Physician assistants, nurse practitioners gain stature, value in urology practices

Urology Times spoke to urologists around the country and found that while some practices are adding physician extenders, others are having almost as much trouble finding them as in finding urologists. Some use staff members who are not certified as physician assistants or nurse practitioners; others say they aren't interested in using non-physician aides.

Looking back over 36 years in practice, John M. Barry, MD, professor of surgery at the Oregon Health Sciences Center, Portland, notes that changes in academic practice have contributed to the need for physician extenders.

"Most of us have subspecialty practices and we still have to get the job done. It's a great waste of a physician's time to do things that can be done by an extender just as efficiently, at less cost.

After hiring the first nurse practitioner for his Albany, NY, office 10 years ago, David H. Zornow, MD, was sold on the benefits of physician extenders, so much so that he took on a third nurse practitioner this year. Their duties are expanding and Dr. Zornow says their cost effectiveness is important to the practice.

"Our nurse practitioners wear two hats," Dr. Zornow said. "They all do exams and see patients along with the 11 urologists in our group, but then they do other tasks. One is the primary assistant in all robotic surgery, and that's better than having different scrub nurses every time we do surgery. Another nurse practitioner is our clinical research coordinator and handles most of the paperwork for that aspect of our practice."

Dr. Zornow says having nurse practitioners on staff is rather like allowing him and his colleagues to be in two places at once.

"One of our nurse practitioners can do an exam and I can cover her and see another patient at the same time," he explained. "They can also see emergencies and same-day patients that we might not be able to fit in for several days. Patients like that convenience."

Another proponent of physician extenders is Timothy M. Roddy, MD, who notes that two physician assistants are joining a nurse practitioner in his group of five urologists in Edmonds, WA, this summer.

"We still want another urologist because of patient volume, but I think the future is going to be such that we will be forced to use physician extenders, whether we want to or not, just to do the day-to-day work."