Starting Out Strong: Top 10 Tips for New GI APPs

New advanced practice provider graduates entering the field of gastroenterology are stepping into a dynamic and evolving specialty that offers a wealth of opportunities for advancing clinical practice and overall professional growth. The field of GI encompasses a wide range of clinical disease states and procedures, providing a unique blend of challenges and rewards that can help APPs develop a comprehensive skill set.

This installment of GI APP Corner aims to address common questions and considerations for new APPs in GI, ranging from the importance of foundational knowledge and skills to the benefits of subspecialization, the nuances related to inpatient versus outpatient roles, and the value of engaging with professional societies. Sarah Enslin, PA-C, and Kimberly Orleck, PA-C, discuss some key areas of interest for new GI APPs and provide insights into both the academic and private practice realms of GI practice. By exploring these topics, we hope to provide graduates with some practical advice that gives them a clearer understanding of how to navigate an early career in gastroenterology, make informed decisions, and set themselves up for long-term success.

Panelists

1. Why should a newly graduated APP consider a career in gastroenterology?

Ms. Orleck: Because the field of GI encompasses so many different clinical scenarios, it is one specialty that has the potential to keep you interested, growing, and learning for many years. The GI tract includes the stomach, esophagus, small bowel, colon, pancreas, liver, and more. Also, many GI conditions overlap with non-GI conditions (eg, extraintestinal manifestations of inflammatory bowel disease), so you can stay informed in non-GI medicine as well. GI has shifted so much in the last decade to include APPs as autonomous providers, so I think it is a great specialty if you want to practice to the full extent of your license.

Ms. Enslin: I agree. The diversity in GI conditions enables APPs to develop a broad set of skills and manage conditions of varying complexity and acuity. In addition, the field is constantly advancing with new clinical research, innovative treatments, and cutting-edge technologies, presenting numerous opportunities for professional growth and involvement in research initiatives.

2. Is it beneficial for an incoming APP to have a background in GI/endoscopic procedural skills?

Ms. Orleck: It is definitely not a requirement, but any background in GI or endoscopy is a huge plus if you are starting a career as an APP in GI. In any case, you will acquire a ton of endoscopy knowledge once you start in GI, and while APPs often do not do scoping, I recommend that all APPs new to GI observe procedures and ask to get involved in any that your practice can accommodate (eg, percutaneous endoscopic gastrostomy tube placements or hemorrhoid bandings).

Ms. Enslin: Many APPs acquire the necessary skills through on-the-job training and mentorship, so it’s certainly not essential to have prior experience. If you are not familiar with endoscopic procedures, spending time in the endoscopy suite and observing these procedures during your orientation is beneficial. Even after you are established, it is often very rewarding to swing by the endoscopy unit and observe procedures, when possible, especially when complex and/or novel procedures are being done. It encourages discussion, enhances knowledge, and offers valuable insight that can enhance clinical practice.

3. Given the evolution of gastroenterology into multiple subspecialties, should an APP new to GI focus on general practice or consider subspecialization from the get-go? How can an APP decide which subspecialty to pursue?

Ms. Orleck: I truly think a lot of this depends on the practice you are joining and your individual passion. In community practice, the majority of APPs I know start out as general GI APPs and then over time start to develop a true passion for certain subspecialties, and their patient panel in this area of interest grows over time (eg, IBD, motility, hepatology, etc). There are some community-based APPs who enter a role with a specific subspecialty (such as hepatology), so that does happen, but starting with general GI gives you a strong foundation to then develop into a subspecialty role if you find one that you love. Unless you know for sure that you love a single subspecialty in GI, I recommend that you start out as a general GI APP.

Ms. Enslin: Ultimately, whether to focus on general GI practice or pursue subspecialization depends on your personal interests, career aspirations, and the opportunities available in your desired practice/location. There are positives to both pathways. Starting in a general role can provide a solid foundation and flexibility. If you are interested in subspecialization, I recommend you first familiarize yourself with each subspecialty and develop an understanding of the scope of practice, patient population, and typical day-to-day responsibilities. Your passion drives your motivation and satisfaction in a particular subspecialty. Your real-world experience helps shape your passion into a final decision. Also speak with others practicing in different areas about their experiences and challenges before you decide.

4. What are the pros and cons of working in outpatient versus inpatient settings?

Ms. Orleck: Having done both, this is a great question and here are my thoughts:

• Outpatient pros: You really establish a rapport with patients; you get to follow patients from beginning to end and for many years; you know your schedule and what you are walking into each day; you can prep your charts ahead of time and so forth.
• Outpatient cons: The work (seemingly) never ends (patient calls, results, portal messages); you may not get as comfortable with high acuity in this setting.
• Inpatient pros: You get comfortable with higher acuity; you get to see a lot of internal medicine patients in addition to GI; you have the oversight (and collaboration) of a supervising MD to round on patients on a daily basis.
• Inpatient cons: You never know what your day will look like—consults love to come in at 5 PM! You don’t manage chronic conditions as much (eg, IBD maintenance meds); you don’t always know the “outcome of the patient” and what happens post-hospitalization.

Ms. Enslin: Outpatient settings provide a structured schedule with the potential for long-term patient relationships and subspecialization. However, there is often a significant volume of electronic messages that require timely attention and response. It can be hard to set and maintain boundaries to protect your work–life balance. Inpatient settings are ideal for those who enjoy high-acuity cases and complex medical management. In an academic setting, the hours are generally predictable with set sign-out times, but there is less continuity of care post-hospitalization and less exposure to management of chronic conditions.

5. Should you consider remote, in-person, or hybrid roles in GI practice?

Ms. Orleck: I personally think a new APP is best suited for an in-person position to get comfortable with clinical practice, and then there is a lot of potential for adding telemedicine to your schedule once you are more comfortable, have more experience, and have built a strong rapport with patients. I think it is hard to build rapport via telehealth and become a strong GI APP without being in-person for a few years at first.

Ms. Enslin: In-person roles allow for direct patient interaction, team building with colleagues, and hands-on learning, especially during the initial phase of your career. As telemedicine continues to grow, a hybrid role could provide a balance between direct patient care experience and the flexibility of remote work, but I agree that it would be better to take advantage of this opportunity after developing competence, confidence, and experience.

6. What is the importance of engaging with national professional societies?

Ms. Orleck: National societies are so important for APPs in GI, both new and established. In addition to learning opportunities (ie, journals, virtual events, CME events), these societies are great for networking, and the GI APP community loves to support other APPs.

Ms. Enslin: Participation in societies (eg, the American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Gastroenterology and Hepatology Advanced Practice Providers) provides education, networking, leadership opportunities, and access to valuable resources. These societies offer platforms for continuous learning, community building, and long-term professional development in many ways.

7. Are additional degrees or certifications valuable for a career in GI?

Ms. Orleck: I don’t think there is a need for additional degrees or certificates in GI practice, but certain ones are a big plus, in my mind. For example, I was a dietitian and know many other APPs in GI who were dietitians, and this really improves our ability to provide the nutrition advice we can give to patients. GI APPs who come with GI endoscopy nurse experience add a lot of value to the education of patients on the endoscopy side of things. I think GI APPs who want to go into teaching could benefit from doctoral programs, but it is certainly not a requirement.

Ms. Enslin: I do not think additional degrees or certifications are necessary for a career in GI, although they can certainly add value. Degrees such as DNP or DMSc can open pathways to advanced roles in clinical leadership, academia, or administration. In gastroenterology, this might mean leading a clinical team, managing a GI practice, or developing educational programs for patients and staff. An MBA equips APPs with essential skills in practice management, including financial management, operations, human resources, and strategic planning. This can be particularly valuable in managing a gastroenterology clinic or department, facilitating improved operational efficiency, and optimized patient flow. Formal certifications in GI subspecialities are not available, but with the current trend in healthcare, I wouldn’t be surprised if these opportunities develop in the future.

8. How do experienced GI APPs manage burnout and maintain wellness?

Ms. Orleck: I haven’t quite cracked the code on this one yet, but it’s such an important area, as burnout is real. A few personal recommendations: Ensure that you make time for yourself and do things you love and that allow you to relax. For me that is exercise and spending time with my family. We all need work–life balance. I highly encourage everyone use some PTO days just to rest and enjoy themselves. In addition, try some of the “wellness” options at CME events. They often offer GI provider runs or yoga, and many events also have formal lectures on self-care and wellness.

Ms. Enslin: This is a difficult one to master, and I think it changes based on your own personal situation and career stage. I encourage APPs to set, and maintain, clear boundaries between work and personal time to avoid burnout. This becomes easier once you become more comfortable triaging and prioritizing tasks and using time efficiently. Investing time and using resources to improve efficiency, such as optimizing the EHR to your preferences and creating smartphrases, can be helpful as well. Opportunities for professional growth and self-care practices, such as physical activity, mindfulness, and adequate rest, are crucial for preventing burnout in the long run.

9. What are key considerations when negotiating a contract as a GI APP?

Ms. Orleck: For the salary part, really come in knowledgeable about national market data and use that to negotiate what you deserve but with a reasonable expectation based on your experience. I highly recommend looking at the American Academy of Physician Associates salary report, which looks at salary based on experience, setting, location (inpatient/outpatient), and the state you work in. There are likely other valid market resources with similar data. Also, think beyond the salary. Think about the benefits, as well as negotiating in other areas including CME days, CME stipend, and PTO. Ensure that you get “medical necessities,” such as hospital fees, licensing fees, etc, covered. Ask about your malpractice coverage, and know who your contact is for malpractice and/or patient safety in your practice.

Ms. Enslin: There are several aspects to this. When it comes to compensation and benefits, one should understand what the entire compensation package includes—salary, any bonuses and incentives, and the benefits package (health insurance, life insurance, retirement plans, disability insurance, tuition benefits, etc). It is helpful to understand fair market value in your area. In some practices, particularly academic centers, salary may be standardized and nonnegotiable. Other aspects that may be negotiable include CME money and time off, amount of vacation/PTO, work hours (days/evenings/nights, 8- or 10-hour days), and equipment such as laptops, tablets, phones, etc.

10. What are some important pearls or recommendations for new GI APPs?

Ms. Orleck: Remember that GI encompasses a lot, and it, therefore, takes a while to become a comfortable and competent GI APP. But you will get there. Don’t be too hard on yourself, and lean on others (eg, collaborating MDs, co-worker APP colleagues and supervisors, and APPs you meet at conferences) to grow into your role. The first year is hard—think of it like “our residency!”

Ms. Enslin: Entering a new specialty can be challenging, especially during the first 2 years, but remember that it’s a time for growth and learning. Start by focusing on building a strong foundation of knowledge. Each day, try to review and reflect on the cases and diagnoses you’ve encountered. Don’t hesitate to seek mentorship—having someone guide you can make a big difference. Also, prioritize your well-being with self-care, and get involved in professional societies in which you can learn and connect with others. Networking with fellow APPs at conferences is invaluable! They can provide support and share experiences that can help you navigate this exciting new phase of your career. You’re not alone on this journey, and with time, patience, and effort, you’ll find your footing and thrive!

Summary

Starting a career as an APP in gastroenterology offers a diverse array of experiences, from managing various digestive conditions to engaging in innovative research, procedures, and treatments. Whether a new APP decides to specialize or remain a generalist, work in outpatient or inpatient settings, or explore remote and hybrid roles, success in this field hinges on continuous learning, networking, and adapting to the ever-changing landscape of GI medicine. By seizing educational opportunities, seeking mentorship, and participating in professional societies, new APPs can hone their skills, mitigate burnout, and make meaningful contributions to patient care. The most critical aspect is to find a path that aligns with individual interests and strengths and fosters personal and professional growth in this rewarding specialty.

Ms. Enslin and Dr. Kaul are members of the Gastroenterology & Endoscopy News editorial board.

This article is from the October 2024 print issue.