Adele M. Caruso, DNP, CRNP, FAANP

The urology community is coming together for the 2022 American Urological Association (AUA) annual meeting and looking forward to the swarm of activity, scientific findings, and innovation. Although, as a community, we became quite adept at exchanging information virtually, there is no substitute for face-to-face communication, intergenerational interactions, and chance encounters with colleagues that occur at an in-person meeting.

Urology community back together in person

The urology community is looking forward to reconnecting. Urologists and advanced practice providers (APPs), colleagues, and friends, AUA committees, and the various professional societies reconvene for the big event. The human factor, personal contact, and emotions are irreplaceable and impossible to replicate with a virtual meeting. The 2022 AUA annual meeting will be the first in-person meeting for some. Many who have previously met online will be meeting face-to-face, and the anticipation is palpable.

In-person meetings are a primary source of member engagement and can maximize the social experience as well. Social events should incorporate onsite networking as this remains a highly valuable experience to build both personal and scientific relationships.

 Many of these social events are AUA staples and a “must do” for newcomers.

Professional benefits of in-person meetings extend the opportunity to sharpen public speaking skills beyond the 2-dimensional computer screen. This allows interaction with an audience, while defending one’s research and incorporating feedback.Momentous exposure to “urology legends” has a profound effect that spans beyond the meeting, and oftentimes influences a career for a lifetime.

In the face of the pandemic, virtual-only platforms were a lifeline to continue with scientific exchange and to remain connected. As we became more proficient with the nuances of conducting the virtual platform and the process and technology of those virtual platforms improved, other benefits became apparent. One of the benefits of attending virtually was and remains the reduced time to participate and the elimination of travel costs and accommodation costs. The “economy of time” is highly valued when considering a virtual meeting.

 A strength of virtual meetings during the pandemic was the ability to include experts and guests from a distance without significant costs in time, money, and travel.

On a lighter note, our colleagues in neurology designed a calculator expressly designed to decide whether to participate in an online meeting called the Should I Zoom Index (ShIZ Index). Their formula calculation incudes 

ome distraction factor. The interpretation ShiZ Index 

1; do not participate, and ShiZ Index between 1.0 and 3.0 translates to: keep the browser open and make adjustments to your retirement portfolio or follow your Twitter feed.

Finally, there is the matter of participation to consider. In a recent Twitter poll by 

 (@EUplatinum), “As we round out 2020 and the ongoing pandemic: Are you more or less likely to submit an abstract to a conference if the meeting is going to be virtual?” the majority of respondents 54%, indicated that they would be less likely to submit to a virtual conference. If urologists and APPs are less inclined to submit research abstracts to virtual-only conferences, this potentially translates into lost opportunities from the perspectives of both research dissemination and in-person fostering of research and mentoring collaborations.

Hybrid meetings that combine the in-person format and streaming of remote presenters or streaming to a remote audience can be a challenge and are generally held at a higher cost. In hybrid meetings, presenters can speak in a face-to-face format, but also provide a virtual platform for a simultaneous interaction for those who are unable to physically attend.

 Hosting a hybrid meeting requires good-quality technical equipment, especially camera and microphones. Hybrid meetings have advantages of reaching a larger audience and can also offer more choice and personalization, with recording of live content available for viewing at a later time.

Hameed et al conducted a survey in 2020 to understand the preference of “hybrid” urological meetings compared with face-to-face-meetings and virtual meetings during and after the COVID-19 pandemic. Five hundred twenty-six providers were surveyed on factors that may influence their preferences on a 5-point Likert scale for meeting types. They concluded that although there will be a place for face-to-face meetings, the COVID-19 situation has led to a preference toward hybrid meetings and the plausibility that most urological associations may trend towards a hybrid meeting model.

The 2022 AUA annual meeting is an in-person meeting and is also inclusive with a fully virtual option for attendees who are unable to be there in person. As we approach our upcoming meeting, it’s worthwhile to take advantage of all of the aspects of a classical meeting while realizing that the advanced technology and our recent virtual experiences will allow us to optimize our interactions as we go forward.

I say, let’s engage in another annual meeting by sharing in the latest research and innovations. Let’s embrace the opportunity to connect with our urology, APP, research and industry partners. I am personally looking forward to interacting with my urologist and APP colleagues in the society meetings, plenary sessions and course offerings, and special AUA events. Let’s be reunited and reignited in New Orleans!

As always, please feel free to provide your perspective by emailing me at 

1. Porpiglia F, Checcucci E, Autorino R, et al. Traditional and virtual congress meetings during the COVID-19 pandemic and the post-COVID-19 Era: Is it time to change the paradigm? 

2020;78(3):301-303. doi:10.1016/j.eururo.2020.04.018

2. Ellis R, Goodacre T, Mortensen N, et al. Application of human factors at hybrid meetings: facilitating productivity and inclusivity. 

2022;S0266-4356(21)00489-7. doi:10.1016/j.bjoms.2021.12.055

3. Rutkove SB, Shefner JM, Bowser R, et al. To Zoom or not to Zoom: The should I travel index revisited during the coronavirus disease pandemic. 

2021;89(6):1057-1058. doi:10.1002/ana.26038

4. Woodruff P, Wallis CJD, Albers P, Klaassen Z. Virtual conferences and the COVID-19 pandemic: are we missing out with an online only platform? 

2021;80(2):127-128. doi:10.1016/j.eururo.2021.03.019

5. Hameed BZ, Tanidir Y, Naik N, et al. Will "hybrid" meetings replace face-to-face meetings post COVID-19 Era? Perceptions and views from the urological community. 

2021;156:52-57. doi:10.1016/j.urology.2021.02.001

Articles

"There is no substitute for face-to-face communication, intergenerational interactions, and chance encounters with colleagues that occur at an in-person meeting," writes Adele M. Caruso, DNP, CRNP, FAANP.

Back Together: American Urological Association Meeting 2022

 is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia.

The standard components of care for renal cell carcinoma are active and post intervention surveillance. The COVID-19 pandemic presented challenges for urology patients to receive care in the format of the traditional in-person clinic visit. The telemedicine (defined as a televideo encounter) visit format ensured continuity of care during this past year. What have we learned after 1 year? Perhaps that telemedicine is a good model for renal cancer surveillance.

The COVID-19 pandemic presented challenges for urology patients, especially in early 2020. Urologists and urology advanced practice providers (APPs) were faced with delivering care while preventing patients from getting COVID-19 and protecting themselves as health care providers. Telemedicine visits were offered as an alternative. What was the patient perspective? As one might expect, and according to Boehm et al,

 who conducted phone interviews at the onset of the pandemic, 84.7% wished for a telemedicine visit. A visit was not conducted 17.3% of the time due to a technical limitation. In this study, which also looked at risk factors, patients with renal cancer had the highest number of risk factors, followed by urothelial cancer, prostate cancer, then nononcological disease.

Alternative to traditional care, a model during the COVID 19 pandemic

Preliminary findings of 100 patients at the University of Pennsylvania identified telemedicine for renal cancer patients as a good alternative to traditional care during the COVID-19 pandemic.

 The study was conducted solely via televideo platform. Patients perceived telemedicine care favorably. More than 80% of respondents agreed the patient/provider interaction was positive and their visit was effective. More than 78% of respondents reported that the telemedicine platform was easy to access. This conclusion validates the hypothesis that patients found the telemedicine/televideo platform a valuable tool and appropriate mode to receive care with ease of use. Patients expressed a positive experience with their patient/provider interaction with telemedicine/televideo.

Urology as a high user of telemedicine across subspecialties

 of 4405 active surgeons, 2508 utilized telemedicine with 109,610 visits, and urology ranked the highest user of telemedicine across subspecialities. For new patients, urology came in first at 14.3% (prepandemic conversion rate, 7.7%) with neurosurgery at 13.8% (prepandemic conversion rate, 3.7%). The conversion rate defined as new telemedicine visits divided by the mean total of new patient visits. Further analysis supported urology as the leading subspecialty for established patients at 21.6%. Overall, with all patients, prepandemic visits were less than 1% for new patients, which increased to 34% at the height of telemedicine use, followed by a decrease to 3% during the later months, which were indicative of prepandemic levels.

 Other findings related to patient characteristics for new patients showed higher use by women, patients younger than 60 years of age, nonrural area, and a mean income of above $56,458.

Benefits to patients and benefits to providers

Telemedicine afforded continuity of care for needed medical access while abiding by the initial stay-at-home orders. Telemedicine continues to support a safe environment when needed during the COVID-19 pandemic. Additionally, this modality offers convenience to patients with quicker access to health care providers, and minimizes travel time and expense. The question that remains, however, is that of effective patient-provider connection. Is this form of communication appropriate for difficult conversations or managing strong emotions?

 I would say that for certain urologic conditions, and specifically with the population of renal cancer surveillance patients, preliminary evidence is favorable.

Do social disparities play a role in telehealth? One recent study sought to assess demographics and socioeconomic factors and insurance status associated with patient participation in telehealth during the COVID-19 pandemic.

 The cohort included more than 1000 otolaryngology patients with greater than 400 telehealth visits in a tertiary care, academic, multispecialty, multisite practice. The findings suggested that age, sex, median household income, and marital status play roles in patient participation. The findings identify vulnerable populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape. In the Philadelphia Veterans Administration, observations of a group of urology patients who acknowledge transportation issues and cost related to transportation, and who are adept with their mobile phone, seem receptive to telemedicine and to receive care though this modality.

Federal and state emergency declarations early on in the COVID-19 pandemic waived barriers for out-of-state medical licenses in order for providers to treat out-of-state patients. However, the future of licensure reciprocity is unclear. Several reforms have been suggested, including state-based medical licensing, licensure reciprocity, a proposal to practice medicine on the basis of the physician’s location instead of the patient location, or the implementation of a federal medical license.

 Insurance and reimbursement legislation would need to coincide for this to be a viable solution.

Certainly, telemedicine is not a replacement for in-person encounters for all urologic conditions, but rather another tool in our armamentarium. As we rely on and incorporate telemedicine into our daily practice, I would say, consider telemedicine/televideo as a model for your renal cancer surveillance patients, and for other select urology patient populations.

What does the future hold? Is telemedicine here to stay? Time will tell.

1.Boehm K, Ziewers S, Brandt MP, et al. (2020) Telemedicine online visits in Urology during the COVID-19 pandemic-potential risk factors, and patients’ perspective. 

2021;78(1)16-20. doi:10.1016/j.eururo.2020.04.055

2. Caruso AM, Lin G, Malkowicz SB. (2021). Telemedicine/Televideo Platform as a preferred mode for renal cell carcinoma surveillance during the COVID-19 Pandemic. Presented at the meeting of the American Urological Association Meeting 69th Annual 2021 Meeting. Urologic Care for the Advanced Practice Provider.

3.Chao GF, Li KY, Zhu Z, et al. Use of telehealth by surgical specialties during the COVID-19 pandemic. 

Published online March 26, 2021. doi:10.1001/jamasurg.2021.0979.

4. Kapadia MR, Kratzke IM, Sugg SL. The rise and fall of surgical telehealth-can lack of patient connection be blamed? 

Published online March 26, 2021. doi:10.1001/jamasurg.2021.0989

5. Kapadia MR, Kieran K. Being affable, available, and able is not enough: prioritizing surgeon-patient communication. 

. 2020;155(4):277-278. doi:10.1001/jamasurg.2019.5884

6.Darrat I, Tam S, Boulis M, Williams AM. Socioeconomic disparities in patient use of telehealth during the coronavirus disease 2019 surge. 

2021;147(3):287-295. doi:10.1001/jamaoto.2020.5161

7. Mehrotra A, Nimgaonkar A, Richman B, et al. Telemedicine and medical licensure - potential paths for reform. 

2021;384(8):687-690. doi:10.1056/NEJMp2031608

"Certainly, telemedicine is not a replacement for in-person encounters for all urologic conditions, but rather another tool in our armamentarium," writes Adele M. Caruso, DNP, CRNP, FAANP.

Telemedicine as a model for RCC surveillance during the COVID-19 pandemic 

 is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia. 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, MJH Life Sciences.

Our country is in a state of national emergency due to the novel coronavirus, which causes the disease known as COVID-19. Advanced practice providers (APPs) across the nation are on the front lines caring for patients. This includes nurse practitioners and physician assistants who have advanced training and education in many areas of need to combat the COVID-19 pandemic. Urology APPs are doing their part!

The World Health Organization declared a global pandemic related to a novel coronavirus. COVID-19 is a respiratory illness with symptoms of fever, cough, and shortness of breath, different than coronaviruses that are already known. The first cases were reported in Wuhan, China in December 2019.

Coronaviruses in general can cause illness in both humans and animals, and it has been suggested that COVID-19 may have been transmitted to humans from bats, similar to SARS-CoV and MERS-CoV. The severity of the illness varies from very mild cases with minimal symptomatology to severe cases resulting in death. Older patients and those with comorbidities or are immunocompromised are at higher risk for developing severe illness (

NPs and PAs are highly qualified providers with advanced training and education and are an essential part of the health care work force. This is especially important to acknowledge as the majority of the nation is facing a physician shortage, and APPs are filling this gap with over 290,000 NPs and 140,000 PAs practicing nationwide (

). During this unprecedented time, it is crucial to safeguard access to care while ensuring we all stay safe.

APPs are keeping current with regular review of the full Centers for Disease Control and Prevention COVID-19 Guidance Updates (

) and as well as the COVID-19 Policy and Practice Updates disseminated by our government agencies, professional association boards, health systems, and private practices. This is quite the task with the plethora of communications on social distancing, personal protective equipment (PPE), ventilator availability, COVID-19 testing, therapeutics including hydroxychloroquine and plasma therapies, and potential vaccine developments.

While keeping abreast of daily updates, these sources adapt and modify treatments as new information becomes available. APPs, along with our physician colleagues, are on the front lines with managing and monitoring the spread of disease, delivering care, and executing treatment recommendations.

APPs are an integral part of the urology team and are filling administrative roles in handling the day-to-day divisional and departmental flow in an uninterrupted fashion. Urologist/APP teams are managing care seamlessly. They are providing care on site for those necessary or urgent appointments and procuring telemedicine encounters for necessary but non-urgent visits. Patient access to urologic care is being maintained during this COVID-19 pandemic thoughtfully, guided by evidence and expertise. Acute problems, as well as the bulk of crucial oncologic surveillance and treatment regimens, are being skillfully handled via telemedicine, in both the traditional telephone and virtual platforms.

APPs in urology are part of the “boots on the ground” with this triage process. They are calming fears and alleviating anxiety among urology patients who face postponement of surgical procedures. Amidst this pandemic and anticipating a “peak” sometime soon, many APPs either have been deployed or are preparing for deployment to another area of the hospital, location, or practice area to combat this pandemic. Urology APPs are serving on the front lines.

Barriers that limit APP abilities limit APPs’ ability to provide care. APPs are actively advocating for removal of practice barriers at both federal and state levels so they may better serve patients during the COVID-19 emergency. Due to the guidance of President Trump, every state is taking measures to relax regulations imposed on various health care professionals. The American Association of Nurse Practitioners, the largest association representing nurse practitioners of all specialties, is advocating and supporting various legislation to this end. The American Association of Physician Assistants is doing the same.

A recent success on the federal level was the signing of the Coronavirus Aid, Relief and Economic Security (CARES Act) into law by President Trump on March 27. This law strengthens seniors’ access to home health care services and provides needed funding for health care professionals. Most importantly, the law authorizes NPs and PAs to certify and recertify home health care services for Medicare patients, an authorization not previously permitted, strengthens funding for PPE, and secures other vital resources (

In Pennsylvania, regulations were relaxed, and health care professionals licensed under the Department of State’s 

Bureau of Professional and Occupational Affairs

 can provide telemedicine services during the COVID-19 emergency. Patients have access to telehealth and can receive care at home to eliminate the spread to the disease.

APPs are now able to practice telehealth across state lines. Additionally, governors of five states (New York, New Jersey, Kentucky, Louisiana, and Wisconsin) signed executive orders to enact full practice authority for NPs, which includes the removal of the restrictive barrier of a collaborative agreement, and also relaxed regulations for PAs, bolstering their respective health care work forces during this crisis.

Urology APPs are making an impact during this COVID-19 pandemic. Those deployed are using their individualized skillsets to care for patients. APPs with acute care training are taking care of the critically ill inpatients, and those with outpatient experience are posted in triage tents. They are serving regardless of risk to their own health, as are other health care professionals. They are maintaining patient access and managing health care needs. They are protecting patients and guiding them during this crisis.

They are advocating for the removal of regulatory barriers that prevent patient access to care. They are on the front lines and are fulfilling their professional commitment within their department and with deployments to alternate areas of need. I say, thank you to all of those APPs, urologists, and urology teams!

Do you have COVID-19 news to share? Please share your invaluable experiences by sending an email to 

"Urology APPs are making an impact during this COVID-19 pandemic. Those deployed are using their individualized skillsets to care for patients," writes Adele M. Caruso, DNP, CRNP.

Urology APPs: Making an impact during the COVID-19 pandemic

 is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia. 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, MJH Life Sciences.

Advocacy is an integral component of professional life for both advancing and promoting advanced practice provider disciplines, and also championing patient care issues within today’s health care system. So, let’s get active!

Merriam-Webster defines advocacy as “the act or process of supporting a cause or proposal,” while activism is “a doctrine or practice that emphasizes direct vigorous action especially in support of or opposition to one side of a controversial issue.” Advanced practice providers (APPs) provide quality health care in the United States and have demonstrated that they can improve much-needed access to health care for patients. It is imperative that APPs are active in advocacy for issues that remove barriers and ensure direct access to patients for their services.

According to the World Health Organization, “Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.” One of my favorite definitions is by Longest, who defines health policies as “authoritative decisions regarding health or the pursuit of health made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others” (Longest, BB. 

Health Policymaking in the United States,

 Sixth edition. Chicago, Health Administration Press, 2016). Be cognizant of health policies that affect health through health determinants and vice versa; these include physical environment, behavior and biology, social factors, and health services.

The BCG shortage: No short-term solution!

There are also the important extrinsic factors such as money for health care, the provider work force, and technology (Longest, BB. 

 Sixth edition. Chicago, Health Administration Press, 2016). As part of the expanding work force, APPs in urology care for the population health of patients with an array of genitourinary issues. By participating in advocacy and activism, we can support the policies we feel are in the best interest of our patients.

Understanding the phases of the policymaking process is key and includes the formulation phase of agenda setting and development of legislation, the implementation phase upon formal enactment of legislation, and the modification phase where all decisions in both these phases can be revisited and modified.

One must take into consideration the “window of opportunity” and external environment during this process. Know your political climate! This “window of opportunity” described by Kingdon opens when a confluence of problems, possible solutions, and political circumstances converge to stimulate legislation (Kingdon, JW. 

Agendas, Alternatives, and Public Policies, Update Edition, with an Epilogue on Health Care,

 Second edition. Upper Saddle River, NJ, Pearson Longman, 2011).

Nurse practitioners and physician assistants have health policy initiatives, and being familiar with these initiatives is imperative when called upon to articulate these agendas. Become familiar with current legislative objectives both regionally and nationally. If you are not already a member, join your professional association. Nurse practitioners and physician assistants have advocacy agendas for both professional and patient issues on their respective websites 

. You might also consider becoming involved with your state’s advocacy organization; eg, 

There are opportunities to advocate as an individual on both the state and federal levels, as well as advocate as part of an organization.  State advocacy is encouraged, and the AUA supports members to become effective state-level advocates to address legislation and regulations affecting their local communities. Federal and state legislative priorities are set annually and others may be considered as the need arises.

The AUA advocates for the specialty of urology and works at the federal and state level on behalf of its members and patients. Some 

 include preservation of access to appropriate PSA screening, reform of the U.S. Preventive Services Task Force recommendation process, and addressing work force shortages. Examples of 

 are medical liability reform efforts, support of efforts to reduce the burden of prior authorization, and support of legislative and regulatory efforts to expand meaningful patient access to telemedicine services.

Hematuria evaluation: Evidence for optimal practice?

How can you make a difference in your professional practice? How you can help patients through advocacy? I challenge you to stay informed and participate!

As always, please feel free to share your perspective by emailing me at 

"It is imperative that APPs are active in advocacy for issues that remove barriers and ensure direct access to patients for their services," writes Adele M. Caruso, DNP, CRNP.

Adele M. Caruso, DNP, CRNP, FAANP

Articles

Back Together: American Urological Association Meeting 2022

Telemedicine as a model for RCC surveillance during the COVID-19 pandemic

Urology APPs: Making an impact during the COVID-19 pandemic

Advanced practice providers: Make advocacy part of your professional life