Who should deliver primary care—and how can health systems expand access without sacrificing quality or affordability? It’s a high-stakes question playing out in clinics across the country, and it’s at the center of the work of Esita Patel, Assistant Professor in the Department of Implementation Science at Wake Forest University School of Medicine. A 2025 Wake Forest Clinical and Translational Science Institute (CTSI) Shark Tank Awardee, Patel also shared this research as a poster presenter at the 2026 CTSI Day.
Rethinking Who Delivers Primary Care in an Era of Physician Shortages
Her project looks at the role of advanced practice providers (APPs), like nurse practitioners and physician assistants, and whether they can effectively serve as primary care providers alongside (or in place of) physicians in an Accountable Care Organization (ACO). With primary care physician shortages continuing to grow, this isn’t just a theoretical question—it’s a real-world challenge.Using 2023 electronic health record data, Patel analyzed outcomes for more than 50,000 patients who were assigned either to a physician or an APP as their primary care provider. What she found is both reassuring and thought-provoking: for most quality measures, patients did just as well with APPs as they did with physicians. There were a few differences—patients seeing APPs were more likely to stay on top of colorectal cancer screenings but a bit less likely to get their annual flu shot—but overall, the care was comparable.
One of the biggest takeaways? Cost.
Care delivered by APPs was associated with lower total and ambulatory charges, suggesting there’s an opportunity to reduce healthcare spending without compromising outcomes. But Patel’s work goes a step further than just comparing numbers. It highlights that success isn’t only about who provides care—it’s also about how systems are set up to support them. Things like leadership, team structure, and training all play a role in how well APPs can function in these roles.At its core, this project pushes the conversation forward. Instead of debating whether APPs should be used as primary care providers, Patel’s research suggests we should focus on how to use the entire care team more effectively. It’s a practical, data-driven approach that could help health systems better meet patient needs while navigating workforce shortages and rising costs. View Patel’s research poster here.
Spring Research “Shark Tank” Awards: Request for Applications Open
Do you have a healthcare research idea? The CTSI is looking for clinically relevant project
ideas for consideration in a virtual “shark tank” competition, competing for a $5,000 investment and other research resources for the project. Apply by May 22, 2026. Learn more.