Use of Advanced Practice Providers as Part of the Urologic Healthcare Team


Advanced practice providers (APPs) are advanced practice nurses (APN)/nurse practitioners (NP) or physician assistants. Over half of urologists currently employ APPs to extend and enhance their practice. Because APPs can fulfill a variety of roles from surgical assisting to running their own subspecialty clinic, they have emerged as a vital solution to alleviating the looming workforce shortage in urology practice. About 40 % of practicing urologists have not yet incorporated APPs into their practices. Some may still be unfamiliar with the concept of utilizing advanced practice providers, some have concerns about liability or scope of practice, and some are just getting started. Recently, the American Urological Association (AUA) published a consensus statement on advanced practice providers that provides urologists a comprehensive review regarding the education, training, Medicare reimbursement policies, applicable state laws, liability concerns, and examples of utilization of advanced practice providers within a urology practice. The consensus statement represented one of the most comprehensive compendiums of information specific to advanced practice providers in a urologic practice. This review will touch on the AUA Consensus Statement on Advanced Practice Providers, background information that informed that statement, as well as recent responses to the publication.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Hanno PM. Nurse practitioners, physician assistants: will help alleviate urology work force shortage, according to AUA. Urology Times website. Updated 11-1-2010. Accessed 5-14-2014.

  2. 2.•

    The State of the Urology Workforce and Practice in the United States 2014, American Urologic Association Annual Census. This report contains the AUA census data from 2014. Data presented illustrates specific information regarding currently practicing urologists and projected changes in the urology workforce.

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    Collaborative and supervisory relationships between attending physicians and advanced practice nurses in long-term care facilities. J Am Medical Directors Association, 12: 1, 2011.

  4. 4.•

    Kerr RR. APP’s: collaborators, not competitors. Urology Times website. Accessed 5-14-2015. This article suggests urologist’s view APP’s as collaborators within the physician led healthcare team and not competitors striving to displace physicians.

  5. 5.•

    American Urological Association Consensus Statement on Advanced Practice Providers, AUA workforce workgroup, in press Urology Practice. This AUA publication provides the most comprehensive review of Advanced Practice Providers in urology. The paper contains relevant information for urologists and urology practices considering utilization of Advanced Practice Providers.

  6. 6.•

    The role of nurse practitioners in meeting increasing demand for primary care: NGA Paper (Washington, D.C.: National Governors Association Center for Best Practices, December 2012. This paper is a comprehensive review of the varying state legislation governing the scope of practice of nurse practitioners. Governors are challenged to identify and eliminate practice legislation that causes barriers to NP’s ability to assist in alleviating the primary care workforce shortage.

  7. 7.•

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    Center for Medicare & Medicaid Services. Medicare claims processing manual chapter 12 - physicians/non-physician practitioners sections 30.6.4, 110, 110.1, 120. Centers for Medicare & Medicaid Services website. Updated 3-25-2014. Accessed 5-13-2014.

  16. 16.•

    Dunker E. Krofah F. Isasi. The role of physician assistants in health care delivery (Washington, D.C.: National Governors Association Center for Best Practices, September 22, 2014). This paper is a comprehensive review of the varying state legislation governing the scope of practice of physician assistants (PAs). This paper proposes that governors identify and eliminate practice legislation that causes barriers to PA practice reducing the PA’s ability to assist in improving health care delivery.

  17. 17.

    Saylor BP. Top read in February: AUA statement on NPs/PAs Urology Times website February 26, 2015. Accessed 5-20-15

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Kenneth A. Mitchell declares no potential conflicts of interest.

Aaron Spitz reports personal fees from Lily.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Kenneth A. Mitchell.

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This article is part of the Topical Collection on Office Urology

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Mitchell, K.A., Spitz, A. Use of Advanced Practice Providers as Part of the Urologic Healthcare Team. Curr Urol Rep 16, 62 (2015).

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  • Advanced Practice Providers (APPs)
  • Physician Assistant (PA)
  • Advanced Practice Nurse (APN)
  • American Urological Association (AUA)
  • Workforce shortage
  • Consensus Statement