title: Nurse practitioners and physician assistants: preparing new providers for hospital medicine at the mayo clinic.
abstract: BACKGROUND
  Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support.
  
  
  METHODS
  This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN.
  
  
  RESULTS
  In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine.
  
  
  CONCLUSIONS
  The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Megan T
authors.initials: MT
authors.lastname: Spychalla
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Joanne H
authors.initials: JH
authors.lastname: Heathman
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Pearson
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Herber
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: James S
authors.initials: JS
authors.lastname: Newman
keywords: Assistant–physician; hospital medicine; hospitalist; inservice training; nurse practitioner