Practice Profile: Tennessee Urology

Urology Times’® Practice Profile series takes readers behind the scenes of US and Canadian-based urology practices. From solo practitioners to large groups, each installment highlights these practices’ unique qualities, successes, and challenges. To have your practice featured in this series, please email Hannah Clarke at hclarke@mjhlifesciences.com.

In this installment, Christopher E. Ramsey, MD, FACS, and Rachel Vann, MSN, RN, NP-C, highlight Tennessee Urology, an affiliate of United Urology Group (UUG). Ramsey is a urologist specializing in prostate cancer and Vann is a nurse practitioner and the lead advanced practice provider (APP) at Tennessee Urology.

Could you provide some background on yourselves and Tennessee Urology?

Rachel Vann, MSN, RN, NP-C

Vann: Our practice is comprised of 10 APPs and 7 physicians. We started as 3 separate groups and combined with Tennessee Urology and have really come together as a cohesive unit in the past several years. We do general urology and we have a focused practice in prostate cancer, both in new diagnosis and advanced prostate cancer.

Christopher E. Ramsey, MD, FACS

Ramsey: We're a community practice. As far as what I do, I do a lot of localized prostate cancer; Rachel helps with the advanced prostate cancer center. That's associated with one of our other partners, Dr. Timothy J. Leroy, who does the advanced prostate cancer treatments. This includes the typical androgen deprivation therapy with oral oncolytics; we also have Xofigo [radium-223]. We have the capability of treating all prostate cancer, but we also treat every aspect of urology. We treat kidney stones, bladder cancer, kidney cancer, overactive bladder, etc. We have partners that do overactive bladder and urge incontinence in females. One of our partners is doing pelvic prolapse. We do percutaneous nephrolithotomies that can be difficult. We also have 1 partner who does radical cystectomies. So, we treat all aspects of urology from start to finish. We're almost like an academic center as far as the treatments that we offer our patients. It's been helpful being several small groups combining into a larger group. We're looking to expand so that we don't have a problem treating anything that comes through our doors. Essentially, we're a medium-sized practice with large-practice service.

What were some challenges that you or your practice faced in getting started? How did you overcome those challenges?

Ramsey: The main challenge that we have is being a medium-sized practice in a relatively large providing area. Knoxville has about 200,000 people, the metro area has 900,000, and we have a very large rural area that we cover in the Appalachian area. So, we cover areas from Kentucky, most of East Tennessee, sometimes even North Carolina, and we get a lot of referrals from outlying places. That can be a big challenge, especially since we don't have a wide spread as far as our clinic opportunities. That's one of the challenges that we that we deal with.

Vann: Part of the goal is getting those people in the office, and we've tried to expand the roles of our APPs to try and accomplish that. We've expanded our APP templates so that they're seeing between 20 and 25 patients a day, depending on the provider. We want to meet the needs of those underserved populations. We have 2 new APPs starting to help us accomplish that, to get these people in the door and get them seen.

Ramsey: The APPs have been invaluable in helping us treat the volume of patients that we see. It's been helpful in expanding our ability to see patients urgently. The wait times for patients to come into our office can be as little as hours, especially if there's a relatively urgent need, and usually by the next day if someone needs to be seen relatively quickly. Our APPs have been a tremendous help in providing great patient care for everybody—for chronic patients and for acute patients. I can't overstate how helpful they have been.

What are some wins that your practice has experienced since getting started?

Ramsey: I would say the APPs are our biggest win. The ability to collaborate with Tennessee Urology has allowed us to bring in several APPs. Like Rachel said, we have 10 APPs, so we're able to use those providers to [expand] access to our clinics. So, that's one of the big wins. I think another big win is the ability to provide Xofigo, the ability to have our own in-house pharmacy dispensary, the ability to own a CT scanner and X-ray ultrasound and have in-house pathology. It's been a real win to be able to provide all of that in-house and not have to give more referrals to other people.

What conditions do you treat? What are some services that you offer?

Ramsey: We offer a broad range of urological treatment, from kidney stones to complex advanced prostate cancer. I personally see mostly localized prostate cancer, and I do robot-assisted laparoscopic radical prostatectomies. I'd say I'm very high volume—probably the highest volume in East Tennessee, if not the region. I typically [treat] between 250 to 300 prostates a year, and I'll [treat] 6 to 10 prostates a week. We have a very busy robotic prostatectomy practice. The only way I can do that is because my partners have allowed me to be a champion of that, and they refer me their patients so that I can do the surgeries. Then in turn, I refer to them the things that they're interested in. So, a lot of us have been able to subspecialize. One of our partners is doing pelvic prolapse, so doing female pelvic health and overactive bladder treatments, including Botox and InterStim. We do benign prostate services with UroLift, Revolix laser, TURP, Rezum, and robot simple prostatectomies for very large prostates. We treat all kinds of kidney stones. So, we have a pretty broad practice, and we're able to treat about anything that comes in our door.

Vann: In addition to Xofigo for those advanced prostate cancer patients, we also offer Provenge [Sipuleucel-T], which isa type of immunotherapy. For female pelvic health issues, we also have a Mona Lisa laser that we offer as well. All the oral oncolytics are managed through our in-house dispensary. So, we have a lot of available options for our patients with advanced prostate cancer.

What is the makeup of your staff and the roles associated with your practice?

Vann: We have 10 APPs. We have implemented an APP program to help these providers [become] as efficient as possible. As APPs, we see patients from all our physicians and practice independently to help get patients seen and treated appropriately in a timely manner. We've been very lucky that our physicians are easy to collaborate with. They are always helpful and available when we need them. The other thing is we have awesome frontline staff. Our front desk staff, our MAs, our RNs that do infusions, everybody is a team player to [Tennessee Urology] and willing to do what it takes to get our patients taken care of. We're very lucky in that we have very good staffing.

What are some unique elements to your practice?

Vann: A lot of what makes us so successful in the area is that everybody collaborates very well, from frontline staff to physicians, and goes above and beyond to try and get these patients taken care of and getting them where they need to be. Touching on what Dr. Ramsey said, we have some physicians that are subspecialists, and we work hard to get these patients in with our subspecialists. The cooperation between physicians and APPs to get that done is what makes us superior in the area.

Ramsey: We have a very collegial atmosphere in our group among the partners and our APPs. We trust our APPs to take care of our patients, especially with urgent needs when they can't come in to see one of the physicians. We know what our strengths are, we know the things we like to do, we know the things we don't like to do, and we have a pretty good mix of people who will take care of all of that.

Is there anything else that you would like to add?

Ramsey: We provide services to a very wide area and, we're lucky we can see [patients] very quickly and give them care in [everything from] prostate cancer throughout the whole gamut of subspecialties.

You can learn more about Tennessee Urology here.