Onboarding and Working with APPs

C. Gaelyn Garrett, MD, MMHC, Guy M. Maness chair and professor of laryngology and voice in the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center in Nashville, explained that her department first hired an APP—Ken Watford, MSN, DNP—in 2000 to focus on the medical management of balance disorders presenting to the ENT practice. Dr. Watford “also saw some general presenting symptoms, as our MD faculty was much smaller than it is now and we had a need for a generalist practice,” Dr. Garrett said.

“Since then, APPs have been an integral part of our practice, with involvement primarily in the pediatric otolaryngology area, but also with a specific focus in head and neck, rhinology, general otolaryngology, facial plastics, and sleep,” Dr. Garrett said. “We now have a total of 18 APPs in our department, including on both the pediatric and adult sides. They also enhance our regional presence with satellite offices, providing more local care to surrounding communities and counties with otherwise less access to specialty care.”

Onboarding Process

“Prior to 2023, new APPs would rotate within our various divisions to gain experience. Each APP has an MD overseeing their clinical decision making early on, and the APPs are encouraged to reach out when appropriate for questions, etc.,” Dr. Garrett said.

“In 2023, our department developed an APP training program specific to otolaryngology–head and neck surgery, with the initial fellow starting in January 2024,” Dr. Garrett said. The General Otolaryngology–Head and Neck Surgery (O-HNS) Advanced Practice Provider Fellowship Program of Vanderbilt University Medical Center is run by Filipina Cevallos Schnabel, MD, MPH, DNP, FNP-BC, APRN, who is the lead director of the program, and Dr. Watford, co-director of the program. Dr. Garrett explained that Dr. Schnabel and Dr. Watford “have created a curriculum incorporating knowledge and practical learning in all areas of otolaryngology clinical practice.”

Dr. Schnabel believes the fellowship program was the first to accept both PAs and NPs. “This is a one-year program wherein the fellow spends 75% of their time in clinical settings with general O-HNS and its subspecialties, and 25% on didactics, research, and professional development,” Dr. Schnabel said. “The goal of the program is not only to improve the APP’s skill set in O-HNS, but that also leads to safety, increased provider/patient satisfaction, increased APP retention, and decreased costs.”

Currently, the program is planning for its Advanced Practice Provider Fellowship Accreditation (AAPFA) credential through the American Nurses Credentialing Center (AACN). This accreditation recognizes transition-to-practice programs for both PAs and NPs, Dr. Schnabel said.