Onboarding Curriculum For APCs

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LostDesire1989

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Hi all,
I’m currently in my third year of practice in an Interventional pain group. We are looking to hire more APCs to our group. I was wondering if anyone out there has any recommendations of resources that we could use that would be a standardized way of teaching/training APCs new to interventional pain. Their responsibility will be entirely clinic (Assessing pts for injections, fuv, and med mgmt).
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I've defended midlevels repeatedly.

Losing my patience TBH.

It's a CLEAR difference in education.

I've worked with 4, and if you're ethical and GAF about efficiency, accuracy and "doing it right," you will spend a decent amount of time fixing what they break.
 
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MitchLevi said:
I've defended midlevels repeatedly.

Losing my patience TBH.

It's a CLEAR difference in education.

I've worked with 4, and if you're ethical and GAF about efficiency, accuracy and "doing it right," you will spend a decent amount of time fixing what they break.
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I do, and I have 2 full time mid levels. A few times a day I’ll switch levels, or switch procedures. I’ve had my mid levels shadow me for a month when they start, and I regularly have them bring questions to me. We haven’t been able to hire another doctor (income potential is great but it’s rural), so it’s that or make patients wait 3 months to see me, then another 3 for their procedure. Or see 60 patients a day.
 
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My mid-level, who I consider above average, has booked me for intraarticular knee injections on post-TKA patients on multiple occasions.

Always fun when the patient took a day off work just to have their procedure cancelled at the last minute for lack of feasibility, safety concerns, forgetting to address anticoagulation, weren't told they needed a driver, etc.
 
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What is an APC? Doctors are the only advanced practitioners I am aware of.
 
mdo1738 said:
What is an APC? Doctors are the only advanced practitioners I am aware of.
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Antigen Presenting Cells

I think OP is referring to NPPs, Non physician providers
 
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That is correct. I am referring to non-physician providers. We are looking to hire more in order to provide more time for physicians doing interventions and less time dealing with clinic visits. But we need to make sure that they are properly equipped and educated on how to asses patients for procedures. I was wondering if anyone out there had any recommendations for a curriculum or any educational resources. Thanks
 
i think more people use the term APP, for advanced practicing providers.


i think there is a spectrum in how they can be used..

one model has the APP functioning completely independently, where they see patients, order injections, etc. this is most common in an archetypal block shop.

the other end of the spectrum using APPs is where the APP is a physician extender. in this case, the APP is there to see follow ups, to assess post procedure benefit, med management, etc. all under the aegis of the physician.

in this case, as admin will be forthright in arguing, the APP is "not working up to the level of their ability", but is more of a fancy scribe. the APP consults with the physician about changes in treatment rather than independently initiating treatment.



you should decide beforehand on which model you prefer, but be forewarned that if you espouse the former, there are a lot of people on this forum that would like to tear you a new um.....
 
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Ducttape said:
i think more people use the term APP, for advanced practicing providers.


i think there is a spectrum in how they can be used..

one model has the APP functioning completely independently, where they see patients, order injections, etc. this is most common in an archetypal block shop.

the other end of the spectrum using APPs is where the APP is a physician extender. in this case, the APP is there to see follow ups, to assess post procedure benefit, med management, etc. all under the aegis of the physician.

in this case, as admin will be forthright in arguing, the APP is "not working up to the level of their ability", but is more of a fancy scribe. the APP consults with the physician about changes in treatment rather than independently initiating treatment.



you should decide beforehand on which model you prefer, but be forewarned that if you espouse the former, there are a lot of people on this forum that would like to tear you a new um.....
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I can tell the dislike already for this post. But in my opinion, assuming the NPP is adequately trained to assess patients it can be overall beneficial for the business model. As this allows for me to be maximize my productivity in the fluoro suite. But training them to be appropriate is paramount, hence the reason for this post.
 
LostDesire1989 said:
...this allows for me to be maximize my productivity in the fluoro suite.
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We are aware.

You will have to change levels and procedure type virtually every day you're doing procedures.

What an NP/PA will do is see your medication patients and MBB follow ups. That's where they really help you.

They will fill up your procedure schedule, but it stops there...You WILL have to explain everything to the patient, and you will have to fix the mistakes made in the clinic that lead to your procedure.

I'm 4/4 in that regard - Every single one I've worked with has done this to me.

Unfortunately for 100% of pain physicians, you have to see pts in the clinic. Sorry...No getting out of that.

I know we all want to believe there's a magical NP/PA out there who can see all of our clinic pts and we just hang out in the procedure suite listening to GnR and Pink Floyd, but it doesn't work that way.

They're just not capable of running a clinic.
 
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LostDesire1989 said:
I can tell the dislike already for this post. But in my opinion, assuming the NPP is adequately trained to assess patients it can be overall beneficial for the business model. As this allows for me to be maximize my productivity in the fluoro suite. But training them to be appropriate is paramount, hence the reason for this post.
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Great business model but compromises patient care.
 
LostDesire1989 said:
I can tell the dislike already for this post. But in my opinion, assuming the NPP is adequately trained to assess patients it can be overall beneficial for the business model. As this allows for me to be maximize my productivity in the fluoro suite. But training them to be appropriate is paramount, hence the reason for this post.
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if you are using this as a business decision to increase your procedural volume - yes i disagree.

i am one of the biggest advocates here for APPs (NPs and PAs). now there are some really crappy docs out there. there are some great NPs out there who are "better" than these crappy docs. but the number of great NPs out there who is capable of functioning independently is very small. that being said, i have met a few.

almost all of them get there because of great individualized training under the supervision of a physician who invests the time and effort to teach, combined with the providers willingness to learn and to study independently, and experience over time...


MitchLevi said:
I know we all want to believe there's a magical NP/PA out there who can see all of our clinic pts and we just hang out in the procedure suite listening to GnR and Pink Floyd, but it doesn't work that way.
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exactly right.


but we should be listening to the Stones and Eagles Beastie Boys and Red Hot Chili Peppers Clash and Talking Heads......
 
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Mine are great, I rarely have to change their management, and they always check with me if unsure. But they go through like a month of training and close supervision (like resident/fellow training in reading MRI, PE, choosing right procedure/levels, complications)
 
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Baron Samedi said:
What I especially don't understand about "Advanced Practice Provider" is that there is no such thing as a "Basic Practice Provider."
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That's what I hate about the term. Midlevel provider is precise - more than a nurse, less than a doctor. APP leaves "advanced relative to what" intentionally vague. They're not saying that they're more advanced than a doctor, but if a patient chooses to interpret it that way....
 
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Brain of a doctor
Heart of a nurse


That's what you meant
 
MitchLevi said:
We are aware.

You will have to change levels and procedure type virtually every day you're doing procedures.

What an NP/PA will do is see your medication patients and MBB follow ups. That's where they really help you.

They will fill up your procedure schedule, but it stops there...You WILL have to explain everything to the patient, and you will have to fix the mistakes made in the clinic that lead to your procedure.

I'm 4/4 in that regard - Every single one I've worked with has done this to me.

Unfortunately for 100% of pain physicians, you have to see pts in the clinic. Sorry...No getting out of that.

I know we all want to believe there's a magical NP/PA out there who can see all of our clinic pts and we just hang out in the procedure suite listening to GnR and Pink Floyd, but it doesn't work that way.

They're just not capable of running a clinic.
Click to expand...
no

they f$ck up MBBs, too
 
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