Championing Access and Excellence: Leading the future of advanced practice at MUSC

As System Executive Director of the Advance Practice Provider (APP) Best Practice Center at MUSC, Megan Fulton, DMSc, PA-C, Master of Science in Physician Assistant Studies (PAS) Class of 2007, oversees strategic planning, professional practice, and workforce development for over 1000 APPs across 16 hospitals statewide. Drawing on a diverse clinical background and a deep commitment to education, advocacy, and innovation, she champions a collaborative, patient-centered care model that reflects the future of health care.

Tell me more about your role as System Executive Director of MUSC Health’s Advanced Practice Provider (APP) Best Practice Center.

The System Executive Director role is the APP top leader role, which is typical in large health systems. My team and I are responsible for strategic planning that rolls up into the overarching health system strategic plan. At the Center we also oversee professional practice of the six professional APP areas, which includes physician assistant/associate (PA), nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified anesthesiologist assistant (CAA), clinical nurse specialist (CNS), and certified nurse midwife (CNM).

In addition to overseeing professional practice and strategic planning, we look at workforce management and hiring. So, say if we're growing a surgical practice or primary care, we look to see how many APPs are appropriate for that space in that department or practice area and working with a physician. With workforce planning comes physician and APP delivery of care models, and those are rapidly changing across health care.

How has the Center grown under your leadership?

Leading up to the Center, I had worked for several years as a PA clinically and then assumed some of the APP lead roles at MUSC, which were new for the organization. I got my feet wet in different hospital committees. I'll say the leadership space grew. We had consultants come down from the Association of Physician Associates (AAPA), and there were committees formed at MUSC to kick off what that leadership would look like.

In 2016, Paula Brooks and I started the Center as co-founders; we assumed the roles of Director of APRN practice and the Director of PA Practice, respectively. For the first four years, we led the Center together, and then when she left for a new role, I took over the system role for both PA and APRN. We started with roughly 350 collective APPs employed at Charleston, and now going into our 10th anniversary year, we have 1000 employed APPs across our entire MUSC system, including 16 hospitals across South Carolina. In addition, we've gone from two co-directors to an APP system executive leader as well as four additional executive leaders in 2025 and growing.

Why is having an APP Best Practice Center so critical to MUSC and meeting both provider and patient needs?

The Center oversees professional practice, competencies, and standards within the six professions and allows for full integration of our workforce into the health system, aligning us with physicians, nursing, and allied health professionals. We look at the current state of APRN and PA law and how it relates to our internal health system, policies, and procedures. We’re seeing PAs, nurse practitioners, and CRNAs evolving into more autonomous practice providers where sometimes during the week they're seeing their own patient panel and some days working alongside a physician, depending on the type of patient seen. It's about delivering a model of care that serves patients optimally to fulfill our MUSC mission and vision for our community.

In addition to workforce planning and those models, we work toward professional engagement wellbeing and resilience. We facilitate those purposeful projects that bring us a level of meaningful work and joy in our professional lives. That’s what the system executive director oversees in a lot of ways.

What inspired you to become PA? What do you enjoy most about your work?

I think being trained in a medical model and having the ability to practice in any area of medicine was the highlight for me. I've worked in the emergency room. I worked on the trauma team. I've been a first assist in neurosurgery, and now for the last seven years I've practiced in family medicine. All of those experiences collectively have allowed me to build diverse skills and deeply think about how to deliver care in different ways across our health system.

I enjoy working particularly at an academic medical center because we fulfill the tripart mission of clinical practice. Practice: I work in family medicine here. Education: I love to give presentations and lectures for MUSC’s PAS program as well as throughout the state and nationally. Research: We've published several items that really speak to professional practice standards for APPs. I enjoy the work because you're always constantly learning and working with dedicated interprofessionals, in every aspect of medicine and beyond, to create the type of care models needed for today's society.

How did your experience in the MUSC PAS program prepare you for your current professional success?

Because MUSC’s PAS program lives within an academic medical center, we as students were quick to understand interdisciplinary medicine. All the wonderful academic programs that make up the College of Health Professions collectively really replicates those who surround you in clinical practice. In addition, our clinical rotations at MUSC, which were diversified within rural health areas, really brought to light the health disparities that exist and what it takes to close those gaps. So, we experienced that academic medical center environment but were also practicing in rural areas. For example, I completed my family medicine rotation in rural Hollywood, SC, which looks very different than downtown Charleston. That experience was invaluable.

You’re a system executive director, faculty member, primary care provider, and legislative advocate: what inspires you to connect and engage in so many meaningful ways?

For me it’s about providing an environment for people to thrive in life and understanding that different aspects of patient care all stem from educating future providers. From administering new clinical delivery of care models that help open patient access to advocating through legislative sessions and bills to remove barriers for SC patients to access the care that they absolutely need, it’s all critical to the daily work that we engage in. That’s what keeps me excited and really gives me joy in my work.