reviews and OPPE/FPPE evaluation as part of institutional credentialing requirements. When able, we supplement APP education with a formal lecture series conducted by our IR attendings, which covers different IR procedures and the clinical management of IR patients.
Michael J. Miller, Jr., MD, FSIR: We onboard our APPs using a combination of clinical and procedural guidance approaches. This is a 3-month process. We teach new hires the procedures using a one-on-one process of sequential steps toward operator independence. We take small wins early and skill build for all procedures. This involves both APP and IR faculty engagement. For less structured interventions, such as tube exchanges and catheter manipulations, we have a stepwise approach from direct supervision to early escalation to build confidence in the operator. We use materials developed by the division and APPs to orient the new hire about the clinical practice of IR and management of the consult service. They start supporting our Board APP and then work progressively with direct supervision to independent running of the board.
Andrew Bojanovski, PA: We tailor the training process to the individuals’ specific preexisting clinical and procedural skills. Although this will cause some degree of variability in the training process, we still have a general structure. The new APP starts with 2-week rotations within a specific modality, such as fluoroscopy, ultrasound and CT. They are expected to learn about the procedures and departments and begin to do the procedures themselves. The new APP will be paired with a senior APP who will begin involving the new APP within certain portions of the procedure.
We define success by APPs obtaining a certain number of proctored, but independently performed procedures. The new APP will be cycled through all the departments until they have enough proctored cases to be credentialed for the procedure. For a newly graduated APP, this process takes approximately 1 year. As new procedures, like intrathecal chemotherapy injections, are added to our procedural responsibilities, this proctoring process repeats for senior PAs.
16 IRQ | SUMMER 2024
Julie Fung, PA: When I was first hired, there was no structured clinical IR training for APPs. However, I realized the importance of working alongside my attendings, asking questions and reviewing scans. That was how I initially received hands-on experience and understanding of IR. The combination of my previous experiences and newly learned skills elevated me to an integral part of our IR team. This provided me with growing autonomy to review consults prior to procedures as well as post-procedure concerns.
Having an APP as a physician extender improves patient satisfaction by improving access to those who can answer questions or address concerns prior to and after the procedure rather than waiting for the physicians to return a call.
What are the patient-related benefits of utilizing APPs? MA: There are several patient- centered benefits from implementing a robust clinical APP practice in our IR division. As the consistent face of IR in periprocedural care, our regular patients get to know our APPs and appreciate the continuity of care. Our APPs also get to know the specific nuances of some patients and can ensure that their individual needs are met. Many of our APPs now have years of experience in IR and can clearly explain why a procedure is being performed and what patients can expect. This increases patient confidence and comfort. Our APPs have also built strong cross-disciplinary relationships with other services and are very helpful in arranging for necessary care with other teams—which also improves the patient experience.
MM: Our APPs run the venous access service line. They have optimized patient evaluation, procedure performance and follow-up. This has created increased
effectiveness and efficiency for the division and multiple service lines that rely on venous access for care such as our cancer center. APPs also manage our daily low-acuity interventions, so faculty are freed up for more complex cases. They have also taken on optimizing patient evaluations and plans, which allow providers to optimally perform within their scope.
JF: Having an APP as a physician extender improves patient satisfaction by improving access to those who can answer questions or address concerns prior to and after the procedure rather than waiting for the physicians to return a call. In addition, an APP allows workflow improvement to the auxiliary staff. They can assist with any clinical/ scheduling/follow-up issues that arise during a workday to allow efficient teamwork. My role is ensuring that IR plans and recommendations are implemented in a timely manner—by providing detailed plans, patients can be involved and part of the decision and care process, which I believe increases patient compliance as well. I can collaborate with referring providers to resolve issues quickly. This increases trust and rapport for more collaborative patient care in the future.
The attrition rates for NPs and PAs are increasing. How does the model implemented in your practice encourage or increase APP retention? MA: I believe that the strongest way to preserve our team is to foster a culture where every individual is valued and treated with respect, and teams can work closely together in a non- hierarchical manner. IR is also in an exciting phase of growth, with new procedures being introduced regularly— physicians and APPs both want to be part of that. Creating an environment where everyone is excited to learn also provides a lot of professional satisfaction. Flexible work schedules are also important, and this has been shown to reduce burnout and attrition. Ultimately, workplace happiness and satisfaction (and therefore retention) are most often about people liking the team that they work with, feeling appreciated and seeing the value in the work performed. Much of that comes
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