Disclaimer
This podcast is for US healthcare professionals only and is intended to be listened to as it was originally produced by Pfizer. This podcast has been funded by Pfizer, and the participants have been compensated by Pfizer for their time. The healthcare professionals featured are sharing their own opinions based on their clinical experiences. This promotional activity is not certified for continuing medical education.   

Narrator
Welcome to the latest episode in our podcast series, IBD TalkTract, sponsored by Pfizer, designed to engage healthcare leaders in conversations about inflammatory bowel disease (IBD) care management opportunities. Our podcasts feature IBD specialists involved in care innovation at their institutions.    

In this episode, we’re discussing embedding advanced practice providers, or APPs, into IBD care teams to support patients through their care journey.

The supply of APPs, such as physician associates and nurse practitioners, is growing rapidly, along with an improved understanding of their value in delivering care.¹ According to the Consortium for Advanced Practice Providers, 553,000 APPs are practicing in the US,² and the Crohn’s & Colitis Foundation states that APPs play a critical role in caring for patients with IBD, from diagnosis to long-term disease management.³

Today, we’ll discuss best practices for integrating APPs into IBD care teams by hearing about the experiences of our guest, Marita Kametas. Marita is an Advanced Practice Nurse with extensive experience in IBD care. She’s the Director of the IBD Advanced Practice Program and Director of the IBD Advanced Practice Provider Fellowship Program for the University of Chicago IBD Center and the Director of ChatAPP: IBD Case Series by APPs for APPs.   

Welcome to our podcast, Marita.    

Marita Kametas 
Thank you for having me.   

Narrator
Marita, let’s start with how you became an APP specializing in IBD care.     

Marita Kametas 
I started my career as a nurse in acute care, caring for patients with liver transplants, and many of those patients suffer from an inflammatory disease called primary sclerosing cholangitis. And many of those patients also had inflammatory bowel disease, so it seemed like a natural transition when I went over to the University of Chicago. Once I completed my first master’s degree, I transitioned over to a nurse practitioner role, caring for patients with IBD, as well as becoming an ostomy specialist, which I did for several years before growing into my current position as the Advanced Practice Program Director for our IBD Center, where I’m responsible for several educational initiatives both inside and outside my organization.   

Narrator
Wow, that is quite a journey! And it really speaks to the unique skills and experiences that can strengthen IBD care for patients. Building on that thought, can you talk about the different roles APPs play on the IBD care team and how they work alongside gastroenterologists, pharmacists, and other specialists?   

Marita Kametas 
When I think about the role of APPs in IBD, we are integral team members.   

We coordinate closely with our pharmacists on prior authorizations and patient education. We collaborate with gastroenterologists on procedure-related needs. We work with our nurses and staff that support patients receiving care, stepping in to triage as needed. And we consult registered dieticians, gastroenterology psychologists, and other specialists to support the psychosocial and nutritional needs of our patients.   

And like any key team member, we have to understand the big picture goals for a patient. We need to make sure everything aligns not only with their treatment goals but also with current guidelines.   

Narrator
That kind of coordination is so important to patient care. You mentioned education as an area of responsibility in your role. Can you expand on who’s involved and what the goals are?   

Marita Kametas 
Yes, educational initiatives are central to what we do as APPs at our IBD center. We truly feel it’s our mandate to improve outcomes for patients across the country.   

That starts by growing the collective knowledge and skill sets of APPs, not only at the University of Chicago but nationally, and even internationally.    

One of the ways we do that is through our fellowship program. Through this first-of-its-kind fellowship, we’re able to provide APPs with educational opportunities that can enhance patient care and outcomes.   

I’ve also helped spearhead an effort in collaboration with a colleague at the University of California in San Diego, called ChatAPP. This program connects APPs across the world and gives them a constructive and collaborative place to network, ask questions, share knowledge, and learn from each other.   

Through these and other educational initiatives, it’s really about empowering and enhancing the abilities of the team here. And by democratizing access to education, we can improve the lives of people living with IBD across the country and across the world.   

Narrator
Marita, that is truly inspiring and quite an accomplishment. It’s clear that APPs can play a pivotal role in IBD care. How did you initially make the case to your institution’s leadership for a GI APP program?   

Marita Kametas 
Yeah, I think the decision to establish an APP program in GI was based on something we’re seeing across all care settings, both academic and community and private care groups. Physicians are spending more time in the endoscopy suite to meet the growing demand of increased patient volume. In that climate, APPs are the ones who can step in and help manage patients clinically. When leadership looked at what was going on and what was needed to accommodate this new normal, an APP program just made sense.    

Narrator
Yes, there seem to be a number of factors that are changing the complexion of IBD care, including roles within the care team. But investments like this always come with economic considerations. How did you build a structured APP program that addresses those expectations?   

Marita Kametas 
Yes, gaining appropriate buy-in can be challenging depending on leadership structures. First and foremost, it’s crucial to demonstrate the economic and clinical value that APPs bring, not only through patient visits but through the care we help coordinate.    

APP involvement contributes significantly to the broader continuum of care, including imaging, endoscopic procedures, labs and testing, referrals to GI psychology, registered dieticians, and specialty pharmacy. These are essential aspects of patient management, and we are often the ones who help move patients seamlessly through each step of care.   

Second, it’s important to clearly outline expectations for APPs and their role within the team so leadership understands how they fit in and how they contribute to the whole team. In a structured APP program, you are working in partnership with different team members and specialists who each bring value. That collaboration and those interdependencies ensure we are all aligned around meeting patient needs and institutional goals.   

And finally, it’s important to show how an APP program can support long-term growth as the needs of patients and the community evolve.   

Narrator
What specific steps were taken to create your GI APP services program?   

Marita Kametas 
The first step in creating our GI APP services program was to identify the need. As an academic tertiary care center, we serve a high volume of patients with IBD from across the region and beyond, and physicians alone couldn’t meet that demand.   

We also recognized the importance of providing holistic care, treating the whole person, not just the disease, to help meet their broader needs.   

From there, we standardized a collaborative care model, pairing APPs with physicians, which we then expanded across multiple sites so patients could access comprehensive, high-quality care closer to home.    

Narrator
On that note, as director of your APP program, what are some best practices that you can share with our listeners to help them be successful should they undertake a similar program?   

Marita Kametas 
For our IBD APP team, everything comes down to 1 word—investment. Investment in education, professional development, and burnout prevention. When APPs feel supported and fulfilled, retention and patient care improve.   

For example, in addition to the educational initiatives that connect and serve the broader IBD community, we also offer more case-based learning opportunities designed to deepen the skills within our own team here. Some of the ways we do this are through programs like our IBD APP journal club, (CME)-accredited GI APP grand rounds, monthly meetings, and so forth. And we invest in the next generation through our fellowship programs, helping prepare new APPs to quickly become providers who confidently deliver high-quality care.   

Narrator 
Let’s talk about onboarding APPs into the GI department program. What challenges have you encountered, and what solutions have you implemented to help prepare APPs to take on their new role?   

Marita Kametas 
So, there was a time when retention of APPs was a real challenge for us. And credit to our leadership, they recognized the need to have APPs join physicians at the table where they could have their voices heard. This helped leadership better understand the challenges at hand and what support was needed.   

One of the biggest issues is that APPs get credentialed and immediately begin to see patients with little time left to consult with their collaborative provider. That’s a recipe for burnout and employee turnover.    

Once we understood this, we developed a multipronged approach with a focus on education, recognition, and professional growth. In practice, this means ensuring APPs have access to meaningful learning opportunities and creating a formalized structure that acknowledges their contributions and achievements.      

In terms of onboarding, we’ve created a very robust process that pairs new hires with a primary preceptor, providing them opportunities to shadow and learn through direct mentorship. Over a 12- to 16-week period, we gradually increase their autonomy, so they’re not immediately thrown into the deep end after credentialing, which helps prevent burnout and builds confidence.    

Finally, we stay flexible, tailoring onboarding to each APP’s background. This process has strengthened retention and improved both provider satisfaction and patient care.   

Narrator 
Incredible. How do you think this program could be implemented in other departments at your institution or scaled to other organizations?   

Marita Kametas 
I really believe this model can be scaled to any setting. The first thing a leader should do is take a moment to step back, listen, and understand what’s truly happening. You need to know the current state before identifying the opportunities for improvement.    

From there, it’s important to build an intentional structure that supports not only the APPs but also the health and well-being of the preceptors who train them. The preceptors’ knowledge is invaluable, and when managing constant turnover and onboarding, it can quickly lead to burnout.   

Next, be realistic about the time and resources you have. People are a finite resource, and as leaders, we have to be good stewards of their time and energy. Even when there is enthusiasm to participate, you still need systems in place to foster an environment where the work is equally distributed and everyone maintains a healthy work-life balance.   

And finally, set measurable and concrete goals and revisit them regularly to track growth and outcomes. That accountability keeps the program on course and helps demonstrate the impact over time.   

Narrator 
We’ve covered a lot of ground around building, sustaining, and scaling an APP program in IBD. Let’s talk about results! Can you share the successes of your program?   

Marita Kametas 
Yes, I’m really excited to share the successes of our program. The approaches I mentioned earlier—the focus on recognition, education, and making sure our team feels genuinely supported and valued—has led to a dramatic improvement in retention. In our first year, we had 100% retention within our program. Some APPs have left since, but our exit surveys show this was due to outside life factors, not dissatisfaction with the role or the work environment. As a leader, knowing people want to stay and grow within your program is a huge win.   

Narrator 
100% retention at one year is truly impressive! And it must be rewarding to know that when people do move on, they take that expertise with them and help elevate patient care wherever they go. Considering everything we discussed today, do you have any parting pearls of wisdom for managing adult patients with IBD?   

Marita Kametas 
Yes, so my number 1 pearl of wisdom is to really listen to your team and understand what they need. It’s important to remember that we’re all working at the same level, aligned around the same mission to deliver the best possible care to all of our IBD patients.   

Narrator 
Thank you so much Marita. This has been a truly insightful and inspiring discussion. I know this will provide our listeners with some valuable guidance on integrating APPs into the gastroenterology care team.   

If you enjoyed this episode, be sure to visit our IBD TalkTract homepage to explore more episodes! And make sure to check out the next episode featuring Marita’s colleague, Dr David Choi, as he talks about the integration of clinical pharmacists into IBD care at the University of Chicago. Thank you all for listening to this important topic today. Together, we can help improve care for patients with IBD. 

References: 

1. Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2021 to 2036. March 2024. Accessed May 1, 2025. https://www.aamc.org/media/75236/download 2. Mission Consortium for Advanced Practice Providers. July 10, 2024. Accessed May 1, 2025. https://www.apppostgradtraining.com/about-us/mission/#:~:text=There%20are%20currently%20553%2C000%20APPs,PAs)%20practicing%20in%20the%20US 3. Clinician resources: for nurses & advanced practice providers. Crohn’s & Colitis Foundation. Accessed May 1, 2025. https://www.crohnscolitisfoundation.org/science-and-professionals/education-resources/nurses-and-advanced-practice-providers

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