LAUSR

To The Editor, We write to thank the authors of the recently published editorial “A proposal for the addressing the needs of the pediatric pulmonary work force” for including Advanced Practice Providers (APPs) in their proposed initiates. As APPs who have worked in pediatric pulmonary medicine for more than 16 years combined, we can attest to the contribution of our roles to our division, our institution, and our patients. As the number of pulmonologists in our division have waxed and waned over the years, we have been able to help support the clinical functions and meet the needs of the patients. During the pandemic we have worked along our pulmonologist colleges to adapt to the change in the healthcare landscape and adopt telehealth, pilot novel solutions to clinical problems, and support each other through difficult times. As APPs who received their pulmonary training on the job in the absence of a formal training program, the concept of the Pediatric pulmonary certification for APPs is exciting. While there is little information on APPs in pediatric pulmonary, a survey of APPS in U.S. CF programs mirrors our experience. The idea of learning alongside pulmonary MD fellows sets the stage for multidisciplinary care and collaboration. In our experience there is a variety of knowledge and understanding of the APP role amongst pediatric pulmonologists. Some are open and welcoming collaboration while others less so. In our pulmonary and sleep medicine division, APPs function in many roles including inpatient and outpatient care of pediatric pulmonary patients, participation in clinical research, quality improvement, patient care management/care coordination as well as leadership functions. We add to the teaching mission at our academic institution by providing clinical education for medical students/residents in both the inpatient and outpatient settings, presenting at pulmonary grand rounds and providing diagnosis specific education as needed. There is variation in how academic medical center's utilize APPs. Depending on the state legislation surrounding various APPs practice, individual provider's knowledge and experience, as well as institutional polices, routine care may be independent or in collaboration with an MD. We function independently in outpatient clinic in accordance with our state laws and institutional policies. One element of pediatric pulmonary practice and academic medicine that we would like to see changed is increased acknowledgement of the contribution of the APPs to their divisions, departments, and institutions. Moote, Kresk, Kleinepll and Todd found that 69% of the academic medical centers that responded to their survey did not have a means for documenting the financial impact of APPs to their institution. We would suggest as APP utilization increases within pediatric pulmonology and the academic medical center in which much pediatric pulmonary care is delivered, that there be consideration for how to measure APP value. Otherwise, it may be difficult to maintain such positions. Brown et al noted that this was an issue in their surveys of US CF programs and the pandemic has likely increased the pressure for many institutions.