"The nurse practitioner that I work with is not only very knowledgeable in office-based pediatric urology but also, for problems like voiding dysfunction, more available to spend extra time with patients and their families," writes Barry A. Kogan, MD.
Having personally worked with a single nurse practitioner in my practice for the past 15 years, I feel uniquely qualified to understand the benefits of advanced practice providers (APPs), as well as the drawbacks.
Pediatric urologists have seen the benefits for APPs for years, but general urologists have been slow adopters. However, studies now show 62% of urologists report using APPs in their practice (Curr Urol Rep 2015; 16:62).
A survey discussed in this issue of Urology Times (see page 5) found that 81% of APPs report they are doing procedures, including 8% who report doing cystoscopy for diagnostic reasons and 6% who do prostate biopsies. There continues to be debate over the appropriateness of this, as well as uncertainty about adequate training. Despite the concerns, a recent publication using Centers for Medicare & Medicaid Services data documented a dramatic increase in APP urology procedures in Medicare patients (eg, a 6-fold increase in cystoscopy procedures and a 24-fold increase in cystoscopic stent removal between 2003 and 2014) (Urol Prac 2017; 4:169-75).
The nurse practitioner that I work with is not only very knowledgeable in office-based pediatric urology but also, for problems like voiding dysfunction, more available to spend extra time with patients and their families. In addition, she can also competently and safely perform standard procedures (eg, neonatal and OR circumcisions) that free me up to perform more complex procedures.
There are few formal programs for training APPs in urology, so the burden rests with the practice. In addition, effective use of APPs requires delegating patient care to them (and being responsible for their practice!). Finally, it is essential to have confidence in your APP so that your patients will accept (and perhaps ask for) him or her.
Considering the pros and cons (nicely summarized in a 2015 AUA Consensus Statement), my experience is, “If you try working with an APP, you’ll like it!”
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