Advanced Practice Provider (APP) Fellowship Program in Psychiatry/Behavioral Health

The purpose of this APP Fellowship is to provide high caliber, post-graduate education to Nurse Practitioners and Physician’s Assistants interested in enhanced skills in Psychiatry and Behavioral Health.  We hope to increase the number and expertise of providers in the field and help ensure that all patients with psychiatric conditions have access to evidence-based, high quality, patient-centered care.   

This Adult Psychiatric Advanced Practice Provider Fellowship will create an opportunity for both new graduates and experienced Nurse Practitioners and Physician Assistants (collectively referred to as “Advanced Practice Providers” or APPs) to gain specialized knowledge and experience in the care of psychiatric patients.  We seek licensed practitioners with interests in developing or deepening specialty skills in Psychiatry and Behavioral Health, with a focus on adult, outpatient care.  The program provides 12 intensive months of specialty training to prepare recent graduates or established providers for work as Behavioral Health specialists, working as independent members of psychiatric teams across diverse behavioral health settings and/or as confident, collaborative members of integrated behavioral health teams.  We focus on enhancing competence and confidence in managing adult psychiatric outpatients using both pharmacological and psychotherapeutic tools, with an emphasis on creating practitioners who are highly skilled in the use of empirically-based treatments. The transition-to-practice focus prepares the Advanced Practice Provider with specialty skills through hands-on experience with superior patient care within a protected, multi-disciplinary learning environment, growing in knowledge and skill alongside Psychiatric Residents and Fellows and current APP staff.

Goals and Objectives

  • Offer an immersion experience in mental health care provision.
  • Prepare providers in specialty psychiatric and patient management skills.
  • Enhance clinical outcomes for practitioners developing subspecialty skills, by providing the clinical knowledge and expertise needed to practice to the full extent of their license and certification.
  • Promote critical thinking and specialty skills at a level above and beyond that provided by graduate education.
  • Facilitate comfort with a comprehensive, integrated model of mental health care that combines skills in assessment, diagnosis, triage and treatment and that integrates biological and behavioral approaches to treatment in a culturally sensitive approach to psychiatric care.
  • Deliver quality patient care in the context of a dynamic and integrated mental health care environment that employs a collaborative, inter-disciplinary approach.
  • Develop skills to manage an established plan of psychiatric care, assuming leadership as appropriate.
  • Expand the knowledge of evidenced-based practices and skill in delivering them.
  • Build on understanding of the scientific basis of practice and develop the tools needed to stay on the cutting edge of patient care as the science advances, with a commitment to life-long learning and continuous quality improvement.
  • Develop an understanding of psychiatric billing and coding.
  • Provide the depth, breadth, volume and intensity of clinical training needed to prepare Fellows to serve as effective mental health providers in whatever setting in which they might choose to practice.
  • Expand the role of advanced practice nurses and physician assistants as independent practitioners and as members of interdisciplinary psychiatric care teams.
  • Increase the number of APPs ready to serve in mental health clinics and in other practice settings.

The Educational Program

Clinical and didactic instruction is integrated with our MD/DO residency training programs, allowing us to offer APP Fellows a wide range of experiences and in depth exposure to clinical management, overseen by established teaching faculty and staff clinicians, including Nurse Practitioners and Physician Assistants with mental health expertise.  There are opportunities for exposure to outpatients across the lifespan, experiencing the full range of behavioral health problems including mood disorders, anxiety disorders, substance use disorders, psychosis, and somatic symptom disorders. There are also opportunities for some exposure to inpatient psychiatric settings, though the focus is on ambulatory care.  We provide training in psychopharmacology and psychotherapy, and foster skills in multi-modal treatment delivery and appropriate triage within and between modalities. 

The Fellowship has two key components:

Supervised Experience in Psychiatric Specialty Clinics: 
The primary training site will be in the Rachel Upjohn Building, which houses Ambulatory Services for the Department of Psychiatry, including specialty clinics in Depression, Bipolar Disorder, Anxiety, Substance Abuse, Early Psychosis, Perinatal, and Rapid Evaluation.  There are additional opportunities for exposure to Geriatric Psychiatry, a Sleep Disorders Clinic and a growing Collaborative Care Program (embedded Behavioral Heath in Med/Surg Clinics).  Fellows will work as full team members within selected clinics, providing direct patient care under the authority of a Physician Team Leader who is available for consultations, with close supervision by an experienced APP, while also working in close conjunction with other faculty Psychiatrists and Clinical Psychologists, APPs and Therapists, Social Workers, and trainees from all disciplines.  The focus of this experience is on episodic, acute, and sub-chronic care of psychiatric patients, from assessment and triage to treatment planning, multi-modal treatment delivery, intermediate duration management, and disposition to other treatment contexts.  The bulk of our training in psychopharmacology will take place in this closely monitored clinical training experience with supervision provided by specialists in each area.  There may be opportunities for access to other settings, including embedded behavioral health care in other medical clinics and opportunity for limited exposure to inpatient and to Psychiatric emergency settings to enhance understanding of the hospital-ambulatory interface.

Didactic and Patient-Centered Education Sessions:
Topics covered in APP-specific didactics will include detailed review of state-of-the-art psychopharmacology and its empirical foundation (to support lifelong updating); APP essential skills and scope of practice; and psychotherapy.  Fellows will also participate in established psychotherapy mentorships with residents and other trainees.  These accompany clinical rotations in subspecialty clinics and are designed to provide both didactic and patient-based exposure to clinic-relevant therapy skills and to enhance understanding of multi-modal and integrated treatment approaches.  Mentorships cover a broad range of psychotherapies, including cognitive-behavioral therapy (CBT) for both anxiety and depression, Interpersonal Psychotherapy (IPT), Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), Couples and Family Therapy, and Group Psychotherapies.  We believe that some understanding of empirically-proven psychotherapies, and their appropriate applications, is essential for all mental health specialists. Additional training opportunities also include access to the Department of Psychiatry’s weekly Grand Rounds (designed to keep our faculty aware of the cutting edge of evolving science relevant to mental health) and a variety of other seminars that create opportunities to tailor a set of didactics to personal interests and needs.  We also encourage attendance at regional or national meetings, and there are opportunities to explore the rich academic offerings across the University of Michigan campus.

Entry Requirements

We are eager to train both Nurse Practitioners and Physician’s Assistants.  The program is appropriate for (1) New graduate APPs who wish to work in behavioral health and are seeking advanced clinical training and experience; (2) Experienced APPs seeking to change specialties or career paths and enter a mental health practice environment, and (3) New or experienced APPs who wish to take specialty skills back to primary care or integrated specialty care settings, where the majority of psychiatric patients initially present.

We require:

  • Nurse Practitioners
    • Bachelor’s in Nursing from an AACN, CCNE or NLN accredited institution
    • Master’s (MSN, MN, MS in nursing) or Doctor of Nursing Practice degree
    • Current licensure to practice as a Registered Nurse and Nurse Practitioner in the State of Michigan
    • Certification as a Nurse Practitioner recognized by the National Council of State Boards of Nursing (NCSBN).
      • Certification as a Psychiatric NP, Family Practice NP, Adult NP, or Adult-Gerontology Primary Care NP
      • CNSs are not eligible to apply
  • Physician Assistants
    • Satisfactory completion of a Physician Assistant program accredited by Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or one of its predecessor agencies, CAHEA or CAAHEP.
    • Certification by the National Commission on Certification for Physician Assistants (NCCPA).
    • Current license to practice as a Physician Assistant in the State of Michigan.

NOTE: Full credentialing, to include DEA registration and State of Michigan Controlled Substance License will be required by start date.

Application Dates and Procedures

  • Application Opens: March 9, 2020.
  • Application Deadline: May 15, 2020. 
  • Qualified candidates will be reviewed by a selection committee and interviews will be conducted. 
  • Start date: We are targeting October 1, 2020, but have some flexibility. 
  • End date: This is a 12-month training program and does not guarantee employment at the University of Michigan following its completion.
  • We invite qualified (see entry requirements) NPs and PAs to see our job posting on the UM job site
  • You will be asked there to register with us and upload the following application materials.  We ask that you also e-mail them to: sullivje@med.umich.edu.  
    • 1-page cover letter / personal statement describing professional history and interest in the field of psychiatry / behavioral health, including long-term ambitions regarding specialization and anticipated practice setting, and role of fellowship in pursuit of your goals.
    • Resume or Curriculum Vitae, to include all of the following information: Full name and full contact information; birth date and place; citizenship; undergraduate and graduate institutions with location, years, degree, degree years and field of study; employment history with name of all employers, including address, title, start and end dates; post-graduate training experiences.
    • For Nurse Practitioners, please include RN license number and NP Certification with issue and expiration dates.
    • For PAs, please include license number, issue and expiration dates.
    • Your statement and CV will be reviewed quickly and strong candidates will be contacted and asked to have submitted directly to us three letters of recommendation, including one from a clinical preceptor and one from an academic instructor or mentor. Letters should indicate that the applicant is personally known to the letter writer, and should include an assessment of medical knowledge, clinical skills, and academic and/or leadership potential.

For any questions about the job posting and application process, please contact:

Jen Sullivan at sullivje@med.umich.edu

For questions about the educational program and its fit for you, please contact:

James L. Abelson, MD, PhD, at jabelson@med.umich.edu.

Stipend and Benefits

Program Rationale and Training Philosophy

Rationale

Nurse Practitioners and Physician Assistants (APPs) enter practice well prepared by their intensive graduate education and clinical training and are able to provide safe, high-quality care in primary care or acute care settings.  However, APPs also have increasingly important roles in medical subspecialty areas, including in mental health programs, and performance in these specialized areas would be enhanced by additional training in specific specialty skills.  The need for APPs in all areas of Psychiatry is growing rapidly.  We believe this need can best be met with additional formal training to help bridge the transition from graduate school training or primary care contexts, to sharpen and deepen the unique skills needed to function optimally in the complex world of modern mental health.  APPs are needed because demand for behavioral health services is expanding more rapidly than available resources, as stigma is reduced and insurance coverage expanded.  The demand is particularly strong here in Michigan due to a limited number of mental health providers who serve the Medicaid population in our state, and as we at Michigan Medicine are expanding our lives covered locally and across the state.  Mental health providers – especially those prepared to deliver empirically proven, state-of-the-art pharmacological and psychotherapeutic treatments for people with psychiatric disorders – are in particularly short supply.  We need APPs with specialty level skills and we need to provide the training required to optimize those skills, in order to expand service delivery capacity, develop additional models of integrated medical and psychological care, and support the growing movement towards inter-disciplinary and collaborative care models.

Training Philosophy

This training program will be integrally connected to the overall teaching mission of the Department of Psychiatry.  We are committed to interdisciplinary approaches to treatment, collaborative care models, and science-based care.  We do our teaching and supervision and run our clinical operations within these frames.  Quality, committed supervisors, overseeing trainee delivery of direct patient-care, are the foundation of our clinical education enterprise.  We are committed to providing cutting-edge, experiential clinical training, challenging work, and dynamic experiences at the interface of science and practice. Fellows will work closely with faculty, staff, and trainees from a variety of disciplines in order to best facilitate both personal growth and professional development.