Dr. Rosevear is a urologist in community practice in Colorado Springs, CO. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, UBM Medica. Please let your voice be heard by joining the conversation in the comments section of each post.
For a long time, my practice bucked one of the most common trends in urology. Specifically, we did not employ advanced practice providers (APPs). The only explanation given was that we had a bad experience with one many years ago, and that was that. Over that same period, though, we hired and fired numerous staff for a multitude of reasons, so that explanation always seemed a bit shallow.
I always figured that we would change one day, but being too busy building my own practice and trying to keep up with my girls at home, I didn’t worry about it and just thought, as Urology Times reported in 2010, that it was only a “a matter of time” before we hire APPs.
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It turns out that time is now. With the retirement of our senior partner and the rise in the number of patients we are seeing, we recently concluded that our patient wait times were too long and decided to bring on two APPs. So far, they are working out great.
As I researched how to use an APP, I learned that our urology group is not the only one to decide that now is the time to make this change. According to the AUA’s 2015 Census, 43% of urologists work with a physician assistant (PA) and 45% work with a nurse practitioner (NP). Those percentages have consistently increased since the AUA started asking about the use of APPs.
In terms of PAs, the current percentage translates to almost 1,200 PAs working with urologists across the country, according to the 2015 Statistical Profile on Certified Physician Assistants by Specialty. Not surprising to me, as it matches my own very limited experience, urology PAs tend to be young (median age, 38) and female (2:1 ratio). Most work in an office-based setting (53%) and see a median of 60 patients a week. They are also well compensated, making $100,000 a year on average. They even have their own society (Urological Association of Physician Assistants).
A recent article published in Urology Practice (which while still a bit too academic for my taste is quickly becoming a very useful journal for practicing urologists) further demonstrates the extent to which APPs are being used in the real world. Looking at just Medicare’s data regarding urology, the study noted that between 2003 and 2014, the number of cystoscopies done by APPs increased from 328 to 2,284 (Urol Pract 2017; 4:169–75). While that is certainly a large percentage increase, it still represents only 1.5% of all cystoscopies done nationwide, and I for one am not ready to have an APP do a cystoscopy yet. Why? Surveillance cystoscopy is my physical exam, and I’m not ready to give that up. On the other hand, a cystoscopy and stent removal seems like a procedure that an APP would excel at.
I realize the reasons for my practice choosing to include APPs in our practice are not unique. We all know that we are a “wise,” (ie, old) specialty (the most recent, 2017 AUA Census showed that 29% of all practicing urologists are 65 or older). Further, as the population in general continues to age, the need for our services will only increase. Given those trends, it is only logical to outsource some of our work to well-trained and well-supervised APPs—within certain limitations. It is the pushing of those boundaries that bothers me.
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