Current State of Advanced Practice Providers in Urological Practice

Abstract

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.

Increasing Role of the Advanced Practice Provider in Men’s Health Clinics: An Analysis of Medicare and Commercial Claims in the United States

“…Previous studies have only studied the growth of specific procedures performed by APPs. 5,11,12 In addition, most studies have not examined recent growth trends past 2017. 7 We examine growth of APP roles in various men's health conditions through 2021, allowing a unique perspective on the care provided to a subset of the urological patient population.…”

“…This physician-led team approach allows APPs to achieve "delegated autonomy" that evolves as the partnership matures. 12 Further, the role of APPs within men's health will become clearer in coming years as more postgraduate fellowships in men's health and sexual medicine become available. However, with the rise of telemedicine and direct-to-consumer men's clinics providing testosterone injections and ED therapy, there is a concern for inadequate physician oversight of APPs.…”

Editorial Commentary

“…The American Urological Association’s Ad Hoc Workgroup on APPs in Urology recently published an updated white paper which addressed APP inpatient utilization, performance of procedures and compensation. 1 This analysis can be used with the authors’ present and future data to create incentives for APPs to assist, as part of urologist-led teams, in covering underserved areas in a way that is safe, makes economic sense and is professionally fulfilling.…”