Do most HM programs that bring on NPPs go through growing pains?
In the beginning, often there’s a little drama or controversy. Someone oversteps their bounds, someone is too rigid and doesn’t allow a mid-level provider to do something, or someone gets their feelings hurt.
How can you survive that process without the partnership breaking down?
It’s like when you’re driving a car and it starts to pull off the road. If you overcorrect and turn the wheel too hard, you’re going to end up crashing. Instead, you just turn the wheel a little bit. It’s very important that you don’t panic and try to overcorrect. Sometimes only a small adjustment needs to be made. If everyone is committed to one another, it will work out.
What advice would you give to NPPs who are thinking about joining an HM program?
First, be ready to work hard. It’s very rewarding, but it’s a rapid pace and it’s stressful. Second, align yourself with someone who is sympathetic to and supportive of the role of a mid-level provider within a hospitalist group. Third, never give up, because hospital medicine is a great career.
What advice would you give to physicians whose programs are considering hiring NPPs?
Check out the SHM website (www.hospitalmedicine.org), because it is a tremendous resource. Also, treat the NPPs the same way they would treat another physician. Give them the same assistance, invite them to the same meetings, and give them the same education or training. Realize that even though physicians, NPs, and physician assistants have different educations, everyone brings their own skill set to the table that adds to this stew of excellence.
How do you see the role of NPPs evolving as they become more prevalent in HM?
Given residency work-hour reforms and the fact there are not physicians to do all of the work, NPPs are going to be utilized much more. NPPs bring a ton of experience to the care of inpatients, so a hospital medicine group should utilize them in all kinds of roles, whether it’s orienting new physicians or educating nursing staff about the care of their specialized patients. NPPs also can take on leadership roles as part of quality improvement projects. We are going to be needed in patient care, but we shouldn’t just be relegated to patient care. The experience is there to help in many other areas.
You have spoken about the integration of NPs in hospitalist programs at two HM meetings and will do so again at HM12. What does that mean to you?
It’s my passion. I’m fascinated by the entire process. I always say, “Why am I up here speaking about this? Because I’ve made every mistake; learn from me.” My program director [Chad Whelan, MD, FHM], who was so calm and so rational and helped me integrate so well, has impacted me so greatly. I get to pass that on to other people, and it’s a tremendous opportunity.
Mark Leiser is a freelance writer in New Jersey.