Hospital Medicine Fellowship Program Can Launch PA Leadership Roles

PA Meredith Wold to Outline at Upcoming Executive Leadership Conference

September 5, 2018

By Jennifer Walker

PA Meredith Wold is passionate about getting more PAs interested in leadership positions. “We are the boots-on-the-ground clinicians, but we have so much more to offer,” she says.

Meredith Wold, PA-C; APC Fellowship Co-Director

At Regions Hospital in St. Paul, Minnesota, Wold has taken on several leadership roles. In addition to her position as lead advanced practice clinician (APC) for Hospital and Critical Care Medicine, she also co-created and co-directs the HealthPartners Hospital Medicine APC Fellowship Program for PAs and NPs. When the 12-month program began in 2015, it was only the fifth hospital medicine postgraduate program for APCs in the United States; today, Wold estimates that there are still fewer than 10 of these programs nationwide.

At the Center for Healthcare Leadership and Management’s (CHLM) Executive Leadership Conference in November, Wold will share how she started the fellowship during the PA Innovation Panel. Additionally, she will share a larger piece of advice for PAs: Whether they are interested in starting a similar program for APCs or getting involved in other leadership positions, they should always be thinking about their next step.

Why a Fellowship Program?

About five years ago, HealthPartners, a hospital medical group, was onboarding new APCs for a year or more at Regions Hospital, one of the nine medical sites the company staffs, only to find they weren’t the best fit for hospital medicine. “To expect PAs and NPs to be practice-ready in hospital medicine as a new grad is very, very challenging,” says Wold, adding that it took her 12 to 18 months to feel like she was contributing to the team at Regions. It takes time for PAs and NPs to learn when they can provide care to patients within the scope of their practice and when to reach out and partner with their physician colleagues, for example.

She continued, “It’s just devastating to put all that time and energy and support into that colleague and have it not be a good fit a year and a half later,” Wold says.

(L to R) Meredith Wold; Hannah Rector, PA-C APC Fellow, Graduated July 2018; Lisa Rector, PA-C APC Fellow, Anticipated graduation Sept 2018; and Scott Faust, APRN CNP APC Fellowship Co-Director.

Wold—who, as the lead APC at Regions, also oversees recruitment, scheduling, and finances for the 14 PAs and 6 NPs on her team—created the HealthPartners APC Fellowship Program as a way to prepare PAs and NPs for careers in hospital medicine. She came up with the idea for the fellowship with Gary Bowrey, PA, who was her partner in all aspects of starting and running the program until he transitioned to a position in cardiology. Now she co-directs the program with NP Scott Faust.

The fellowship curriculum is based on the Society of Hospital Medicine’s core competencies, which include management of clinical conditions such as acute coronary syndrome, diabetes, and gastrointestinal bleeding, along with procedural and health systems knowledge. During their 12-month fellowship at Regions Hospital, fellows spend six months working alongside the hospital medicine physicians and APCs at Regions Hospital and six months with HealthPartners’ subspecialty partners in cardiology, nephrology, neurology, and other specialties. Two APCs are accepted each year. So far, three PA fellows have completed the program, all of whom have been hired by HealthPartners and placed at Regions Hospital.

Building a Fellowship

Wold says that starting the fellowship was the most complicated thing she has ever done. “We had this grand idea, but then we actually had to break it down and make it operational,” she adds.

Because Regions Hospital is a teaching site for the University of Minnesota Physician Residency Program, Wold first talked to the physician residency leaders to get APC fellows into the daily didactic lectures for physician residents. Then she reached out to the specialty services department heads to see if APC fellows could do rotations with each specialty. “This relationship building on the front end was probably the most time consuming, but the most integral to making sure that what came next—all the details that we filled in afterward—would fall in line,” she says.

(L to R) Meredith Wold, with Tom Yacovella, MD APC Fellowship Medical Director, and Hannah Rector, PA-C APC Fellow.

Then Wold created the curriculum. She started with the Internal Medicine Physician Residency Program curriculum, then added didactic lectures given by hospital medicine physicians and staff APCs as needed. Fellows would also attend the Society of Hospital Medicine’s annual Boot Camp to further strengthen their hospital medicine knowledge.

During these early stages, Wold’s ability to partner and communicate with others was an asset. “A passionate PA who has a vision greater than what his or her group might have can articulate that and get people on board,” she says.

 Advice for PAs

PAs interested in starting fellowship programs should set aside time in their schedules for administration, Wold says. These tasks include recruiting applicants, organizing interviews, working with subspecialty partners, and setting up regular check-ins with fellows. “Carving out that administrative time on the front end would really allow PAs the time to systematically set up the program for success.” PAs who are able to set aside even more time to collect data might also have an opportunity to publish their research.

More broadly though, any PA who is interested in leadership shouldn’t be afraid to ask for what they need to grow professionally. A year ago, Wold, who is considering getting an MBA, asked Jack Dressen, Director of Hospital Medicine at HealthPartners, for more leadership training. Now the company is sending her to the Society for Hospital Medicine Leadership Academy in Vancouver this fall—a conference that is historically attended by physicians. This will be the first time HealthPartners has sponsored an APC to attend this integral leadership training.

“PAs are ripe to be able to do this type of work,” Wold says. “But we have to seek out these leadership positions and ask for them.”

She adds, “Leadership is dynamic; it requires deliberate attention, focus, and reflection over time. Attending CHLM’s Executive Leadership Conference is a great way for PAs to take stock of their leadership qualities and better identify their opportunities that may be preventing them from taking the next step. Because of its diverse speakers and topics, it’s also a wonderful opportunity to network with a broad group of leaders from across the country.”

Register for CHLM’s Executive Leadership Conference, Nov. 6-8, 2018.

Jennifer Walker is a freelance writer in Baltimore, MD. Contact Jennifer at [email protected].