Advanced Practitioner Transition to Practice Program
Advanced Practitioner Transition to Practice Program We recognize that both nurse practitioners and physician assistants are increasingly important team members in the hospitalist model. Thus, our goal is to ensure both professions have the necessary competencies and skills to succeed in a hospital-based environment. The Advanced Practitioner Transition to Practice Program is a 12-month program designed to help new nurse practitioners and physician assistants transition into hospital-based medicine. (A truncated six-month program is available for those who have prior experience and demonstrate competency at the time of application.) The program uses a combination of case-based, self-directed and team-based learning, one-on-one mentor assignments, and didactic sessions to develop the competencies and skills necessary for practice in hospitalist care. Students are assigned a mentor and interact with a core group of physicians, PharmDs, and other select faculty throughout the program.
When safe and effective to do so, using Advanced Clinical Practitioners (ACPs), such as nurse practitioners and physician assistants, ensures local care is readily available and delays in care are prevented. Current models demonstrate that these outcomes are equivalent to, or exceed physician-only care delivery models. Western North Carolina has significantly lower availability of both physicians and Advanced Clinical Practitioners per capita than the rest of the state. Mission Health is experiencing the greatest shortage in rural delivery of care, with only six and half physicians and eight ACPs to staff five rural hospitals in the Mission Health System. This severely limits our capacity to meet acute healthcare needs in our rural communities. The need for increased rural hospitalist care is significant: All 18 counties served by the proposed project are designated by HRSA as HPSAs (Health Professional Shortage Areas), and six of the 18 counties are designated “Medically Underserved Areas� (MUAs).
Provider Availability in Western North Carolina Finding the right care delivery model is key to the sustainability of rural healthcare. In a rural setting, recruiting and retaining primary care practitioners and specialists is often a challenge. With advanced training, nurse practitioners (NPs) and physician assistants (PAs) are qualified to fill that gap in rural hospitalist care, serving as a critical connection to the local patient population.
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About the Program The Advanced Practitioner Transition to Practice Program seeks to better equip NPs and PAs with the necessary skills to serve as part of a tertiary care or rural hospitalist team. Unlike physician post-graduate residency programs, no such formal residency program structure exists for ACPs. Currently, academic medicine centers offering a similar program are extremely limited. In a 2007 survey of 562 NPs, only ten percent of new graduates reported being “very well prepared” for clinical practice. In fact, half of the surveyed sample believed they were only “somewhat” or “minimally” prepared to enter practice as an NP. 87 percent of the respondents expressed an interest in pursuing a “residency program of supervised clinical training,” should one be available to them after their NP training. The expressed interest of NP graduates for additional training, the necessary growth of the hospitalist model, and the need for additional inpatient care providers create the ideal environment to foster NP hospital medicine training programs.
Formed by the Mission Center for Innovation, the Mission Center for Advanced Practice developed an ACP-specific curriculum, piloted in early 2015 with tremendous success. To build on this success, funding is needed to fully implement a long-term residency program. Unlike physician residency programs, no governmental funding is available for an Advanced Practitioner Transition to Practice Program. Ideal candidates will be newly graduating NPs or PAs interested in becoming a general hospitalist provider or working primarily in a hospital-based specialty. This program is designed to address the needs of advanced practitioners requiring more acute inpatient skills. Additionally, the flexible program accelerates graduation for mid-career clinicians who do not have prior acute inpatient management skills, but are able to demonstrate early competency. Many of the program’s clinical rotations will occur in collaboration with the Asheville Hospitalist Group of Mission Medical Associates, a Mission Health practice. Founded in 1999 with four full-time, board-certified internal medicine physicians, the hospitalist practice has since grown to more than 50 board-certified, full-time providers, managing over 25,000 patient encounters per year. The Advanced Practitioner Transition to Practice Program is funded by Mission Health, and program residents are committed to a Mission Health member organization for two years following the residency.
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Advanced Clinical Practitioner: Readiness to Practice Forty percent of Advanced Practitioners reported having no precepting experience (one-on-one time with a trained clinical instructor during orientation) before hiring and acting as an independent provider. Of those who had precepting experience, 48 percent reported that not enough time was given during orientation to allow for optimal effectiveness. Our Advanced Practitioner Transition to Practice Program will provide the experience needed to enter hospital-based care.
How You Can Help The cost for each Advanced Clinical Practitioner resident to go through the Advanced Practitioner Transition to Practice Program is $104,000. This covers the cost of faculty, resident salary, education, materials, and recruitment of residents. The program will enroll eight residents each year.
“Spending one-on-one time with a preceptor is imperative to success as an Advanced Practitioner. The first year is critical for establishing good practices upon which to build your practice. Any new graduate who begins his first year(s) without proper precepting, risks building a career on less-than-solid ground.� - MMA Advanced Practitioner
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