Site Logo

Hello, you are using an old browser that's unsafe and no longer supported. Please consider updating your browser to a newer version, or downloading a modern browser.

Skip to main content

This article appears in the March 2020 issue of the

PE GI Journal


Advanced practice providers (APPs), whether physician assistants or nurse practitioners, are becoming an indispensable part of the GI healthcare team. In the average GI practice, each patient visit can generate 1.2 to 1.3 endoscopic procedures. APPs greatly increase a practice’s ability to see patients. Having capable, well-trained APPs enhances the level of service your practice can provide and, ultimately, helps further an important goal: improving the patient experience.

Invest in Your Team

Because of their importance to GI practices, successfully onboarding APPs should be a priority. However, many practices don’t take the time to properly onboard their APP team members. While it’s understandable that you or your colleagues may feel too busy to take the time to go over general, everyday issues like office workflow, coding and billing, culture, or scheduling with new APP hires, fighting that feeling and investing the time in your APPs up front will pay dividends down the road.

APPs who aren’t properly onboarded to your practice can potentially find themselves on a “treadmill of chaos.” They can be pulled in many different directions. Consequently, they operate without guidance or oversight on your practice’s culture, their role or their daily workflow. I’ve seen this hinder practices when people are thrown into roles and expected to run a race on their own. Then when they burn out, the practice has to go through the often expensive process of finding and onboarding a new hire all over again.

First Steps: Planning for Success

Before determining the details of what to include in your APP onboarding process, your practice needs to commit to creating the process. Without a physician champion who both believes in the importance of having an onboarding process and wants to see it through, it is difficult to make any progress.

Ideally, you can create a core team or committee that will be responsible for leading the onboarding process. This is through creation and implementation. I recommend that this group includes your physician champion, a clinical supervisor or nurse clinical leader stakeholder and an administrative stakeholder. Of course, depending on your practice’s culture, you may want to include more voices. Our practice has seven APPs who provide important insight and knowledge to the process as we update our APP program. However, having one physician champion as the leader has helped ensure our progress is tracked and improvements are implemented.

Establishing a Well-Considered Process

Once you have decided developing a successful APP onboarding process is a priority for your office, and you’ve identified the stakeholders who will help form the process, the next natural question is: What does a successful process look like?

When answering this question, we take a three-pronged approach. A successful onboarding process needs to address:

(1) the clinical role and responsibilities of APPs in your practice,

(2) coding and billing, and

(3) the culture of your practice.


1. Clinical. It is important that APPs understand the fundamentals of a GI consult, as opposed to a history and physical. The consult is like a targeted interview, and a quality consult lays a strong foundation for future patient interactions.

Beyond the consult, there are a number of questions you should address with new APPs that will differ depending on how your office operates. For example: How does an APP’s day flow? Do you use block scheduling or another system? How much time is an APP expected to spend per new patient visit and follow-up visit? What type of electronic medical record system do you use? Are they properly trained in this system? Of course, this list of questions goes on. Therefore, your team or committee will want to determine what issues to prioritize. As you learn what works best, you can hone this part of the process.

Coding and Billing

2. Coding and Billing. Coding and billing understandably trip up many new APPs, so training needs to be part of the onboarding process. APPs should spend time with your coders, particularly in their first months of work. While more in-depth training up front will pave the way for a smoother experience, coding and billing is an ongoing task. In addition to onboarding, we bring in an outside expert every year to work with the practice on new updates in coding and billing.


3. Culture. Any new employee needs to understand the culture of an organization and its mission before joining it. How you view the practice and delivery of healthcare and what you value as an organization are key concepts that need to be communicated to your new APPs. Making culture part of the employee interview can help you figure out who would be a good fit and communicate your values from the start.

When we discuss culture with our new employees, we always come back to one idea: patients first. When you put patients first, you put quality first. That philosophy will trickle down from lead physicians and managing partners to APPs and your administrative staff.

The Spirit of Collaboration

We have only scratched the surface of best practices and advice for creating a successful APP onboarding process. In fact, I will be co-directing a 1½ day course for the American Society for Gastrointestinal Endoscopy covering this topic (see “Onboarding Course” for more information).

With so much to cover, it can feel impossible to adequately touch on every topic in your APP onboarding process. To help with the inevitable questions that APPs will have that aren’t covered by onboarding, every new APP in our office is assigned a physician teacher or mentor as a resource for their first three to six months (or longer). This is a policy that I recommend all practices use as part of (and as a complement to) the onboarding process.

Mentorship is extremely helpful in avoiding the “treadmill of chaos.” It provides accountability, but more importantly, it gives the APP a much-needed resource for questions. It also helps relieve stress that would otherwise build up if the APP were left alone. However, just as with the task of creating an onboarding process, a mentorship system doesn’t work unless everyone involved embraces it. Having a team that wants to promote success as much as your new APP hires want to be successful can mean the difference between discussions toward a process that withers on the vine, and creating a strong, growing system that adds enormous value to your practice.