Advanced practice providers (APPs) such as advanced practice nurses (APNs)/nurse practitioners (NPs) and physician assistants (PAs) can significantly enhance a urologic or sexual medicine practice. According to the results of the 2018 National Survey of Demographics and Clinical Roles in Urology, 72.5% of urologists have used the services of an APP in their practice.
To provide a comprehensive overview of the role an APP can play to enhance urologic practices, the American Urological Association (AUA) published a guideline regarding APPs in urology called the “Current State of Advanced Practice Providers in Urologic Practice.” Below are some of the ways an APP can be a valuable partner in addressing patients’ health. However, it is important to know that federal and state regulations govern the training requirements and scope of practice for APNs and PAs. Therefore, physicians and APPs should be aware of the laws and regulations for the state in which they practice. Additionally, the medical bylaws of health care institutes may further define and/or limit the scope of practice of an APP and should be considered along with state and federal laws.
One way in which APPs can provide support in a urologic practice is through assisting with common procedures. The 2018 survey completed by APPs reveals they are performing many different tasks such as pessary insertion, catheter care, circumcision, cystoscopy, hydrocele aspiration, intravesical Botox, prostate biopsy, Testopel injection for low testosterone, Xiaflex injection for Peyronie’s disease, and vasectomies. An APP working for an orthopedic practice would be trained to do very different procedures than an APP supervised and trained by urologists and urogynecologists. The boundaries of each PA’s scope of practice are determined by these parameters: education and experience, state law, policies of employers and facilities, and the needs of the patients.
Studies have shown that the percentage of such procedures done by APPs without direct supervision continues to increase. Notably, data collected by the AUA in 2017 indicated that the most common procedures that APPs performed on their own were as follows: bladder instillations (56.3%), intracavernosal injections for erectile dysfunction (55%), urodynamics interpretation (40%), tibial nerve stimulation (39%), and chemotherapy injections (34%).
With a growing workforce shortage and the excess strain it puts on physicians, perhaps one of the most valuable roles an APP can play in a urology practice is increasing patient knowledge and access to high-quality, safe care. In addition, as APPs are knowledgeable about urologic care, they can offer enhanced patient education and are well-positioned to communicate information to patients before and after procedures. As such, NPs and PAs across the country can work to the full scope of their practice and be an integral part of the urology team.
To see the full AUA guideline, click here: Current State of Advanced Practice Providers in Urologic Practice.
Resources:
Brand, T.C., Mitchell, K., Quallich, S., Rubenstein, J., Shanley, K.Z., Gutierrez, A., Hooper, G., Motola, J., Zilinskas, B., Robles, J., Erickson, B., Rhee , E., & Spitz, A. (2022). Current State of Advanced Practice Providers in Urological Practice. Urology Practice, 9(1), 1-7. DOI: https://doi.org/10.1097/UPJ.0000000000000278
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