In the U.S. there are just three formal neurology fellowship programs for Advanced Practice Providers (APPs). “That’s simply not enough,” says Calli Cook, DNP, FNP-C, considering how many are entering the field. “So, the vast majority of the time the training falls on the practice hiring the APP.” That can be a pretty big hump to get over, considering the benefit they can bring to the practice of neurology.

Adding an APP—the collective term used most commonly for nurse practitioners (NP) and physicians assistants (PA)—is increasingly seen as a solution to many of the problems plaguing neurology practice today. “Wait time for new patient referrals decreased from four months to two to three weeks,” said Dr. James C. Stevens, MD, of Fort Wayne Neurological Center to an audience at the recent annual meeting of the American Academy of Neurology (AAN). He also said APPs have been a consistent profit center for his practice and their use has resulted in increased satisfaction among patients as well as physicians.

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To get this kind of value from an APP, you have to use them as revenue producers, says Cook, chair of the Consortium of Neurology Advanced Practice Providers for the AAN. “You should have someone who, the majority of their time, is spent seeing patients. You don’t want this person filling out FMLA paperwork. You don’t want them returning phone calls, calling in prescriptions. You really want them seeing patients, billing for services, completing procedures.”

That brings us back to that big hump we mentioned earlier: the lack of APP training in neurology.

In order for APPs to perform the clinical services that will benefit a neurology practice, they need the proper training. “The focus in APP training programs is in primary, not specialty care,” said Stevens. “During their educational programs, there is limited exposure or clinical opportunities in neurology.” The burden of training, for the majority of APPs in neurology practice, falls on the practice itself.

Stevens and Cook (who also spoke at the annual AAN meeting this year and last) are both trying to change that through their work with the Academy. “We knew that we needed to get all the APP education materials that the AAN offers in a place where APPs can access it,” says Cook. “But we also realized that we needed to have a companion toolkit [for neurologists]. So when you go to the APP section site, there is what physicians need to know, and then what APPs need to know.”

AAN Resources for APPs

  • Introduction to Clinical Neurology (Coursera)
  • Four-part series of neuroanatomy lectures
  • Continuum® Audio CME courses
  • Consortium of Neurology Advanced Practice Providers Community online (Synapse)

AAN Resources for Neurologists

  • Article: APPS—What Physicians Need to Know
  • Recorded webinars
  • Tip Sheets: Do’s & Don’ts, FAQs, and Quick Reference Guide
  • Links to multiple journal articles
  • Consortium of Neurology Advanced Practice Providers Community online (Synapse)

“​We really want to continue to create this high level education for neurology advanced practice providers,” says Cook. “Our second aim is to retain neurology advanced practice providers. We want neurology to be their career, and we feel that if we can meet this educational need for many neurology advanced practice providers, we’re hitting the root of the problem.”