Objective:

To describe the development and institutional impact of a neurology Advanced Practice Provider (APP) fellowship program, as experienced by the lead APP, the first fellow, and the most recent graduate.

Background:

New graduate APPs often face a turbulent transition into clinical practice, marked by role ambiguity, limited structural support, and high turnover, nearly twice of physicians. A national shortage of neurologists' further strains access to care. In response, the American Academy of Neurology has called for creative care models that integrate APPs into specialty teams. Saint Luke’s Health System developed a structured fellowship program aligned with national recommendations to support clinical readiness, professional identity formation, and long-term retention.

Design/Methods:

Initiated in 2019, the 6-month fellowship hired APPs into budgeted roles with asynchronous enrollment by departmental needs. It expanded to include experienced hybrid fellows. Core components included APP co-director leadership, milestone-based salary adjustments, protected education time for 1-year, weekly mentorship, and optional stress assessments. Fellows accessed resident didactics, AAN’s Continuum journal review, peer-led teaching, and multidisciplinary sessions. Additional foundational activities included shadowing APP/physician experts, monthly meetings on ethics, legal training, professionalism, career development, and a flexible peer support comprehensive program tailored to clinical focus.

Results:

Twenty-one fellows across seven subspecialties graduated with 100% two-year and 90% seven-year retention rate. APPs evolved into educators and mentors. Physician engagement increased, cultivating a collaborative teaching culture. APP Journal club participation fostered leadership and collaboration. Fellows reported increased confidence in safe, effective practice. Unanticipated outcomes included APP-led research, system-wide committee work, statewide service, and expanded leadership roles.

Conclusions: