Advanced practice providers in pediatric urology: A single-institution analysis of clinical and surgical productivity.

INTRODUCTION

Advanced practice providers (APPs) originally were integrated into healthcare out of necessity to aid primary care accessibility and have since dispersed across various surgical and nonsurgical specialties. There is a paucity of literature surrounding how APP involvement can impact divisional productivity within pediatric urology. The objective of this study is to identify the significance of APP implementation within the division of pediatric urology at a large academic pediatric institution.

METHODS

Data from the Surgery Department Executive Committee annual reports from October 2011 to September 2024 was retrospectively reviewed. Descriptive analysis was completed, examining trends by provider type in productivity including clinic and surgical volume, and surgery to clinic visit ratio.

RESULTS

Since fiscal year 2012, the ratio of APPs to MDs in the division of urology provider personnel has trended towards a 1-to-1 ratio with 1 APP per 1.49 MDs in 2024. Total divisional clinic volume has significantly grown since 2012, with APP clinic volume specifically increasing by over 200% from 2013 to 2024. The largest surgical volume was observed in 2024 at 3655 cases, over 225% greater than 2012.

CONCLUSION

Implementation of highly autonomous APPs facilitates optimal surgeon practice, resulting in clinical and potential financial benefits within pediatric urology practices. This finding corresponds to the demand for outpatient access for non-surgical conditions, particularly bladder and bowel dysfunction, along with patients needing pediatric urologic surgery. A standardized onboarding process ensures well-trained APPs who transition seamlessly into autonomous practice. This observational study suggests that APPs improve access to care, perioperative efficiency, and productivity without requiring a significant increase in the number of surgeons.