After working as a nurse practitioner for 20 years in a broad range of settings – small private practices, large healthcare systems, advisory councils – Catherine Baglieri, MSN, APN, CRNP, found herself drawn to the opportunity to shape a brand-new role in her own mold.
When she became the Director of Advanced Practice Providers (APPs) for what would become Penn Primary Care five years ago, she oversaw about 100 APPs. In the years since, her role has grown to also encompass Penn Specialty Care Practices. Today, she’s responsible for about about 260 APPs and Certified Registered Nurse Anesthetists, which includes helping steer their professional development.
At the core of it all, Baglieri says, is a deep respect for the APP and their contributions to the health system.
“Twenty-five years into what’s been a very rich and rewarding career, I can say without a doubt that Penn has been the best place I’ve worked,” she says. “Here, the APP is truly recognized as a provider. Through experience, I’ve learned just how unique and valuable that is.”
Onboarding and transitions
Baglieri views successful professional development for APPs at Penn Primary Care in relation to where one is in their career. There is a focus on clinical support for new hires, but there are also opportunities for career growth that allow APPs to grow in different directions.
For all APPs who join Penn Medicine, there is a Penn Medicine Advanced Practice Orientation that helps familiarize new hires with the vast resources available across the system. New-to-practice APPs participate in the Transitions to Practice program, which supports role transition for APPs. In addition, Penn Primary Care offers extensive and individualized clinical orientation to new hires to help them onboard at their practice and navigate clinical resources systemwide. This process also involves defined support and peer mentoring to assist with understanding the nuances and protocols of a practice and delivery of optimal patient care.
“We really want you to be successful in your practice, so we offer a wealth of different support to help you get acclimated,” Baglieri says.
As an APP becomes more experienced, they may look to expand their role. The path for those interested in diversifying (or concentrating) their roles can follow a few different directions: specialization, committees, and leadership.
Specialization. If an APP expresses an interest in specializing in a particular aspect of primary care, say behavioral health, they can pursue additional training and then dedicate a portion of their time to their new clinical focus.
Committees. Penn Primary Care APPs can be involved in various committees from those focused on education, quality, and practice to those organizing APP Week celebrations and APP Awards. As an example, the APP Education Committee has implemented an evidence-based medicine series and “Skills Days,” among other professional education measures. Penn Primary Care APPs also support the division’s diversity, equity, and inclusion office.
Leadership. A formal leadership infrastructure provides aspiring leaders with training, developmental opportunities, and mentorship. Each Penn Primary Care practice has a clinical leader, for which both physicians and APPs are considered. Both are also considered for the Penn Primary Care regional medical director positions.
As a culmination of all of the above, the Professional Advancement and Clinical Excellence Program provides a deliberate roadmap to advancement for experienced APPs who have made significant headway in the four domains of advanced practice: practice, leadership, education, and professional contributions. The program helps prepare those APPs for forays into research, teaching, and special projects, among other types of professional development.
Pouring the foundation at LGH
Lancaster General Health Primary Care provides its new APPs with an intensive onboarding program that John C. Wood, MD, MBA, FAAFP, Executive Medical Director of Primary Care and Population Health for Penn Medicine Lancaster General Health, likens to a “mini-residency program.”
Six part-time faculty members, which include APPs and physicians, conduct the competency-based program across two practices, Strasburg and Twin Rose-Columbia. Each new APP undergoes an initial assessment to determine the caliber of their clinical experience and expertise.
“For experienced APPs, the program serves as a kind of refresher course and orientation that could last four months,” Dr. Wood says. “New graduates, by contrast, may remain in the program for up to eight months. We really try to customize the experience so that everyone is comfortable and confident once they begin practicing.”
Program participants start out fielding walk-in sick visits. From there, they move to chronic care and wellness visits and then all varieties of primary care, including procedures, laceration repairs, casting and splinting, and skin biopsies.
“What we’ve found since we started this program 18 months ago,” Dr. Wood says, “is that our new APPs emerge from it much more medically knowledgeable, and they’re highly efficient and productive in their independent practice.”
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