Are NPs/PAs a viable short-term solution to the urologist shortage?

“PAs and nurse practitioners are helpful in the clinic. Can they work independently? That varies from one state to another.

In terms of technicality, teaching an NP or PA to do minor procedures in the clinic is doable. Whether urologists are willing to do it is a different question.

The other controversial issue I foresee is how the billing and reimbursement of the physician might be affected, especially if a nurse practitioner or PA can do a procedure in an independent fashion.

I think you will find resistance in the urology community, because the shortage is relative. It might be more feasible in academic centers and rural areas, but that varies, too, depending on location and practice patterns.

Training more urologists is a long-term plan that’s needed, but PAs/NPs aren’t a solution everywhere because the distribution of specialists can vary, even within the same state.”

Rabii Madi, MD

Augusta, GA

“For the most part, they are. We opened this practice a few years ago and are looking at using a PA. Some primary care doctors around here use PAs extensively to make it easy for people to get in when sick. So yes, it’s definitely part of the solution.

I expect to spend time training the right person. I’ve found most staff in urology come in with very little knowledge. To find a PA or NP with extensive urology experience would be great; to find one who wants to move to western Wyoming, I’m not going to hang my hat on that.

An NP can practice here without supervision; a PA cannot. A nurse practitioner could be beneficial in my practice because I have clinics over an area the size of New York City.”

Michael McManus, MD

Lander, WY

“I teach the physician assistant program here at Knoxville and use physician assistants in my practice. Nurse practitioners and physician assistants provide valuable patient assistance, but their depth of knowledge is not at all close to that of a board-certified urologist. As the number of anticipated patients increases, we will certainly need more highly trained urologists; NPs and PAs can only fill part of that demand.

I don’t recommend that PAs and NPs perform anything other than the most basic of procedures because their ability to diagnose problems and handle complications is extremely limited.

Nurse practitioners and PAs do an excellent job of gathering information, making initial assessments, and presenting information to a urologist. Decision making can then be done more expeditiously by the urologist. They can help in that regard quite a bit.”

Paul Hatcher, MD

Knoxville, TN

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