Learning needs of physician assistants working in hospital medicine

Torok, Haruka Matsubara; Lackner, Christina; Landis, Regina; Wright, Scott M.

doi:10.1002/jhm.1001

Cited by 12 publications

(9 citation statements)

References 16 publications

(42 reference statements)

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“…28 To this point, in one survey of hospitalist PAs, almost all reported that they would have been interested in completing a fellowship, even it meant a lower initial salary. 29 Despite having the same general goals and using similar national resources, our study reveals that APP fellows are trained and assessed very differently between programs. This might represent an area of future growth in the field of hospitalist APP education.…”

Section: Discussionmentioning

confidence: 84%

The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

Klimpl

Tackett

Cardin³

et al. 2019

J Hosp Med

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BACKGROUND Postgraduate training for advanced practice providers (APPs) is a growing field in hospital medicine. As hospital programs continue to benefit from highly trained physician assistants (PAs) and nurse practitioners (NPs), fellowship programs have become more prevalent. However, little is known about the number of active programs or how they prepare trainees. OBJECTIVES To describe the existing APP fellowships in hospital medicine, with a focus on program characteristics, rationale, curricula, and learner assessment. METHODS An electronic survey was distributed by e‐mail to hospital medicine program directors in May 2018. The survey consisted of 25 multiple choice and short answer questions. Descriptive statistics were calculated utilizing Stata 13 for data analysis. RESULTS Of the 11 fellowships identified, 10 (91%) of directors responded to the survey. Eighty percent of programs accept both NPs and PAs and 80% are between 12 and 13 months long. All programs cite “training and retaining” as the main driver for their creation and 90% were founded in institutions with existing physician residencies. Ninety percent of program curricula are informed by Society of Hospital Medicine resources. Despite these similarities, there was wide variation in both curricular content and APP fellow assessment. CONCLUSION APP fellowships in hospital medicine are quickly growing as a means to train and retain nonphysician hospitalists. While most programs accept similar types of applicants and share a common rationale for program development, there is little standardization in terms of curriculum or assessment. Further research may be valuable to characterize the best practices to guide the future of these fellowships.

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Section: Discussionmentioning

confidence: 84%

The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

Klimpl

Tackett

Cardin³

et al. 2019

J Hosp Med

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“…Studies have shown that APPs are interested in formal postgraduate hospital medicine training, even if it means having a lower stipend during the first year after graduating from their NP or PA program. 9,15,18 The growing need for hospitalists, driven by residency workhour reform, increased age and complexity of patients, and the need to improve the quality of inpatient care while simultaneously reducing waste, has contributed to the increasing utilization of and need for highly qualified APPs in hospital medicine. 11,19,20 We established a fellowship to train APPs.…”

Section: Discussionmentioning

confidence: 99%

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

Lackner

Eid

Panek

et al. 2019

Journal of Hospital Medicine

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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

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“…Hospitalists need to be attuned to the liability risks related to the care of patients requiring surgical management and ensure areas of responsibility are clearly delineated between the hospital medicine and surgical services 26 . We also found that hospitalist claims increasingly involve PAs and NPs, likely reflecting their increasing role in providing care on hospitalist services 27,28 . The naming of these other services and provider types does not necessarily mean a breakdown in interdisciplinary collaboration occurred.…”

Section: Discussionmentioning

confidence: 79%

“…26 We also found that hospitalist claims increasingly involve PAs and NPs, likely reflecting their increasing role in providing care on hospitalist services. 27,28 The naming of these other services and provider types does not necessarily mean a breakdown in interdisciplinary collaboration occurred. Rather, these findings highlight the importance of including these surgical services, PAs, and NPs as integral participants in the patient safety and risk management efforts undertaken by hospitalists.…”

Section: Discussionmentioning

confidence: 99%

Rates and Characteristics of Medical Malpractice Claims Against Hospitalists

Schaffer¹,

Yu-Moe²,

Babayan³

et al. 2021

J Hosp Med

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BACKGROUND: Hospitalists practice in high-stakes and litigious settings. However, little data exist about the malpractice claims risk faced by hospitalists. OBJECTIVE: To characterize the rates and characteristics of malpractice claims against hospitalists. DESIGN, SETTING, AND PARTICIPANTS: An analysis was performed of malpractice claims against hospitalists, as well as against select other specialties, using data from a malpractice claims database that includes approximately 31% of US malpractice claims. MAIN OUTCOMES AND MEASURES: For malpractice claims against hospitalists (n = 1,216) and comparator specialties (n = 18,644): claims rates (using a data subset), percentage of claims paid, median indemnity payment amounts, allegation types, and injury severity. RESULTS: Hospitalists had an annual malpractice claims rate of 1.95 claims per 100 physician-years, similar to that of nonhospitalist general internal medicine physicians (1.92 claims per 100 physician-years), and significantly greater than that of internal medicine subspecialists (1.30 claims per 100 physician-years) (P < .001). Claims rates for hospitalists nonsignificantly increased during the study period (2009-2018), whereas claims rates for four of the five other specialties examined significantly decreased over this period. The median indemnity payment for hospitalist claims was $231,454 (interquartile range, $100,000-$503,015), significantly higher than the amounts for all the other specialties except neurosurgery. The greatest predictor of a hospitalist case closing with payment (compared with no payment) was an error in clinical judgment as a contributing factor, with an adjusted odds ratio of 5.01 (95% CI, 3.37-7.45). CONCLUSION: During the study period, hospitalist claims rates did not drop, whereas they fell for other specialties. Hospitalists’ claims had relatively high injury severity and median indemnity payment amounts. The malpractice environment for hospitalists is becoming less favorable.

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Learning needs of physician assistants working in hospital medicine

Cited by 12 publications

References 16 publications

The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

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

Rates and Characteristics of Medical Malpractice Claims Against Hospitalists

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