ACG PERSPECTIVES

Mary S. Vetter, NP, University of Rochester (UR) Medical Center. Ms. Vetter is Chair of ACG's new Committee on Advanced Practice Providers. She serves on the Women in Gastroenterology and Membership Committees and contributed to the Annual Scientific Meeting Planning Subcommittee for 2018 and 2019.

I have been a Nurse Practitioner in GI or hepatology since 2001. Initially, I worked in the Solid Organ Transplant Program at UR, specifically in liver transplant surgery and hepatology. The GI needs of pre- and post-liver transplant patients became increasingly interesting to me in this time. I transitioned to a pancreaticobiliary, general GI and non-transplant hepatology position in 2013. Initially I was humbled by the enormity of the broader practice of gastroenterology, as I had focused on transplant hepatology for so long. GI is an exciting field that continues to grow and expand, with so many therapeutic and interventional opportunities. This is one of the great things I love about working in GI.

“A WEEK IN THE LIFE”

I work in an outpatient tertiary care setting in mainly a clinical role, precept NP students, and am involved with the UR School of Nursing, where I teach NP students in the area of hepatology/liver disease. In addition, I am involved as a sub-investigator for multiple clinical trials. In the clinical area, I spend a portion of my week following patients collaboratively with Shivangi T. Kothari, MD, FACG. Together, we see patients with hepatobiliary and pancreatic abnormalities, develop plans of care, and schedule the complex interventional procedures. We often must carefully and compassionately guide patients through the initial diagnosis and treatment stages of cancer. It requires identifying appropriate patients for procedures, thorough history and physical exams, education, preparation and follow-up.

Typically, my week starts in our hepatology clinic, seeing a range of patients from those with elevated liver function tests and hepatic lesions to acute and chronic liver disease, as well as those who need a liver transplant. From here, I transition to see new and follow-up patients with general GI, hepatology and pancreatobiliary needs.

Clinics are structured in a couple of ways. Collaborative attending clinics are sub-specialized to follow patients with specific needs e.g., IBD, pancreatobiliary, hepatology and general GI. Independent APP clinics allow patients with a variety of GI needs to be seen. This configuration allows me to focus and gain specialty knowledge. This really helps when you need to "change your hat" from one focus to another in the same day.

ACG AS A PROFESSIONAL HOME FOR GI ADVANCED PRACTICE PROVIDERS & WAYS TO GET INVOLVED

At the recommendation of Dr. Kothari, I joined ACG in 2015. Together, we wrote a case study, "Isolated enteric mastocytosis causing recurrent small bowel obstruction," which was accepted as a poster presentation at the 2015 ACG Annual Scientific Meeting. This was a great experience!

I believe it is really important to belong to a national organization that supports clinicians with opportunities for education, research, academic growth and exposure to legislative and financial issues that affect our patients and practice. It can be challenging to remain current with so many issues in GI, therefore it is helpful to have an organization that offers updates to guidelines and stateof-the-art therapies. I also wanted an avenue to collaborate with other NPs and PAs who work in GI. I strongly believe we can learn so much from each other to improve and strengthen our practices and provide the highest level of care to our patients. One main barrier for APPs to join GI societies may be a lack of awareness of what the organizations can offer to the APP. The cost of maintaining membership may also be an issue for some. As APPs comprise a growing part of the GI and hepatology community, there has never been a better time than now to join ACG. A recent ACG survey showed that there are many new APPs in GI practice, including a large base who plan to remain long term. This growing number represents a need to offer GI APPs opportunities for professional growth and leadership.

ACG offers a wide variety of resources and benefits that range from promoting quality in patient care, to education, and ways to remain current on issues, including legislative issues. The yearly membership fee is reasonable. Resources, education opportunities and clinical guidelines are among the online tools and are easy to navigate. ACG’s online professional networking forums, such as the IBD Circle and the Women in GI Circle, are current and interactive.

One way to increase membership and involvement in the College is for attending GI providers and APP members to encourage and create an atmosphere to join and get involved in ACG, just like I was supported and encouraged by Dr. Kothari. This is an exciting time to join ACG and get involved. Membership and involvement with ACG will help shape the path forward for GI physicians and their APP colleagues. Together we can create opportunities that improve and maintain professional standards and promote education, new ideas and programs.

“It can be challenging to remain current with so many issues in GI, therefore it is helpful to have an organization that offers updates to guidelines and state-of-the-art therapies. I also wanted an avenue to collaborate with other NPs and PAs who work in GI. I strongly believe we can learn so much from each other to improve and strengthen our practices and provide the highest level of care to our patients.”

LEARNING from

“ENDOSCOPIC MASTERS” WITH THE GENEROUS SUPPORT OF THE 2015 ACG INTERNATIONAL GI TRAINING GRANT, I had the honor of learning interventional endoscopy procedures from the endoscopic masters at the Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, FL. After my general gastroenterology fellowship, I developed a keen interest in advanced endoscopic procedures, particularly endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). My clinical supervisor and guide in Mumbai, India, Professor Dr. Pravin Rathi, taught me ERCP. It was a privilege to learn EUS from Piyush Somani, MD Jaswant Rai Speciality Hospital, two world leaders—Professor Sun Siyu of Shenjing Hospital,

Saket, Meerut, Uttar Pradesh, India China, and Malay Sharma, MD, of Jaswant Rai Speciality Hospital, India. To obtain a Western perspective and learn more about interventional EUS, endoscopic mucosal resection and cholangioscopy, I applied for the ACG International GI Training Grant backed by the immense support of Shyam S. Varadarajulu, MD, and Udayakumar Navaneethan, MD, FACG. 