over the last 20-plus years, the PAs role in the care delivery has grown across all medical specialties.

Before I was a PA, I was an athletic trainer. I loved being in healthcare, but I wanted more responsibility and autonomy. While PAs had been around as a profession for more than 30 years, they were becoming a more prominent part of the care team in more and more specialties. It was the perfect role for me.

Back then (and to some degree today), PAs were largely trained for internal medicine. I wanted to do orthopedic surgery, which meant on-the-job training with the orthopedic surgeons. I enjoyed the learning experience and taking on more responsibility in the OR as I earned the surgeons’ trust. I got a lot of satisfaction as our surgeries became more efficient and we grew to truly collaborate on decisions during procedures. My hope is that PA education will continue to evolve to provide specialty-specific training. Schools are adapting beyond their traditional primary care focus by providing clinical exposure to various specialties, but more needs to be done to prepare PAs for the duties they will perform after graduation.

The PA profession has grown dramatically in size and scope. When I became a PA, there were about 110 accredited programs and 41,000 PAs in the U.S. As of last year, there were more than 250 accredited programs and nearly 150,000 practicing PAs. More important has been the PA growth in nearly every medical specialty. At the beginning of the profession, PAs practiced mostly in a primary care setting. Now, PAs are more evenly distributed across specialties, with the number practicing in surgical subspecialties exceeding those in primary care.

At AP Health, our advanced practitioners – many of whom are PAs – are an integral part of the care team and a proven resource for the delivery of high-quality, cost-effective care. Our highly skilled professionals take on an increasingly important role in the OR, which lowers operating costs and increases efficiency.

The scope of duties that PAs are allowed to perform is regulated at the state level. However, the trend over the years has been to give PAs more freedom to work more independently, without physician supervision. The challenges of COVID-19 have accelerated that trend. The pandemic exacerbated the physician shortage, and PAs stepped in to deliver more care. Florida, home to many of AP Health’s practitioners, passed a law earlier this year to modernize regulations, granting PAs more powers to provide care independently.

I am pleased that there is a growing recognition of the vital role of the PA by regulators, physicians and the patients they serve. The change in the definition of PA from “physician assistant” to “physician associate” is just one more recognition of the growing and critical role the PA plays in the delivery of quality care in America.

I have been a cardiac physician assistant (PA) for 38 years and have seen what it takes to make a cardiac program function successfully. While I still love being in the Operating Room (OR), I also like taking a more global view of a cardiac program. I have helped start three cardiac programs from scratch, so I know the intricacies of how each unit needs to function within the hospital to not just deliver quality care, but also be operationally sound.

Setting up a cardiac program can be a challenge if the hospital has never done heart surgery before. This is due to the highly specialized procedures that are performed and the elevated risk of morbidity and mortality of cardiothoracic patients. This program’s critical nature calls for quick-to-act teams, so when we order stat labs, they truly need to be stat – not in an hour. When we need respiratory in the ICU, it needs to be there instantly, not in 10 minutes.

There are a lot of things that people take for granted, like how we enter orders. Cardiac order sets need to be built and there are drugs that need to be stored within the unit itself. For example, a cardiac unit uses vasoactive drugs, which are rich, intensive medications. Normally, these would be ordered from the pharmacy, but because the patient’s condition can change so quickly, they actually have to be stocked in the cardiac unit. Processes and implementations like these can make or break the success of a program; it takes communication, systems and procedures to initiate a heart surgery program successfully.

Staffing Essential for Operational Success

Once a cardiac program is set up, the biggest factor determining operational success is staffing. This doesn’t just mean finding the right team member for the right surgeon – it’s also finding the right people for the OR, for the ICU and for the floor.

You really need to be able to match the right staff with what needs to be done, because not everybody can do everything. There are advanced practitioners that can first assist but cannot do an endoscopic vein harvest. There are some that can do an endoscopic vein harvest but not an endoscopic radial harvest. Then, there are others who are excellent in surgery but don’t have the clinical background to do intensive care management. In addition, there are practitioners who are very good at making rounds on the floor but not experienced enough to do ICU management. To have a successful program, you need to attract and retain staff that excel in all areas of cardiac care. And, you need to be able to adjust staffing to meet the inevitable ebbs and flows of activity and patient volumes.

Hospitals Find Staffing Challenging

Many hospitals face challenges when staffing a cardiac program because the unique skill set that is required puts these highly-skilled practitioners in high demand. Furthermore, they often don’t have the ability to adjust staffing to flex up and down with volume as needed. As a result, they tend to be understaffed, especially when volumes are high. Staff are often required to be on call every other day, every other weekend or every other night. This offers no work-life balance, which subsequently leads to high turnover. I know this because I’ve spent most of my career working for either a hospital or a physician group, and I know that on-staff burnout and turnover has fueled AP Health’s growth in cardiothoracic care.

At AP Health, we manage three different cardiac programs in South Florida. We have a deep bench of advanced practitioners, and most have privileges in more than one hospital. This allows us to match the right people to the right jobs and move our staff around our clients’ needs. This provides our practitioners with a more manageable work-life balance and a variety of different assignments. The result is that they don’t suffer burnout like many of their hospital-employed counterparts. Alternatively, our hospital customers benefit by receiving both a high performing staff and cost savings which benefits overall operations. It’s a win-win scenario.

Jupiter Awarded ‘Best Heart Center’

In 2020, I was brought on to direct AP Health’s team of cardiothoracic advanced practice providers at Jupiter Medical Center and to help build their new cardiothoracic program. AP Health provides advanced practitioners for all pre-op, intraoperative and postoperative care. Last month, the readers of the Palm Beach Post named Jupiter the “Best Heart Center” in the county. That’s quite an achievement for a program that started just over a year ago. Jupiter’s success is due to the leadership of Dr. Arthur Katz, one of the most respected cardiothoracic surgeons in the region. I also think the quality of care delivered by our experienced practitioners has made an impact on patients’ opinions of the program.