Survey: Wide variation in urologist engagement with APPs

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The analysis “gives urologists the first accurate idea of how many physician assistants and nurse practitioners are working in urology,” says researcher Raymond Fang.

Findings from the 2015 AUA Annual Census show wide variation across urologic practices in engagement with advanced practice providers (APPs).

Ongoing research is examining the roles performed by APPs, and ultimately it is hoped that the gathered information will lead to strategies for increasing APP utilization and the associated benefits, said Raymond Fang, director of data management & statistical analysis for the AUA. He reported the findings at the AUA annual meeting.

Fang’s research interest in APP utilization in urologic care stems from a growing trend in APP utilization in specialty care.

“Proper use of mid-level providers can allow urologists time to focus on more complex procedures while lowering health care costs. Integrating APPs into a urologist-led practice team can help increase cost-effectiveness in care delivery, improve patient access to urologic care, and may help address the projected problem of urologist work force shortages,” Fang said.

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“First, however, we need to understand the true scope of APP utilization by urologists and reasons for any variation. Our initial analysis gives urologists the first accurate idea of how many physician assistants (PAs) and nurse practitioners (NPs) are working in urology.”

Through a collaborative initiative with multiple institutions across the country, questions on medical team composition were added to the AUA 2015 Annual Census that asked urologists to indicate the total number of urologists, Pas, and NPs working directly with them in their practice team. Using complex survey methods, samples were weighted that would be representative of the entire practicing urologist population in the United States.

Extrapolating from the sample, it was estimated that, in 2015, there were approximately 2,500 PAs and 2,665 NPs working in urology practices across the country. The percentages of urologists working with the two types of APPs varied by practice setting and region. A majority of urologists (50% to ~70%) working in Veterans Affairs hospitals, academic medical centers, and community health center/HMO/managed care organizations worked with PAs. Approximately 75% of urologists in academic medical centers and 56% of those working in VA hospitals worked directly with NPs. Less than 50% of urologists in other practice settings worked directly with either NPs or PAs.

Next: Urologists were more likely to work with an APP if they practiced in a metropolitan areaThe analysis also found that urologists were more likely to work with an APP if they practiced in a metropolitan area compared with in a non-metropolitan area and if they worked in the New England, Northeastern, and North Central AUA geographic sections.

“States in these AUA sections tend to have favorable practice regulations for APPs,” said Fang, who previously served as vice president for research at the American Academy of Physician Assistants.

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Data are now being analyzed from questionnaires sent to APPs that were designed to gather information about the roles APPs play in urologic care practice. The questionnaires included a list of procedures and asked the respondents to indicate their clinical roles for each procedure. The 2018 AUA Annual Census is collecting the same information from urologists.

“We hope the data outlining the role of APPs in urology practices described by practicing urologists and APPs can be used to develop closely and formally defined team models with urologists who serve in a supervisory role and APPs who work with delegated autonomy associated with work settings, APP experience, physician comfort level, and state laws. Findings from this and future studies will be used to improve state practice regulations that in turn should improve APP utilization,” Fang said.

Fang’s collaborators on the study were Patrick McKenna, MD, Madison, WI, J. Stuart Wolf, Jr., MD, Austin, TX, William Meeks, Linthicum, MD, Brad Erickson, MD, Iowa City, IA, Christopher Gonzalez, Cleveland, Steve Schlossberg, MD, Walnut Creek, CA, Heddy Hubbard, PhD, Linthicum, MD and J. Quentin Clemens, MD, Ann Arbor, MI.