A Look Inside a APP Fellowship Program

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Corinne Young, APAPP President:
Hello and welcome to the APAP podcast. Today we are going to be discussing APP fellowship programs. And with me today as our expert on this topic is Vincent Derincio. So Vincent received his undergraduate from the University of Rochester. His master’s from Damien University. in the medical ICU of a large academic hospital in western New York as the assistant director for the advanced practice provider critical care medicine fellowship program there. Prior to working there he worked as a physician assistant in clinical research in emergency medicine.

His professional passions include APP education which is why we have him here today, research and promoting scientific literacy. Outside of work he enjoys all things Star Wars which I love. And reading and with his wife and family, particularly on the shores of Lake Ontario, which I have not been there. I’m sorry, I’m sorry.

Vinny DeRienzo:
Oh, we have to get you out then. Yeah.

Corinne Young, APAPP President:
Yeah, it’s one place I haven’t been. All right, so today we are talking about these fellowship programs. So please tell us about how your fellowship program came about because this is starting to become more and more of a topic among APPs, especially pulmonary critical care sleep where we don’t have nationally accredited fellowship programs. So tell me about how your program got started.

Vinny DeRienzo:
First things first, thank you for the great introduction and the generous use of the term expert there. I’ll try to love up to the folks that I know that are doing much better work than I am. So we’re fortunate enough at the time of this recording, we just made our offers to the eighth class of APPs for our Critical Care Fellowship. So this program has been in place before I got involved in the university. I actually am a graduate of the program. I was in the third class, so we had a few, a few trial and error years before I joined. Had a great experience with it.

And after I got my clinical feed underneath me, the educational side of my career that I wanted to build, this was kind of a natural fit. So for the folks that got the program started, it really came about at a time when the university was expanding its role as a tertiary care center. So we had more coverage areas that were going from the shores of Lake Ontario down to the Pennsylvania state border. So with that, we had expansions in the ICU coming, and 10 to 20 bed expansion across all of critical care, including our sub-specialty ICUs, and we were adding continually year after year FTEs to our critical care APP pool. This really came about the same time that you also had changes in resident work hour rules. So there was less coverage of our internal medicine residents in the ICUs as well. So there was a avoided some of those typical workforces that you had that opened the way for this.

One of the other challenges and one of the things that was talked about a lot in the business plan that was pitched to our corporate suite was really, you know, where does this fit in the budget line? And I know that’s kind of an intimidating thing for a lot of folks to think about if they’re trying to get one of these programs started. What we really had the advantage of is that expansion piece. So if you’re at an institution that’s undergoing something like that, that was kind of a ripe time for us to fit in this new program and get people on board with it. is that it really is a cost saving measure as you look forward in terms of orientation costs. Folks that maybe aren’t as committed to the role as they may be if they were to go through a program like this. And then the part that maybe is a little bit more palatable for other folks too is the rigor of the program and the quality of APP that comes out.

From my own personal experience when I was going through school, the ICU was kind of like Narnia. We didn’t really know what happened went there they just we just knew how to get them there that was the goal of the primary education there. So to have this rigor and to have folks come out and have an opportunity to to learn in a protected learning environment they come out and they’ve gone on to be very successful.

We’ve had 14 graduates at this point and the feedback from the folks that have been hiring them is that they come out with you know APPs that have the equivalent of three years of experience and we’ll get into the curriculum a little bit about how they is a little bit more unique than someone just coming out into the workforce.

Corinne Young, APAPP President:
I feel like that’s the most important piece

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
of that fellowship program when I’ve gotten in arguments with the physicians that I’ve worked with about why I didn’t have experience with something. I would say, you know that pulmonary fellowship you did? I didn’t have that. I’m at the mercy of learning from who I work with or at the mercy of learning on my own time. And it’s very difficult to know what you don’t know sometimes, right? And so that’s what’s so great about a fellowship program is it holds everyone accountable in that program to know the same things. So yeah, I think that’s the biggest piece. And I hope this grows to something that is kind of a nationally expected program for APPs, especially in these subspecialty areas that are so critically focused, like critical care and pulmonary medicine,

Vinny DeRienzo:
Yeah,

Vinny DeRienzo:
absolutely.

Corinne Young, APAPP President:
So who all was involved in developing the program? Was there like a brain child you know, type thing that then brought it to other places. You know, how exactly did that work for you?

Vinny DeRienzo:
the first director of the program, a guy named Brent Lorke, who’s still with our institution, had the idea first to say, hey, this is an opportunity for us to grow as a place of higher learning and to really push the APP workforce piece there as well. We had two other founding directors that are still involved with the programs at various levels, Brett Hogan and Seth Zebrack. So those were the three coaches. directors when it was first coming up off the ground. Now of course they had a lot of help along the way that they would be, and I’d be remiss not to mention, our medical director for the program was one of our surgical intensivists and has actually played a big part in some of the curriculum building and some of the earmarking that we have for our trainees that go through the program. And then we had the support too of the critical care division. our institution we have a big umbrella for critical care and then underneath it is all of the subspecialty ICUs with our pulmonary group being the primary separate group for our medical intensive care unit.

Our surgical ICU is a closed unit so they have participating subspecialties underneath them. Our cardiac surgery, our burn trauma and our neuro medicine ICU as well. So we to really get this thing off the ground it was buy-in not just from the folks in faculty and it was also the lead APPs in each of those sub-specialty ICUs that weren’t part of that initial directorship piece there because we were going to be sending them additional trainees and they’ve already have so many coming through.

Corinne Young, APAPP President:
Right.

Vinny DeRienzo:
So those are really kind of the key players in terms of just getting buy-in before even bringing it to that you know business proposal level.

Corinne Young, APAPP President:
there obstacles making that happen? Was there any pushback?

Vinny DeRienzo:
Not so much perspective. We’re really fortunate. You know, in my institution, it’s a there’s a deep commitment to the learning environment. And I think everyone saw the benefit of this as a learning opportunity. So from the buy-in standpoint, I think everyone was on board right from the beginning. It was trying to find the folks that were going to commit the time, as is always kind of a barrier when you have something new like this

Corinne Young, APAPP President:
Yeah.

Vinny DeRienzo:
starting up. And we’re very fortunate for the folks that donated their time early on to get the program up and running as we’ve kind of evolved over the years here. Biggest challenge as most folks were is that formal piece and getting that budget line item approved for the FTEs. And it’s one of the things that we’re kind of fortunate for. I don’t want to bore anyone with the quick book side of this talk, but some of the fellowships at our institution and others, those fellowship positions are actually kind of hobbled together from available FTEs from family leave time or maybe folks that are on extended leave. Whereas we actually got our critical care division to buy into two full time positions for the fellowship. So it’s an actual hired spot that is committed to on the budget year after year. And makes it a lot harder to just kind of wave a hand and make it all go away. What no one would do. But those are the kind of things that have helped us really have a solid foundation and feel good about what we’re doing.

Corinne Young, APAPP President:
Thank you. Well, I’m sure that was also very enticing for fellows coming in, right? That it’s a full-time position paid at, I’m assuming, a fairly competitive rate for someone without experience.

Vinny DeRienzo:
Yes, very much so. Well, and I know we’ll talk a lot about the recruitment piece there that got, I’ve got a lot to say about that. Yeah. Yeah. Yeah.

Corinne Young, APAPP President:
Once the program was up and going, what would you say were the biggest obstacles, road bumps, you know, for a fledgling fellowship program?

Vinny DeRienzo:
Yeah, you know, one of the things that the program did in the early years, which I was a part of as a learner. And then as I’ve seen now as a faculty member for it is the feedback and the evolution really of the curriculum. Uh, so one of the things that set our program apart from some of the other ones that I had investigated as I was trying to figure out where I wanted my clinical career to go, uh, was a commitment to protected learning time. So not just having the trainees be kind of plugged into fill holes in the schedule, um, to them being with a preceptor.

Vinny DeRienzo:
Yeah, absolutely.

Corinne Young, APAPP President:
And so I think that’s a good point.

Vinny DeRienzo:
So the first thing is recruitment and trying to pitch the idea of additional learning to folks that have been in school already again and they thought they were ready to enter the workforce fully fledged. And in a program that’s still evolving, APP fellowships really have come to prominence in the past decade. Really the last five years has been more of a boom. So to educate folks about the benefit for them as learners has always, a little bit of a challenge, prior to a little more work in the beginning, we’re pretty well established now, so that becomes a little bit less of a challenge. But then ongoing in those first few years is really being comfortable with being wrong about the curriculum development, about the expectations that you had of the learners and of the program and how things were gonna play out. It’s a very dynamic situation. And even going into our eighth class here, we still have regular check-ins with our fellows, with our preceptors, to see what we can do faculty to improve the program from all aspects.

Corinne Young, APAPP President:
So you guys have, I’m assuming you guys have a pulmonary physician fellowship program

Vinny DeRienzo:
We do, we have quite a few critical care fellowships. So we have a pulmonary critical care fellowship, we have a critical care fellowship, surgical critical care, anesthesia critical care, neuro critical care. So yeah, so we have the MD and the DO fellows with us.

Corinne Young, APAPP President:
Were you guys able to utilize any of the didactics from the critical care physician fellows to your program? I mean,

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
is that something that could, I don’t wanna say copy paste, but you know that that can be kind of, you don’t have to completely reinvent

Vinny DeRienzo:
Yeah, and that’s a great point. That’s one of the things that I, for anyone that’s thinking about starting one of these programs, the resources are there for you through your institution nationally, through other of these professional organizations, it’s there. At our shop, we had quite a few things that we could take advantage of. So particularly, particularly to critical care, there’s a fundamentals and critical care support class, that is a certification class that are, all of our MD and DO fellows take before they start their fellowship. And we got our APP fellows enrolled in that same course So not only are they, you know, learning with them, but they’re developing those social ties with these folks that they’re going to work with throughout their training and their early years in the profession too.

There’s other things that we do at our shop. We have a three o’clock lecture every weekday that is open to our residents, our interns, our APP fellows, our MD and DO fellows as well. And then there’s other things throughout the year that our physician fellows do their own conference on Wednesday mornings and those talks are open invites to all of our trainees. There’s a lot of other things that come up over the course of the year in terms of all of the alphabet soup certificate courses that they’re participating in together. So yeah, so there was a lot of things that we were able to take advantage of and also kind of expand that role in terms of involvement as fellowship’s gone on over the years. Those early years, a little bit less involved in some of that cross training, but then was able to take advantage of more of that as we went through.

Corinne Young, APAPP President:
What a great representation of APPs to new physician fellows,

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
right? Because for the most part, I think a lot of physicians who don’t work with APPs, or even those that may work with them may not really understand our background in education

Vinny DeRienzo:
Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Yeah.

Corinne Young, APAPP President:
or training. And for them to kind of come up the ranks with each other in a fellowship program, I feel like those physicians are more likely to go out in the world and say, they have a little more faith in APPs or, you know, I know in my own practice and the different practices I’ve been with, when I meet new physicians who did residency fellowship with APPs in that environment, they were a lot more

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
collaborative than those who had really not worked with any. They didn’t know what I could do, what I couldn’t do, what they could, you know, it’s that feeling out period.

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
So I think that’s great that you put them together, coming in, fledgling together

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
through. I think that’s great.

Vinny DeRienzo:
thanks. We like it too and it’s all been positive feedback from all sides as we’ve started to integrate more and more. So, yeah.

Corinne Young, APAPP President:
That’s great, that’s great. So talk to me a little bit more about, well, first I wanna ask about

Vinny DeRienzo:
Mm.

Corinne Young, APAPP President:
timeline. So if someone were thinking about, you know, maybe they have the buy-in, you know, from the hospital system, university,

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
wherever they are, what would you say is a reasonable timeline to get everything up and going and have a

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
class?

Vinny DeRienzo:
I’m going to drop some stomachs with this one. I think 12 to 24 months is reasonable to expect from true like inception

Corinne Young, APAPP President:
Yeah.

Vinny DeRienzo:
to getting everything

Corinne Young, APAPP President:
Uh-huh.

Vinny DeRienzo:
moving. Obviously, I’ve talked with other folks that have been running programs for a while or just getting them started. And based on other obstacles that other institutions, it may take longer. It may take that buy in

Corinne Young, APAPP President:
Thank

Vinny DeRienzo:
time

Corinne Young, APAPP President:
you.

Vinny DeRienzo:
may take a little bit more. Or just finding some of the faculty members that are willing to commit early on and add something else the plate of an already, you know, busy physician, busy lead APP, those kinds of things.

Corinne Young, APAPP President:
Thank you. Thank you.

Vinny DeRienzo:
So yeah, that one to two years to actually get a class that’s in front of you ready to learn. It was probably a reasonable expectation for those folks.

Corinne Young, APAPP President:
and how large are your classes?

Vinny DeRienzo:
We range, so we have the two dedicated spots, and then we have some ability to flex up and down based on the quality of applicants. So our largest class was two years ago now. We had four fellows in that class. Mine was three, we average around two. And it looks like that’s kind of the, and that’s been something that we’ve played with over the years too in terms of scheduling with the ICUs, and then also just kind of giving them a rich enough of an educational opportunity and still get them the one-on-one time that they deserve to grow in that year.

Corinne Young, APAPP President:
more

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
quality over quantity type thing. Well, talk to me about your curriculum development. How did you guys develop your curriculum and maybe just a brief overview of

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
what that

Vinny DeRienzo:
absolutely.

Corinne Young, APAPP President:
looks like?

Vinny DeRienzo:
So there’s a few kind of cornerstones that we’ve identified. And again, this has been an evolved process. This is not how it was all ironed out year one. But we started essentially with a boot camp session. The first month with us is spent doing things like the hospital orientation. We’ve identified some mixed media learning from some of the professional societies. Society of critical care medicine has these virtual critical care rounds, about 64 lectures total, section. So we have our learners do that in the first two months. We have identified some kind of key knowledge points before they even hit the units about the things that you would expect to be kind of foundational in critical care. So we do a boot camp week with a curriculum we’ve put together. And then the next week is spent in a mixed learning environment as well. We have a class called Poison. It’s put on by our critical care faculty with fourth year medical students as well as our APP Fellows, and it’s a very basic science, heavy case presentation type course that last a week goes through just about everything that you can see in the ICU from a basic science. It’s a little bit of clinical knowledge level too. So they do all that upfront. And then as we go throughout the year, there’s a few things that we’ve identified. So there’s the kind of one-off educational opportunities, all the alphabet soup certification courses that we can get them aligned with help them as they go through the specialty ICUs, you know, burn life support when they go to burn trauma, you know, the ENLS course offered by the national, the Neurocritical Care Society, all those different kinds of things. So those are the kind of one-off educational opportunities that we give them. And then we have the recurring piece, and this is what I think is the most important and keeps folks engaged the most. So we have, like I said, those daily lectures available in-house. We do a conference every two weeks with our fellows. where they’re doing case presentations or journal club, they alternate on and off, as well as getting some additional more advanced lectures as the year goes on. So this is when we start introducing, you know, our advanced human dynamics with ECMOs and things like that. So those are really kind of the key pieces we’ve identified so that the place up front are additional one-off things. One of the things that we’re particularly excited about too is we have a cadaver lab that we run who’s our surgical intensivist and our surgical critical care fellows. So I think it’s American College of Surgeons has the asset course, which is essentially a surgical anatomy course that the, this is a benefit everyone. So the surgical critical care physician fellows come in and teach the course under the tutelage of our surgical intensivist to our APP fellows. And this is an opportunity for them to

Corinne Young, APAPP President:
Thanks.

Vinny DeRienzo:
see some surgical anatomy that they wouldn’t necessarily otherwise they get an opportunity to do procedures like search for thorough costumies, all the central lines that you can imagine, emergency traits, things like that, in a controlled setting on the cadaver. And that’s a unique thing to our program. There’s a few others that are doing it, and we’re particularly proud of that. The overarching thing here is, there’s a lot of curriculum that’s out there already. So it’s just identifying those resources and kind of circling the wagons as you will. to bring them to your folks.

Corinne Young, APAPP President:
Yeah. I would love if we could review some of those resources. But as a little side nugget, if any of you are planning on attending Chest in Hawaii this year in 23, Vinnie and two other speakers who come from other fellowship programs are going to be doing a session at Chest on behalf of APAP regarding fellowship programs and development.

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
Correct? Have you guys come up with a title

Vinny DeRienzo:
absolutely.

Corinne Young, APAPP President:
yet of the

Vinny DeRienzo:
Not

Corinne Young, APAPP President:
session?

Vinny DeRienzo:
quite yet. We’re playing with a few things. It’s a work in progress, but if y’all were looking for another reason to come to Honolulu, let that be your excuse.

Corinne Young, APAPP President:
Yes. Like Han and Lulu was enough, but I know they’re really gonna want to go for

Vinny DeRienzo:
Exactly,

Corinne Young, APAPP President:
fellowship discussion,

Vinny DeRienzo:
that’s the main

Corinne Young, APAPP President:
right?

Vinny DeRienzo:
draw. Yeah.

Corinne Young, APAPP President:
Exactly. Well, I think definitely at that session we’ll have some resources for everyone

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
too,

Vinny DeRienzo:
absolutely.

Corinne Young, APAPP President:
I hope. So, well, let’s move on to talking about your own personal experience coming through as a brand new fellow. What was your first

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
year like?

Vinny DeRienzo:
so I talked a bit about the choice to join the ICU, and this gets to the philosophical, I think, debate that’s going on a little bit right now about fellowships is there are some folks from the PA side, and they’ll try to stay in my lane on this one, that think that specialty training can pull away from the generalist role that PAs have kind of naturally fallen into. I obviously have a bias in favor of fellowships with my training. I pursued that because it was something that I felt, yes, I could go into a generalist role, try to work my way into the ICU from there, coming as a direct hire, but the fellowship gave me a lot of opportunities that I wouldn’t otherwise had. From a learner standpoint to get paid to learn for a year was a very attractive opportunity for me to be able to rotate through the seven different clinical settings that I was in is something that that just getting jobs in seven different places would have taken 10 years or would have looked horrible on a CV, right? So to have a chance

Corinne Young, APAPP President:
Mm-hmm.

Vinny DeRienzo:
to cycle through,

Corinne Young, APAPP President:
Yep.

Vinny DeRienzo:
see what these environments have like, see what patient population I really enjoyed working with. And then as a benefit too, you get to kind of interview the groups that you’re working with as well. Unfortunately enough, where that was not a deciding factor for me, I was able to go with my passion, which is, which is the medical ICU with the variety, and the, the kind of role that the you piece have there. But yeah, so those were the kind of things that drew me towards a fellowship as opposed to just going in as a as a direct hire. Going through the year I was very fortunate you know camaraderie is an important piece as you’re going through something with so much rigor. So to have my co-fellows with me was a nice way socially to kind of get ingrained into the hospital and have that person who you know is going through the same experience as you. That was an important piece. And then the rigor you learn how to be a better had gone back to PA school after another career for three or four years. I was a terrible student when I started PA school. Those skills did not stay with me.

Corinne Young, APAPP President:
Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

Vinny DeRienzo:
So they developed over time. And then that fellowship year with the expectations and everything else that we had, uh, taught me to be efficient, to identify my resources, uh, really reignited that fire for lifelong learning that I was curious, I was going to have after a, a grilling masters program. But, uh, yeah. So it was, It was a hard year. It was busy schedule, a lot of learning, a lot of the additional projects that come with case presentations and things like that.

Corinne Young, APAPP President:
Thank you.

Vinny DeRienzo:
But the clinical experience that I got, the interpersonal relationships that I got out of it as well were just so important. To be able to talk with really anyone in the hospital and call the cell phone instead of trying to page them is a nice thing to have, especially as we… I graduated

Corinne Young, APAPP President:
Yeah.

Vinny DeRienzo:
my fellowship and the pandemic came shortly thereafter. So it was a nice setup to have those resources available.

Corinne Young, APAPP President:
Yeah, I don’t think anybody was prepared for that, but I guess if anybody was going to be, it’s somebody

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
out of fellowship. Versus just right out of school going into that. So how do you guys recruit? How do you guys recruit

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
to your

Vinny DeRienzo:
so

Corinne Young, APAPP President:
program?

Vinny DeRienzo:
it’s evolved, again, as with most other things in the world, the pandemic has changed a lot. In the past, there was a strong contingent of our bedside RNs in critical care that was kind of the natural flow as they would go back to get their NP and then come back into the fellowship or work process a direct hire. And unfortunately, you know, three years of really busy and really acute care, I think turned a lot of people off. and it also scared, I think our PAs away a little bit, that didn’t know the ICU. So I’m not sure if this was a case out near you, but in the early days, students weren’t allowed to the ICU, right? It was kind of a person in a gratis situation. So we didn’t have students coming in, working with us, seeing what the environment’s actually like. And so then it’s left up to kind of the fairy tales and filling in the blank. So our normal pathways, to readjust a little bit over the course of the pandemic. Utilizing social media has been a piece that we’ve taken advantage of. Our university has a page for all of the APP fellowships, which there are currently, I’m going to get in trouble for this one, eight or nine I think across the university for APPs.

Corinne Young, APAPP President:
Thank you. Thank you.

Vinny DeRienzo:
So we’re able to recruit utilizing some of those things, taking advantage of alumni how bless is always helpful. And then trying to simplify the recruiting process as much as possible in terms of applications for our potential learners. So we’ve really tried to streamline the process as much as possible. We published the dates. It’s the same week in March every single year. So if there’s anybody thinking about applying to a critical care fellowship, we’ll see you guys in March and try to keep it simple that way. One of the other things too is there are a lot of different organizations that offer accreditation for fellowship. and they act as a repository for potential applicants to go towards. And that’s, you know, nice easy look up programs you can filter based on which organization you’re a part of and they can kind of redirect you that way. So, like anything, had to make kind of a digital pivot as opposed to more of the in-person, the job fairs and things like that that we were doing. But it’s ebbed and flowed a little bit. We’ve had, you know, a couple of thinner years and a couple of more robust years, the pandemic. So I think my prediction is that things will level out as we get more learners in the ICU as things kind of turn down a little bit in terms of the acuity and things like that.

Corinne Young, APAPP President:
Mm-hmm. On average, how many applicants

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
do you get a year?

Vinny DeRienzo:
anywhere from six to, I think, 20 was the most that we had. Yeah,

Corinne Young, APAPP President:
Okay.

Vinny DeRienzo:
for our two to four spots. So it’s a it’s a competitive process. We try to again try to make it simple. We’re not doing anything out of the norm here. Just a CV cover letter and a day of interviews that we, you know, try to try to make it not not too too unbearable for folks. But yeah, so it

Corinne Young, APAPP President:
I don’t.

Vinny DeRienzo:
but it we’re very blessed year, we sit down and really,

Corinne Young, APAPP President:
Yes.

Vinny DeRienzo:
really agonize over those decisions.

Corinne Young, APAPP President:
I think it’s great. I mean, it definitely just sharpens the profession. It’s a great representation of the profession. It’s, I think, where it needs

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
to go. And, you know, I’m glad to have this conversation with you because when I talk to other APPs, and I don’t know everyone, but, you know, when I bump into people and I talk to people about fellowship programs, there are some that are very shocked that they

Vinny DeRienzo:
Mm.

Corinne Young, APAPP President:
exist anywhere. They’ve never heard of one. There’s others who are very motivated to start them to be involved and want to have one. And then there’s people like you that I meet that are already in a well-oiled machine running that I think everyone could

Vinny DeRienzo:
Thank

Corinne Young, APAPP President:
learn

Vinny DeRienzo:
you.

Corinne Young, APAPP President:
from. Because again, hopefully one day this is

Vinny DeRienzo:
Yep.

Corinne Young, APAPP President:
the way of the future, especially these very acute care settings that is more than what you’re gonna get in school. There’s

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
so much

Vinny DeRienzo:
I agree.

Corinne Young, APAPP President:
more. what

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
you’re

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
gonna get in school. You know, they just can’t cover it.

Vinny DeRienzo:
There was an op-ed,

Corinne Young, APAPP President:
Yeah.

Vinny DeRienzo:
I was reading it in the past year or two, where at least when I was going through school, the adage was medical knowledge doubles every 18 months and now it doubles every 72 days or something like that. So yeah, I agree. This is, for me, it’s the only way I think I would have felt comfortable coming out of school and going into these acute care and these really kind of medically complex sub-specialties. So happy to be a part of it.

Corinne Young, APAPP President:
Yeah, well, we’re very happy to have you. Any last minute thoughts on those out there thinking, maybe those both thinking of being the person on the soapbox to their organization to start a fellowship program, and maybe to those who are considering applying to a fellowship program. Like maybe they’ve been in practice, other places wanting to transition to critical care, or maybe right out of school, or somebody old

Vinny DeRienzo:
Thank

Corinne Young, APAPP President:
like

Vinny DeRienzo:
you. Bye.

Corinne Young, APAPP President:
me. to give us your words of wisdom for those

Vinny DeRienzo:
Yeah,

Corinne Young, APAPP President:
two groups.

Vinny DeRienzo:
absolutely. So for the folks that are looking to get a program started, creating buy-in at the faculty level is really an important piece. We all have our own way, but you try to take advantage of those relationships that you’ve built up over your career. The more buy-in you get, the easier it’s gonna be for you, and then you can figure out all the budget line and the number of stuff afterwards. You know, most of the time, it’s tough to offer stipends up front, but offering, you know, titles, medical director, director of the program, adjunct faculty, those kind of things go a long way for folks, especially when we’re asking them to volunteer their time and trying to emphasize to them, you know, what they can get out of it. So for the example, our asset course there, it’s an opportunity for our surgical critical care physician fellows to further their career from the education standpoint, all those types of things. a lot of butter, it’s a lot of butter,

Corinne Young, APAPP President:
Thank

Vinny DeRienzo:
but it goes a

Corinne Young, APAPP President:
you.

Vinny DeRienzo:
long

Corinne Young, APAPP President:
Bye.

Vinny DeRienzo:
way. And then for the applicants, it’s one thing that I, if I gave a new grad bias throughout most of this talk, I apologize. That is, that’s not the only person that can apply or should apply to a fellowship. And actually this most recent class, we have someone who’s been an NP for six years, in hospital medicine, it was looking to make that transition. I was coming from a community hospital with lower acuity. And you know, looking for just more to do. And this was a way to make that transition. So we have applicants from all over the spectrum in terms of, you know, we have a pretty even split between PAs and NPs. We have new grads, we’ve got folks that have been practicing for a year or two. We have some people that are switching careers 10 years in and looking to make that transition. You know, someone who’s been outpatient their whole life and they want to make their first dayliance into the inpatient up for them. So don’t hesitate. What I will say is for the folks that are applying, you know, do the homework, find the program that’s going to be right for you and really ask those questions. What am I getting out of this? As a learner, how protected is my time? Am I just another number or am I actually going to get something out of this

Corinne Young, APAPP President:
Thank

Vinny DeRienzo:
year?

Corinne Young, APAPP President:
you. Thank you.

Vinny DeRienzo:
And if you guys ask those questions and advocate for yourself, you can only succeed.

Corinne Young, APAPP President:
Wonderful. Well, I thank you so much for joining me today. And for those of you who want to learn more about fellowship programs, because we’ll be talking about pulmonary fellowship programs,

Vinny DeRienzo:
Thank you.

Corinne Young, APAPP President:
critical care fellowship programs at Chess 2023, depending on when you’re listening to this podcast, but it will be recorded on the Chess content as well. We’ll be trying to live stream it on our social media pages also. Vinnie, I really appreciate you joining

Vinny DeRienzo:
Yeah.

Corinne Young, APAPP President:
us and helping advance the profession. Again, I’m very proud

Vinny DeRienzo:
Likewise.

Corinne Young, APAPP President:
to know you. And everyone for listening make sure you subscribe so that you can get notified of future

Vinny DeRienzo:
Thanks,

Corinne Young, APAPP President:
podcasts.

Vinny DeRienzo:
Grin. Appreciate you.

Corinne Young, APAPP President:
Thank you.

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