Onboarding and Working with APPs

According to Dr. Schmalbach, “One of the greatest challenges is allowing patients and their families to feel comfortable being seen and treated by APPs. This challenge can be overcome by having APPs participate on the inpatient floors during rounds so that they are a familiar face and very knowledgeable of the patient’s diagnosis, care, challenges, and needs, and having APPs spend some clinic sessions working side by side with the attending physician. During this time, the patient/family can meet the APP and establish a rapport. I have found it very helpful to have the attending physician then introduce the idea that the follow-up is with the APP.”

Success is measured through formal performance reviews that include competency measures, patient satisfaction scores, and informal feedback. “The ultimate measure of onboarding success is the APP gaining independence to conduct clinic. Equally important is both the patient’s satisfaction with the care as well as the APP’s satisfaction with growth and career development. A great deal of time is required for the physician to onboard an APP, so retention becomes imperative,” Dr. Schmalbach said. “It is important for the APP to feel a part of the team and to be allowed to function at the highest level of their license— they are more than glorified scribes. It is helpful to have career development opportunities for APPs and a leadership trajectory for their field.”

The best practices for onboarding AAPs, according to Dr. Zanation, include “a longitudinal mentorship experience that focuses both on learning anatomy and disease processes as well as the technical expertise in performing procedures. Additionally, having direct access to a laryngologist as long-term mentors or to ask questions about specific patients at all times is important—never leaving your APPs solely on an island.”

Private Versus Academic Settings

The APP’s role in private practice is inherently different from most of the academic practice environments Dr. Zanation has worked in. He explained that in academic settings, “APPs are often partially supported by health system resources and have a significant component of their work related to inpatient care. Additionally, APPs would often see clinic patients with the doctor in the doctor’s clinic, not working with their own independent schedule, which results in independent revenue.”

“In private practice, the traditional model for APPs is to run independent clinical practices in the outpatient setting, usually as part of new and returning patient overflow care,” Dr. Zanation said. He explained that his clinic is moving away from this model. “Our practice is moving to more disease-specific APP clinic processes. These include a head and neck cancer survivorship clinic and a vestibular disorders clinic. Additionally, there are plans for endocrine as well as sleep disease follow-up as additional disease-specific APP clinics. These types of clinics allow us to have templated patient workup as well as integration with our physician clinics.”