As director of the Advanced Practice Fellowship in the University of Colorado Anschutz Division of Hospital Medicine, Frannie Lorenzi, MMS, PA-C, has been asked for years by health care providers across the country how the division has built a successful training program — known for its high retention and job satisfaction rates — for physician assistants and acute care nurse practitioners. Now, the division is offering answers through its APP Consulting Program (APPCon).
This program offers training, virtual or in person, to health care institutions and hospitals nationwide on how to best train and equip their advanced practice providers (APPs), which are health care professionals with advanced degrees who play key roles in advancing the health of patients, such as physician assistants and nurse practitioners.
APPCon is led by Lorenzi and her colleague Alexandra “Lexie” Gallant, PA-C, the CU Anschutz Division of Hospital Medicine’s director of APP onboarding and co-director of provider experience and wellbeing. Lorenzi and Gallant, both assistant professors of hospital medicine in the CU Anschutz Department of Medicine, are physician assistants at the UCHealth University of Colorado Hospital (UCH) who completed their fellowship training in the division and found it was a unique program that empowered APPs, leading them to stay at the institution.
With a growing workforce demand projected for physician assistants and nurse practitioners in the upcoming decade, establishing excellent APP groups and fellowship programs is important, and Lorenzi and Gallant hope to promote more of these types of programs through APPCon.
“In my opinion, our division has the national model for how APPs and physicians should be working together,” Lorenzi says. “We want to make sure that other APP groups are able to provide the same exceptional care that we’re providing here, and we hope that APPCon can help get other groups to where we’re at.”
When Lorenzi and Gallant each did their fellowship training at CU Anschutz, it was the program’s emphasis on collaboration that impressed them.
“The training here was different from any other place I had trained at, given how the hospital medicine division treated its APPs,” Lorenzi says. “Seeing that physicians worked with their APP — instead of having their APP work for them — was what made me want to stay here. That collaborative model is the reason why most of us continue to stay in the division after finishing fellowship.”
Gallant agrees, describing the division’s model as a dyad in which a physician and APP work as a pair to provide care to patients who are hospitalized at UCH. This is different from most other hospital APP models, because the physicians and APPs typically see patients separately and have more siloed work.
“Here at UCH, our APPs and physicians see patients together, develop plans together, round together, sit together, and divide up tasks together,” Gallant says. “Our division also encourages our APPs to be engaged in educational opportunities and take on leadership positions, just as our physicians do. We want people to know our APPs are as valuable to our academic mission as our physicians are.”
The Division of Hospital Medicine’s 13-month APP fellowship training prioritizes educating fellows on how to provide high quality, team-based care to hospitalized patients, explains Lorenzi.
“To our knowledge, our program is the oldest hospital medicine-based APP fellowship in the country, and by the end of this year, we will have graduated over 130 fellows,” she says. “We’re definitely a model of success, and our education-first approach has led to high retention rates, with about 70% of our graduates staying in the UCHealth system.”
Because of the fellowship program’s success in terms of retaining fellows and the division’s APPs reporting high levels of job satisfaction, leaders at health care institutions across the country began contacting Lorenzi to ask for advice on how they can enhance their APP programs, whether it be through creating a fellowship program or improving their career development opportunities for APPs.
The idea to establish a formal consulting program initially sparked from a collaboration in 2023 with the UT Southwestern Medical Center. Lorenzi recalls that a former APP fellow had begun working there and spoke so highly of the division’s fellowship program that leaders at UT Southwestern asked if they could visit. In November, they spent two days at CU Anschutz, shadowing fellows and speaking with APP division leaders to learn how to create their own fellowship program. Lorenzi remembers them commenting about how much they admired the program as well as the leadership development initiatives the division offered to its APPs.
“Immediately afterward, they expressed a lot of appreciation,” Gallant says. “They said that the experience would be valuable to help them develop their own fellowship program.”
Since the visit, they have launched a fellowship program, Lorenzi says, and the experience led to Lorenzi and Gallant deciding to establish APPCon to help other institutions and, ultimately, help other APPs.
The APPCon program offers two consulting tracks: a track that focuses on career development for APPs and a track that teaches institutions how to create a fellowship program. These consultations can be virtual or in person.
Through the APP Development Track, Lorenzi and Gallant provide insight on the best practices for hiring APPs, onboarding APPs and physicians, integrating APPs into hospital models, and establishing mentorship opportunities for APPs.
“This track offers advice on how to create leadership positions for APPs and successfully develop strong mentorship and coaching initiatives, because these opportunities are absent for a lot of APPs,” Gallant says.
The APF Development Track, on the other hand, teaches how to organize and establish a fellowship program, and it includes the opportunity to shadow fellows and collaborate with multiple CU Anschutz leaders.
There are three different consulting options that APPCon participants can choose from. Under the first option, the APPCon consulting team will travel to the location of the participants, providing an in-person consultation that allows for hands-on discussions. The second option is also in person, but the participants instead travel to CU Anschutz for one or two days to shadow and meet with various APP leaders. The last option is to meet virtually for three separate 60-minute consultations.
Ultimately, through this consulting initiative, Lorenzi and Gallant hope to create more well-rounded APP fellowship programs and career development opportunities that will further improve the field nationwide.
“If there is an opportunity to help another APP group, no matter where it is located, it only benefits our profession as a whole by helping APPs be utilized the best way that they can be. Not only are we teaching them to be excellent clinicians, but we also hope to provide more opportunities for them to do more in education and leadership positions,” Gallant says. “We believe our model creates a better environment for APPs and physicians alike, and we hope it can help reduce burnout and improve retention.”