APPs are not just for your iPhone

Dr. Kogan, a member of the Urology Times Editorial Council, is chief of urology at Albany Medical College, Albany, NY.

The era of team-based health care is upon us. Indeed, almost all aspects of your patient’s outcomes are influenced by your team members. If you doubt this, consider whether your receptionists, team members you may rarely have contact with, can have an influence on how patients rate your care. In recent years, in our practice, advanced-practice providers (APPs), including both nurse practitioners (NPs) and physician assistants (PAs), have become highly valued team members.

They participate in all aspects of patient care, including evaluation of new patients, pre- and postoperative care, office procedures, and drug administration. They practice both as support for our urologists but also as independent practitioners (under indirect supervision). They even do non-complex procedures in the operating room (again with indirect supervision).

Related - Survey: Wide variation in urologist engagement with APPs

As many other practices have found, they help us to improve access, increase capacity, keep our costs low, and just as important, they allow our urologists to focus on more complex functions; and our patients feel very comfortable with them. Overall, they make me look good. With an aging population that will require more urologic care and with a shortage of urologists and an aging workforce, APPs are ideal team members to advance urologic care.

An abstract presented at the 2018 AUA annual meeting in San Francisco highlights just how pervasive APPs are in urologic practice. Data collected from the AUA Census suggest that, in 2015, there were over 5,000 NPs/PAs working in urology practices in the U.S. (Bear in mind that there were only 11,990 AUA members in the U.S. in 2015.) Striking, though, is the variability in use of APPs. In New England, approximately 62% of practices had a PA but only 35% just further south in New York City. There are very similar numbers for NPs.

More disappointing was the difference in PA utilization between metropolitan and non-metropolitan practices (45% vs. 26% for PAs). Since rural areas are underserved by urologists and this correlates with poorer outcomes, APPs would be prime candidates to help solve this problem. Future surveys that aim to determine why this is and how it might be improved would be very valuable. Overall, I am delighted that our practice is on the “right” side of the AUA Census survey results and if your practice is not yet there, bear in mind that APPs are not just for your iPhone.