So this is a little bit of a different talk, building APP leaders, and I'm going to present things really as more general concepts. It is, as you'll see as we go through it, kind of built towards GI practices, institutions, whether it's private practice or academic institutions, but I do think that you can take a lot of these concepts and apply them into any APP leadership position. And so really what I wanted to do was be able to identify APP leaders and their responsibilities, describe some APP reporting structures, discuss what some leadership qualities are and what the value of adding APP leaders to a GI practice or healthcare organization is, and then look at some training opportunities. And so before I get going, I always like to kind of judge my audience and see where we're at here. So does your GI practice have a dedicated APP leadership structure? Okay, so about two thirds do not. Good. So we'll talk a bit about what that might look like then. And then the second question is for those of you that are APP leaders, just wondering kind of who's on the course today. So the first one, looking at directors, senior directors, vice presidents, chief advanced practice officers, system directors or clinical directors, APP managers, lead APPs or senior APPs or APP champions, or not currently in a leadership role. Great. So we do have some people here that are currently in a leadership role. And then finally, APP leaders can influence clinical practice, practice operations, hiring and retention, state legislation, or all of the above. Excellent. Absolutely. That's really, I think, the importance of this talk today. So let's start from the beginning. Why is it important to develop APP leaders? We know there's been a rapid increase in the APP workforce. I talked about that a little bit in my first talk earlier this morning. And so 30% of the US clinical workforce are APPs. There's over 150,000 PAs and over 355,000 NPs. There are unique policies and regulations so that national certification and that state licensure really do differ. And so having that designated leadership structure and those APP leaders who can oversee that can certainly make it much more efficient. And then preparation for anticipated future growth. And so I showed this earlier also, but by 2031, we're looking at a growth of 28 to 40%. And then also to address current gaps. We've seen that the APP profession has evolved so rapidly over the last 10 to 15 years that we know that there's some gaps in not only current practice environment, but also in being able to practice to the top of our license. There are a lot of different titles. So again, I'm talking a lot about GI practices and institutions, but I do think we can take a lot of this and apply it into other leadership roles also. And so some of those are directors or senior directors, vice presidents of advanced practice, chief advanced practice officers, system directors, clinical directors, APP managers, lead APPs, senior APPs, APP champions. And then there's other leadership positions too. So those are like your director positions, like a director of a motility lab or another ancillary service. APPs can lead quality improvement projects. They can be the PI in clinical research. Those are leadership opportunities. Serving on local, state, or national committees. And I just listed a few national committees, but so many opportunities for APPs to get involved and to have a voice at this level. Teaching or director positions at your local APP schools. And then more recently, we've seen a lot more of the APP education officers or DEI officers or wellness officer roles. And so what do APP leaders do? A lot. And it really depends on what their role is. But advocacy for the APP profession is a big one that carries over into most of these roles. Optimization of the role of the APPs, overseeing, developing orientation and onboarding programs, developing educational programs and staff training. And that really could be specific for APPs, but it also could go to your nursing staff, your other clinical staff, even your secretarial staff. Ensuring regulatory licensure and accreditation. Overseeing clinical practice standards, organizational strategic priorities. Collaboration with the APP schools. Being able to bring them in for their preceptorship programs. Professional growth, interdisciplinary collaboration and teamwork. Competence evaluations, kind of your competency evaluations. Clinical advancement models is another really big one. So making sure that we're always investing into our APPs for their continued career advancement and their own professional development and goals. Recruitment and retention. Staffing models. And that, again, if you're really going to have an effective staffing model, it's not just APPs in isolation, but you're enhancing the role of the physician, the APP, your clinic staff, your endoscopy staff. And then quality improvement projects and research initiatives. And so it can be really helpful to have a defined APP reporting structure. And some of the questions, if you're looking to develop this, is who do APP leaders report to? And then who do the APPs report to? Is there a hierarchy of, APP will go to, you know, a lead APP, and then they'll go to a mid-level manager, and then they go to somebody higher. Do they go directly to the physicians? What structure supports communication amongst the APP leaders, the physicians, the nursing leaders? What's appropriate compensation for leadership roles? And what resources are needed? And so this is an example of a reporting structure. And so the chief medical officer, typically physician leaders, are at the top. If we were to start from the orange, the top APP leaders, again, multiple titles, but they could be chief advanced practice officer or director of APPs. And then you have your APP manager, who's typically known as a mid-level APP leader. And then you have your clinic-level APP leaders, so your lead APPs. And those are ones that may be at the practice or the divisional level. And just to break that up a little bit, so your top APP leaders are really involved in that strategic planning. They're standardizing the regulatory processes, working on APP engagement, the workforce initiatives like recruitment, retention, engagement, role optimization, and then dealing with those human resources administrative issues. Your clinic-level leaders, so maybe your lead APPs, are involved in operational at a divisional level. So these are the top in GI. So you're looking at recruitment for GI specifically, onboarding, scheduling, performance reviews and competency assessments, clinic schedule, students, process improvement. And then your mid-level leaders are kind of a liaison between the two. So those clinic-level leaders are going to report to the mid-level leaders. Mid-level leaders are going to be not only invested in one area, but multiple. And they're reporting directly up to the top APP leaders. And this makes sure that APPs have a voice. They have a voice at each level by building a structure like this. There's a lot of different qualities, and I was kind of just downloading my brain. I'm sure there's a lot of other ones, but I think that it's important to take a look at some of these and think about what these terms mean, because part of building APP leaders is being able to recognize who could be an APP leader and what can we do to promote them and to teach them and to mentor them so that they can step into a leadership role in their career. And there's certainly benefits to the GI practice or to the institution as well. And so when you have a clearly defined reporting structure, people know where to go. There's increased engagement. There's increased representation. There are opportunities for career advancement. There's professional satisfaction. And ultimately, it increases the retention. And from an institutional standpoint, we know there's a lot of benefits of retention. There's reduced turnover. You get experienced providers. There's increased morale, increased productivity, and ultimately a reduction in cost. Resources are definitely needed, though, if we're going to talk about how do we build up a program, how do we develop a leadership structure, and how do we build APP leaders. And so I think dedicated time is probably one of the biggest ones, being able to relieve them of some clinical duties and actually devote the time that they need to their administrative tasks. Institutional and program support is also important, and that could include things like an administrative team, an operating budget, compensation, private office space. Mentorship cannot be underemphasized, and that comes in multiple different forms as well, certainly from that APP physician collaboration, but it also can come from other APPs within your group or people that you've worked with in the past or people that you look up to, people from your school. And then, you know, is there any formal training? A lot of the times, particularly when we talk about clinical training, we're learning on the job. I think the same applies to our leadership, though. A lot of what we do, we're learning real time. We're observing it. We're experiencing it. We're applying it into our own practices. And so, again, that role of mentors, really being able to acknowledge those APPs that have leadership potential. So people who are decisive, who are visionary, who are empathetic. Mentors provide constructive feedback. They help us to learn and grow. They help provide networking opportunities and professional development opportunities. They're there for support and guidance. And then they are counsel for our conflict resolution. Leadership training opportunities, multiple different ways. So, you know, sometimes there's professional training courses and conferences. Sometimes it's one-to-one training, meeting with somebody who is in a leadership position above ourselves, self-learning modules, observation, kind of that learning on the job, professional development projects, quality improvement projects, and then that real world experience. And as I was thinking about this and trying to, you know, separate it in my own mind, I think there's a few areas that we can provide that focus training. And so from a personal development standpoint, classes or some kind of sometimes reading materials on emotional intelligence, effective communication, I think a lot of people have heard of crucial conversations. It's one of the really big classes where they start to do a little bit of role playing and how do you handle some of these conflicts and talk through some of these situations and how do you express yourself in an appropriate and clear manner. Personal and professional accountability, clinical knowledge and career advancement, operationally and understanding of clinical outcomes and metrics, finance, so payroll cost benefit analysis, your utilization of resources, HR, hiring, performance improvement plans, labor laws. And then if we look at the leadership, you know, how do we do partnership and team building? What's involved in change, innovation, outcome management, organizational effectiveness, stakeholder focus and strategic thinking, and inclusive leadership. And these are just some examples and I'm sure there are many more out there, but I wanted to just provide some leadership training that I found at an institutional level. And so this is UCSF School of Nursing. They have a leadership academy. Duke has a leadership institute. And then University of Pittsburgh has a certificate course that they offer. And certainly there's some nationally too. And so the AANP has an executive leadership program. And then this was APPEX. And so they provide a leadership summit that's done annually. And this is something that I had seen on LinkedIn a while ago, probably a couple of years ago now. And Tom Peters, who is a American writer and business management, said leaders don't create followers, they create more leaders. And so I have to take an opportunity to kind of recognize and acknowledge people who have played a very pivotal role in my own career. And I think it's important to take a step back in that self-reflection as a leader to be able to say, who has always been there? What have they done? And hopefully that will inspire some other people also to take a look and think about the people who have been their mentors. And so depending on your practice setting, the practice type, the size of your group, there may be one or more APP leaders for a team. I'm fortunate to work with Victoria Howard. We stepped into the lead APP role for GI together several years ago. And so we've been able to develop and work together on strategic operations or administrative tasks. We've really, truly co-managed a large group of APPs. And it's something that I'm very grateful for and I continue to learn from Vicky every day. Anne Swans was a pioneer for APPs in Rochester. She established a separate department for APPs, which is known as the Sobe Center. And she served as chief advanced practice officer for many years, much to her credit. In this role, she really brought together over a thousand APPs in the organization. And she worked closely with executive leadership to be a voice for APPs truly across the enterprise. She's a mentor not only for clinical practice and for APP role optimization, but also professional development, research, and education. And Cheryl Lustick is the current chief advanced practice officer for Sobe. She's been a mentor to me since my first day in clinical practice. She was actually working in the surgical ICU at the time, and I had a patient that was decompensated on day one. And so she initially served as a mentor more clinically. And then as I got more involved in leadership and administration, she's always very calm and thoughtful and available to help. Gregory Rosinski is the director for advanced practice at Sobe. And so he has worked in internal medicine for many years. As we were talking about the incentives in our last Q&A session, I was actually thinking about him because one of his big charges has been to elevate APPs in internal medicine and be able to provide them with some kind of incentive structure. I have been very fortunate to work with Dr. Call for many years now. He really built the APP program that we have at the University of Rochester, and it grew tremendously under his leadership to the group we have now with national recognition. Together we developed our collaborative clinical practice that we're both very passionate about. And much of that is due to the many hours that he has spent teaching me about advanced endoscopy and clinical practice in general. He's also been a strong advocate for my own professional development in leadership and in research, and for that I'm very appreciative of. That extends not only to me, but to APPs in our group and around the country. His passion for team-based practice, his commitment to elevating APPs, I think is evident to all of us on the course today. And then Dr. Vicari, I met several years ago through this course, and I have had the opportunity to work with him on several other projects. Last month we published a paper on APPs in GI hospital services, and we also worked together as section co-editors for the new ASGE journal IGIE. And so, you know, I think the thing about Dr. Vicari is he really does work tirelessly to promote and enhance the role of APPs, and he's really championed this initiative at ASGE. He's also the first one to remind me about burnout and balancing tasks, and so I'm grateful for his mentorship as well. And so what I want to leave everybody with is that leadership opportunities exist. They exist in many different forms, whether it's clinical practice or research, state, local, national committees. A formal leadership structure is needed to optimize the role of APPs. Mentorship is crucial. Training programs are available, and leadership opportunities are ultimately going to help to increase engagement, improve retention, promote professional development, increase career satisfaction, and, you know, at the end of the day, ultimately all of this improves our quality of care, our clinical efficiency, and patient satisfaction. And so with that, I will turn it back over to John.

APP leaders

APP reporting structures

leadership qualities

training opportunities

career advancement opportunities