Login to Access Video or Poster Abstract: MP76-12
Sources of Funding: AUA data grant

Introduction

Projections demonstrate a worsening shortage of urologists in the United States in the next decade. Advanced practice providers (APPs) are increasingly used in urology and other fields to improve physician productivity. While APPs have become common in urology clinics, little data exists regarding the use of APPs in the surgical setting. Though in the past, urologists were often assisted by a second surgeon for complicated operations, we hypothesized that APPs are increasingly filling that role. This study aims to quantify the change in surgical assist patterns over time for commonly performed urologic operations.

Methods

We used data derived from the Medicare Physician/Supplier Procedure Summary Master File to examine the rates of APP-assisted and surgeon-assisted procedures performed by urologists from 2003-2014, as identified by CPT codes and modifiers. The annual frequency is reported by assist type for six common urologic operations: robotic prostatectomy, open prostatectomy, radical cystectomy, open nephrectomy, open partial nephrectomy, and laparoscopic nephrectomy. The average annual rates of change were determined using least squares regression and tested using t-tests (?=0.05).

Results

Of the 677,111 urologic operations analyzed, 5.0% of cases were assisted by APPs compared to 27.0% assisted by a second surgeon. The proportion of cases assisted by an APP rose significantly for all procedures (Figure 1); conversely, the proportion of cases assisted by a second surgeon declined significantly for all procedures, except for open partial nephrectomy. The largest changes were seen in robotic prostatectomies; similar proportions of robotic prostatectomies are now performed by APPs as by second surgeons.

Conclusions

Urologists are increasingly using APPs as assistants in surgery, particularly in laparoscopic and robotic cases. This trend will likely continue as the shortage of urologists worsens in coming years. At the same time, surgical assistance is less frequently being performed by a second surgeon, which may decrease opportunities for refining operative skills. APPs can be a valuable part of the surgical team, but further consideration of the impacts of this shift in practice is needed.

Funding

AUA data grant