An Advanced Practice Provider Clinical Fellowship as a Pipeline to Staffing a Hospitalist Program

Abstract

T here is an increasing utilization of advanced practice providers (APPs) in the delivery of healthcare in the United States. 1,2 As of 2016, there were 157,025 nurse practitioners (NPs) and 102,084 physician assistants (PAs) with a projected growth rate of 6.8% and 4.3%, respectively, which exceeds the physician growth rate of 1.1%. 2 This increased growth rate has been attributed to the expectation that APPs can enhance the quality of physician care, relieve physician shortages, and reduce service costs, as APPs are less expensive to hire than physicians. 3,4 Hospital medicine is the fastest growing medical field in the United States, and approximately 83% of hospitalist groups around the country utilize APPs; however, the demand for hospitalists continues to exceed the supply, and this has led to increased utilization of APPs in hospital medicine. 5-10 APPs receive very limited inpatient training and there is wide variation in their clinical abilities after graduation. 11 This is an issue that has become exacerbated in recent years by a change in the training process for PAs. Before 2005, PA programs were typically two to three years long and required the same prerequisite courses as medical schools. 11 PA students

Patterns of utilization and evaluation of advanced practice providers on academic hospital medicine teams: A national survey

“…Existing literature suggests a lack of standardized postgraduate training in HM-specific competencies for PAs and NPs. 12,13 Further, recently graduating APPs often feel underprepared for clinical practice 14 and undertrained APPs may incur additional costs to HM groups 12 ; under-training may also contribute to turnover. Given these combined results, there may be a role for expanding post- HM groups nationally.…”

“…graduate HM-specific training for APPs. There are already several such postgraduate training programs in existence,12,13 and there is evidence to support that formal HM-specific postgraduate training leads to greater confidence, job satisfaction, and marketability among APPs [12][13][14][15]. These training programs could be further standardized by an accepted accrediting body to ensure graduates meet defined core competencies in HM, similar to those defined for HMphysicians.…”

A novel inpatient PA staffing model for a community hospital

“…This practice is consistent with a growing trend toward postgraduate PA hospitalist training to supplement the variable but often limited PA inpatient training during standard graduate education. 2 , 9 Before 2016, and before the introduction of rounding hospitalist PAs, hospitalist physicians were responsible for about 15 patients each day on 1-week (7-day) rotating shifts, Saturday through Friday. In 2016, our PA-physician model started staffing with the first graduated class of PA fellows; the team worked every other week, with the alternate weeks continuing with the physician-only model.…”

“…1 PAs are considered a cost-effective means to enhance the reach of hospital patient care. 2 Studies have shown that PAs can be successfully integrated into hospitalist services. 2 - 5 However, the optimal working model for hospitalist services and the PA-physician relationship has not been determined in terms of outcomes, patient safety, and patient satisfaction.…”

Academic Hospital Medicine 2.0: If You Aren't Teaching Residents, Are You Still Academic?

“…Finally, as hospitalist teams have grown to include advanced practice providers (APPs), some programs have established formal teaching programs to address professional development needs of these healthcare professionals. 10,11…”