AdventHealth Orlando APP Palliative Medicine "Fellowship"

[hihimedmed]

To those applying to AdventHealth Orlando this year or HPM fellowship in general, I just want you all to be aware of a new APP "Fellowship" in HPM, with this program starting in 2023.

Looks like APP's will be trained alongside you, except their salaries will be $70,000 with full benefits AND a retirement plan, and your salary as a PGY4 will be about $63,000. I also do not see anything about additional retirement plans for physician fellows.

Seems fair.

All in the name of 'Interdisciplinary Training".

I understand that working with midlevels is a must in HPM, but this kind of practice parity is kind of a slap in the face to how much more training we go through to reach the point of real fellowship, just to get paid less in training.

I see similar programs popping up at places like Emory University, which I believe is starting this year.

Kind of bummed since I was excited about applying to AdventHealth next year.

Anyways, good luck applying this year!

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[Frazier]

It is more common than one would think. I think Harvard started it with the program at MGH... then others have joined in including Mayo, Stanford, MSK, AdventHealth (apparently), etc.

A secret is that often these health systems try to retain their freshly HPM-trained NP/PA... so they get a year of overseeing them, having them see patients, and paid only a percentage of what they would otherwise be making if they just applied for a job with the team. Financially it makes great sense for the program/health system... not saying that makes a good reason for this development.

While I disagree with them being paid more than physicians during that year, having an NP/PA who is dedicated to the field of HPM (enough to do this extra training) is ultimately a good thing for patients/families -- and you as likely their supervising physician.

You are going to have NP/PA's on your team in this field 9 times out of 10. Would you rather your NP have just their online degree [hyperbole for effect] and show up to work first day on your team -- or would you rather have an NP that did one of these dedicated training years show up to be on your team so you are rather confident they will know what they are doing and what their personal limitations are?

If the concern is one of NP/PA developing arrogance ("NP/PA is not going to respect me as a physician and think they are Osler reincarnated because they did a "fellowship"!) I am happy to report that you will likely be mistaken. Generally the people (MD/DO/NP/PA/MSW/etc) in this field don't have giant egos, the urge to one-up their team members, or be a cowboy and never ask for help. It isnt going to be the case that NP/PA go out en masse and open up a private practices, make millions, and you lose your job... that's not how this specialty works. You are a physician's physician more than not -- and referrals to be achieve financial viability won't materialize if the clinician (regardless of degree) is crappy/incompetent.

It isn't going to be a problem besides perhaps the theoretical ramification it might have on future physician salary movement -- but from patient care standpoint, it isn't a de facto bad thing... everyone works in the team.

I said similar in another thread: try to find the best job you can to make you happy in a geographic region that you really truly enjoy. Do it ASAP. The mobility and options for new physicians entering the field are going to tighten significantly within this decade IMO.