Onboarding and Working with APPs

Adam Zanation, MD, MBA, an otolaryngologist and head–neck surgeon, partner of Carolina Ear Nose and Throat–Sinus and Allergy Center, and shareholder and board co-chair of Viewmont Surgery Center, both in Hickory, N.C., previously worked with APPs in academia for over five years and has been working with APPs now in private practice for approximately five years.

“Our APPs rotate with each physician, shoulder to shoulder, learning their practice as well as in clinic procedures for a total of approximately three months. After this, they do run independent, clinical practices. However, they have access to physician mentorship and input at all times,” Dr. Zanation said, adding that this onboarding process is important because the learning curve for laryngology-specific diseases and procedures is very steep and often not taught in schools related to APPs.

According to Dr. Schmalbach, “One should anticipate that onboarding will take approximately six months.” During this period, the APP is not seeing patients independently but “shadowing each attending with whomthey will work to learn the different practice patterns. Participating in our laryngologist’s clinic is immensely helpful, as those clinic sessions are a great opportunity to gain hands-on experience with scoping. Similarly, the APP shadows our residents on morning rounds to gain insight into the surgeries and associated post-operative care of our patients. Lastly, we have the other APPs and residents reach out to onboarding APPs when they are doing drain pulls and tracheostomy tube changes in order to gain hands-on experience,” Dr. Schmalbach said. “This onboarding process is imperative in order to give APPs the needed skill set to allow them, as well as the patients/ families, to feel comfortable with the care rendered.”

Dr. Mitchell explained that UT Southwestern Medical Center takes care of the paperwork required for onboarding APPs. “Within the department, we have a detailed process for clinically onboarding APPs that is focused on the experience and background of the individual. We allow three to six months for onboarding new APPs.”

Challenges and Best Practices

“The main challenge is to hire the correct people who work effectively with the current APPs and interact effectively with residents, fellows, and faculty. We want APPs who are well-trained and plan to work with us for many years. Turnover of APPs is wasteful and should be avoided,” Dr. Mitchell said, adding that “we have an excellent track record.”

Onboarding success is constantly monitored, ensuring that clinical competence is present and grows over time. Productivity and patient satisfaction metrics are available monthly, Dr. Mitchell said, adding that it generally takes two years for an APP to be fully trained.