Three Things to Know About Hiring, Onboarding, and Training APPs Save

As the utilization of APPs (nurse practitioners and physician assistants) in rheumatology becomes more prevalent, here are three things to consider if you are thinking about adding an APP to your practice:

1. Support is foundational to the APP’s success. There are many different structures in which the APP and rheumatologist can work together successfully, but the commonality is that the APP has adequate support. Without this, retention will be low. So what does “support” look like?
   1. Starting slow, especially if it’s the APP’s first rheumatology job: shadowing, fewer patients per day and longer visit times for the first 3-6 months, increasing productivity slowly, on-site access to the rheumatologist for questions.
   2. What makes the job satisfying for you, the rheumatologist? This is what will likely make it satisfying for an APP as well—don’t use them to offload all the things you yourself don’t want to do.
   3. While the rheumatologist’s expertise is obviously valuable, there are many great learning resources online for APPs to start with on their own: boards review course, online modules through several organizations, including RhAPP, ACR/ARP, and AWIR. Which leads to the next point…
2. The APP’s interest in rheumatology is key, as the learning curve in the beginning is steep.
   1. If you hire someone who is only interested in rheumatology because it might have a better work-life balance than primary care, the commitment to learning in the beginning may be difficult to accept.
   2. Connecting with a local APP program and offering to precept students in their final year of clinical rotations is a great avenue to find new hires, because you will get to know them far better than you would in a single interview, and will be able to gauge their interest and commitment to learning.
3. Shared expectations and communication are critical.
   1. Clarify the APP’s role up front. There are all kinds of ways to integrate an APP into a practice (shared panel, having the APP see only one disease state in the beginning or only seeing stable long-time patients, setting aside time for precepting hours—using a resource like the Rheumatology Research Foundation’s APP mentorship funding can make this easier financially).
   2. Use objective measures when possible: productivity expectations, length of training period, admin hours.
   3. When does the rheumatologist want to be involved? Discuss expectations clearly if you have strong preferences about this.
   4. Communicate how both the APP and rheumatologist would like to receive feedback.

Adding an APP to a rheumatology practice can be a very helpful endeavor—for patient access, as well as for the financial health of the clinic and alleviating the workload of the rheumatologist, but in order to be successful, the process requires thoughtful hiring, deliberate onboarding, and clear, effective communication.