Onboarding and retaining advanced practice providers in pain management: a call for practice management recommendations

Pain management is a complex field that offers a wide breadth of services and often features multidisciplinary teams. In the United States, advanced practice providers (APPs), such as certified nurse anesthetists, clinical nurse specialists, nurse practitioners, and physician assistants, are master’s- or doctoral-prepared clinicians who diagnose and treat conditions, order and interpret diagnostic studies, perform procedures, and prescribe medications. When properly trained and integrated as pain management team members, APPs increase the clinical services available to patients, promote continuity of care, distribute the workload, and allow specialty-trained physicians to focus on areas of the practice that maximize their medical training. Successful hiring and retention of APPs requires thoughtful consideration of their onboarding, training, and professional development needs. Failure to meet these needs could impair the integration and retention of APPs in a pain management practice. No APP training program produces pain specialists immediately upon graduation. Professional organizations and academic centers offer designations or pain certificates that typically require 2000 hours of pain management experience or incur additional costs—often graduate-level tuition. These barriers make it improbable that such programs can effectively address the onboarding needs of new APPs in pain management. There is a dearth of literature addressing APP onboarding and retention in pain medicine, and this important practice management issue deserves attention. In this article, we describe challenges associated with inadequate APP onboarding, potential solutions, and future research opportunities.