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The Nurse Becoming Podcast 

#072 NP Fellowships: Pros and Cons

Thinking about joining an NP fellowship or residency program?

Recently many nurse practitioner residency programs have popped up around the US. 

And if you’re an NP student or new NP, you might be wondering – “Is this a good option for me?” 

Residency programs serve to give you an immersive experience of being a fully licensed provider under faculty supervision.

Which – sounds great right? Truly, they can be, BUT — there are definite pros and cons to consider…

If you are considering applying for a fellowship, tune in now to get a full breakdown of: 

    • The main upsides & downsides to saying “Yes” to a residency program
    • My personal experience planning and leading a program
    • Whether completion of a program enhances your résumé or not
    • Where to find fellowship programs  🔍

 

LINKS & RESOURCES MENTIONED TODAY: 

  • Find the fellowship directory through the National Nurse Practitioner Fellowship and Residency Consortium at nppostgradtraining.com.  
  • If you are an NP or NP student looking for your first or next job, then you have to check out my workshop, No More Job Boards. Click here to learn more and enroll for just $37!

Listen to more episodes here!

 

What are NP Fellowship Programs & Why Do They Exist?

One of the main differences between NP programs and traditional medical school education is that nurse practitioners do not have any sort of required residency period where they are set up in a highly supervised practice setting. 

As NPs, we have clinical hours, but residency programs serve to provide an immersion experience- one where you are a fully licensed provider under the supervision of faculty as a way to further develop your learning and your skills. This framework has been commonplace for physician education forever.

Since the inception of the NP profession, the aim of education has been to prepare you to practice to the extent of your scope upon graduation and licensure. No transition time required. 

And there are many NPs who still feel strongly that you should be 100% prepared for anything and everything from day 1 of hire…. My, what a wonderful world that would be, but frankly, it’s simply not the reality.

Several years ago, nurse practitioner residency and fellowship programs started gaining in popularity around the country. These programs initially started in community health outpatient settings and quickly branched out into specialty and hospital settings. 

There has not been much standardization of these programs. The programs were essentially created by employers as an ‘enhanced orientation’ program, often lasting about a year, in order to help fully immerse and support new providers in their new roles.

 

My Experience Co-founding & Co-directing a Fellowship Program

When I graduated from NP school in 2011, residency programs weren’t really around… However, in 2015 I co-founded and co-directed a fellowship program at my workplace!

It was a 1 year emergency medicine fellowship for NPs and PAs. I was with that program from 2 cohorts of fellows. We structured the curriculum such that they had a reduced clinical hour load, had 1 day of didactic learning with the physician residency, and another half day of debrief and conference with our small group. We carefully planned out rotations that we were able to coordinate with other departments in the hospital, which was a level 1 academic medical center. The NPs would go off-service (meaning, not in the Emergency Department) for a few weeks at a time for a rotation, and then we would bring them back on-service to give them consistency to the ED environment. 

Their salaries were reduced at about 60% of the traditional full time starting salary, and after the 1 year ended, if they successfully completed the program they were granted a full time position in our department. We fortunately saw great success with the program, which our department specifically created in response to high turnover among new grads in the ED. This program improved provider confidence and retention, as well as helped with staffing.

 

The Pros and Cons of NP Fellowship Programs

If you are considering applying for a fellowship program, here are 3 big Pros:

  1. The program will give you more focused training and immersion in your area of interest.
    It’s possible that you had a more broad training while in school, and these programs are likely one of the few ways to get proper training in focused, sub specialty areas.
  2. These programs recognize the difficulty in transition to practice and have support systems built in for your success.
    Imposter syndrome and lack of confidence are huge issues among new NPs, and these programs have built-in mentorship and community and debriefing – 3 pillars that are key to moving past imposter syndrome into competence and confidence!
    and
  3. They look great on your résumé for future career growth.
    Completion of a program can be very prestigious and catapult you on your preferred trajectory.

I’d like to also present some Cons – Here are what I see as the top 3:

  1. The pay is low.
    Many of these programs have salaries similar to physician salaries, which can be 50-75% of what you could otherwise expect as a new grad NP. Why is this? When crafting a budget for these positions, there are a lot of costs and lost revenue due to the reduced clinical hours, compensation of preceptors and faculty, and expenses of other educational and enrichment activities. It already takes new NPs a while to be productive to the point of profitability for a practice, and these programs have increased expenses and fewer direct patient care hours.
  2. Regulation/accreditation is not streamlined yet.
    There have been a few organizations, including CCNE – the Commission On Collegiate on Nursing Education, as well as the National Nurse Practitioner Fellowship and Residency Consortium – that have come up with their own standards and accreditation processes, but unfortunately this is still a bit fragmented.
  3. These programs are competitive and there aren’t enough spots to fit the demand of people who want spots.
    The pros that we listed are pretty awesome, and not surprisingly, there are a lot of folks who want this type of training. Unfortunately, there just aren’t enough programs in existence at this point, which make the ones that exist pretty competitive.


The Top Fellowship Question I Received on Instagram

Q: “Where do I find fellowship programs?”

A: Based on my research for this episode, the best directory I’ve found is through the National Nurse Practitioner Fellowship and Residency Consortium, which you can find at nppostgradtraining.com.
While it may not be completely up to date, it’s a good place to start. You can also take to google, especially if you’re looking for a specific specialty or specific geographic area.


Final Thoughts…

What do you think of fellowship programs? Have you gone through one? Do you think they should be standard for all NPs? Do you think they are the most terrible thing to be created? I’d love to help kick off this conversation. Tag me on Instagram and let’s chat!