Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles

Langston, Joshua P.; Orcutt, Venetia L.; Smith, Angela M.; Schultz, Heather; Hornberger, Brad; Deal, Allison B.; Doran, Todd; McKibben, Maxim J.; Kirby, E. Will; Nielsen, Matthew E.; Gonzalez, Chris M.; Pruthi, Raj S.

doi:10.1016/j.urpr.2016.09.012

Cited by 13 publications

(13 citation statements)

References 13 publications

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“…In another study, Langston and colleagues found that of 296 APPs surveyed (62% NP), 81% were performing procedures independently, with 63% of those procedures being described as complex in nature. 12 Studies that have evaluated the current use of APPs for urological procedural care have suggested that the percentage of clinical procedures performed by APPs without direct supervision (ie billed to insurance using a modifier) continues to increase. A study by Erickson and colleagues found a nearly 24fold increase (from 0.05% to 1.3%) in the percentage of cystoscopy with ureteral stent pulls from 2003 to 2014 performed independently by APPs.…”

Section: Apps Performing Proceduresmentioning

confidence: 99%

“…Importantly, when the AUA directly asked APPs about their independent procedural practices in 2017, bladder instillations (56.3%), intracavernosal injections for erectile dysfunction (55%), urodynamics interpretation (40%), tibial nerve stimulation (39%), and chemotherapy injections (34%) were most commonly cited as procedures that APPs perform (and bill) on their own. 12 By the AUA APP Census data, more than half of the PAs and NPs independently perform intracavernosal injections for erectile dysfunction and bladder instillation and nearly 1 in 5 APPs assist urologists in performing cystoscopy for difficult catheter placement (19.2%) and stent removal (19.2%). 3 No nationally accredited training programs currently exist for APPs to learn procedures such as flexible cystoscopy 14 despite the fact that regular use of this procedure has been utilized in the outpatient setting for nearly 40 years.…”

Section: Apps Performing Proceduresmentioning

confidence: 99%

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Current State of Advanced Practice Providers in Urological Practice

et al. 2022

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Introduction:This document provides an update to the 2015 consensus statement with new content on inpatient utilization, procedural data, and compensation. The full document is available on the American Urological Association (AUA) website (https://www.auanet.org/ guidelines/guidelines/current-state-of-advanced-practice-providers-in-urologic-practice). This document was created by an ad-hoc group of urological providers formed by the AUA board of directors.Methods: A workforce shortage of 65,000 physicians is projected by the year 2025. In 2018, there were 3.89 urologists per capita, which is amongst the most severe specialty shortages. Urology has the second oldest surgical subspecialty workforce with an average age of 52.5 years. According to the 2018 census, 72.5% of urologists used an advanced practice provider (APP) in their practice, and APPs accounted for 41% of a medical doctor/doctor of osteopathy full-time equivalent. The AUA endorses the use of APPs in the care of patients through a formally defined, supervised role with a board certified urologist under the auspices of applicable state law. This physician-led, teambased approach provides the highest quality urological care.Results: Urologists work with APPs frequently, but many may not know the most efficient way to incorporate them into their practice. This document examines APP integration from a regulatory and practice management approach, as well as provides information on inpatient utilization, procedural data, and compensation.Conclusions: This document supports the AUA's policy statement that in a team-based approach with a board certified urologist in a supervisory role, APPs contribute to the care of the patient with genitourinary disease and, therefore, encourages the proper use of APPs.

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Section: Apps Performing Proceduresmentioning

confidence: 99%

Section: Apps Performing Proceduresmentioning

confidence: 99%

Current State of Advanced Practice Providers in Urological Practice

et al. 2022

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“…But the issue remains in defining what the best role is for APPs in a specialized men's health clinic. More and more specialties are using APPs to improve access and offer a method for continuity of care [2,3,[5][6][7][8][9], and this APP role is particularly effective with geriatric patients [10,11]. This may be of particular interest as the US population continues to age, as there is a clear intersection for urology and geriatric care [12].…”

Section: Men's Clinics: Developing a Role For The Appmentioning

confidence: 99%

“…From the perspective of urology, there is some data that can be used to extrapolate a valuable role for APPs in a specialty men's health clinic. Langston et al [2] reported that APPs in urology were predominantly involved in ambulatory clinics and usually worked independently. These authors further reported that survey participants (n = 296) reported most of their time spent in managing general urology concerns and reported various percentages of time-performing procedures that were unique to the care of men.…”

Section: Introductionmentioning

confidence: 99%

The Role for Nurse Practitioners and Physician Assistants in Men’s Health

Quallich

2020

Design and Implementation of the Modern Men’s Health Center

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“…1 More than 75% of urologists also believe that working with APPs helps to reduce patient wait times. 1,2…”

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confidence: 99%

Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study

et al. 2022

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Introduction: Advanced practice providers (APPs), such as nurse practitioners and physician assistants, are a growing part of urology practices. However, the impact of APPs on improving new patient access in urology is unknown. We examined the impact of APPs on new patient wait times in a real-world sample of urology offices.Methods: Research assistants posing as caretakers called urology offices in the Chicago metropolitan area and attempted to schedule a new patient appointment for an elderly grandparent with gross hematuria. Appointments were requested with any available provider: physician or APP. Descriptive measurements of clinic characteristics were reported and differences in appointment wait times were determined using negative binomial regressions.Results: Of the 86 offices with which we scheduled appointments, 55 (64%) employed at least 1 APP but only 18 (21%) allowed for new patient appointments with APPs. When requested for the earliest appointment regardless of provider type, offices with APPs could offer shorter wait times compared to physician-only offices (10 vs 18 days; p¼0.09). Initial appointments with an APP were available with a significantly shorter wait than those with a physician (5 days vs 15 days; p¼0.04).Conclusions: Urology offices are commonly employing APPs but giving them a limited role in new patient visits. This suggests that offices with APPs may have an unrealized opportunity to improve new patient access. Further work is needed to better elucidate the role of APPs in these offices and how they might best be deployed.

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Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles

Cited by 13 publications

References 13 publications

Current State of Advanced Practice Providers in Urological Practice

Current State of Advanced Practice Providers in Urological Practice

The Role for Nurse Practitioners and Physician Assistants in Men’s Health

Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study

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