The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

The survey tool was developed and validated internally in the AAMC Survey Development style¹⁸ and was influenced by prior validated surveys of postgraduate medical fellowships.^10,19-21 Each question was developed by a team that had expertise in survey design (Wright and Tackett), and two survey design team members were themselves PDs of APP fellowships in hospital medicine (Kisuule and Franco). The survey was revised iteratively by the team on the basis of meetings and pilot testing with PDs of other programs. All qualitative or descriptive questions had a free response option available to allow PDs to answer the survey accurately and exhaustively. The final version of the survey was approved by consensus of all authors. It consisted of 25 multiple choice questions which were created to gather information about the following key areas of APP hospital medicine fellowships: fellowship and learner characteristics, program rationales, curricula, and methods of fellow assessment.

A web-based survey format (Qualtrics) was used to distribute the questionnaire e-mail to the PDs. Follow up e-mail reminders were sent to all nonresponders to encourage full participation. Survey completion was voluntary; no financial incentives or gifts were offered. IRB approval was obtained at Johns Hopkins Bayview (IRB number 00181629). Descriptive statistics (proportions, means, and ranges as appropriate) were calculated for all variables. Stata 13 (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, Texas. StataCorp LP) was used for data analysis.

In total, 11 fellowships were identified using our multimethod approach. We found four (36%) programs by utilizing existing online databases, two (18%) through the SHM questionnaire and HMX forum, three (27%) through internet searches, and the remaining two (18%) were referred to us by the other PDs who were surveyed. Of the programs surveyed, 10 were adult programs and one was a pediatric program. Surveys were sent to the PDs of the 11 fellowships, and all but one of them (10/11, 91%) responded. Respondent programs were given alphabetical designations A through J (Table). 

Fellowship and Individual Characteristics

Most programs have been in existence for five years or fewer. Eighty percent of the programs are about one year in duration; two outlier programs have fellowship lengths of six months and 18 months. The main hospital where training occurs has a mean of 496 beds (range 213 to 900). Ninety percent of the hospitals also have physician residency training programs. Sixty percent of programs enroll two to four fellows per year while 40% enroll five or more. The salary range paid by the programs is $55,000 to >$70,000, and half the programs pay more than $65,000.

The majority of fellows accepted into APP fellowships in hospital medicine are women. Eighty percent of fellows are 26-30 years old, and 90% of fellows have been out of NP or PA school for one year or less. Both NP and PA applicants are accepted in 80% of fellowships.

Program Rationales

All programs reported that training and retaining applicants is the main driver for developing their fellowship, and 50% of them offer financial incentives for retention upon successful completion of the program. Forty percent of PDs stated that there is an implicit or explicit understanding that successful completion of the fellowship would result in further employment. Over the last five years, 89% (range: 71%-100%) of graduates were asked to remain for a full-time position after program completion.