By Kristin F. Austria, NP-C
The role of Advanced Practice Providers (APPs) in urology has grown tremendously in recent years, a trend aimed at improving patient care and satisfaction amidst a growing shortage of specialists to treat an aging population.
APPs now serve in multiple subspecialties, including general urology, cancer care, reconstructive and pelvic health, inpatient care, and men’s health. Each works with assigned physicians on collaborative or independent schedules to cover acute and chronic cases.
Highly-trained Nurse Practitioners (NPs) and Physician Assistants (PAs) can effectively handle many diagnoses that require chronic disease management rather than surgery. Some common examples include recurrent urinary tract infections, kidney stone management, benign prostatic hyperplasia, testosterone replacement, erectile dysfunction, pelvic organ prolapse, overactive bladder, and prostate cancer under active surveillance.
In general, APPs have more time for each appointment and can deliver consistent quality care, emphasizing patient education. Supervising physicians are readily available to answer patients’ questions or concerns and help guide management plans for more complex cases. The overall goal is to help patients become better stewards of their health and learn to manage their disease processes. Often, patients can reduce their reliance on medication – and/or avoid or delay surgery – through dietary and lifestyle adjustments.
Increasingly, APPs also are undergoing training to perform procedures that range from simple to more complex. One of the most frequent is cystoscopy with stent removal following kidney stone surgery.
Depending on the practice, an APP may handle Bonabotulinumtoxin A injections for urge incontinence, subcutaneous implantation of testosterone pellets, transrectal prostate biopsies, complicated Foley catheter placements, posterior tibial nerve stimulation, biofeedback and more. That list likely will continue to expand in the future.
Urology is a natural field for a larger APP presence due to its distinct subspecialties. In addition, more urologists are retiring than are completing training, especially in rural areas. That gap has created an increased demand and wait times for appointments at many offices. Easier access to appointments via APPs should help more patients address painful, frustrating and “embarrassing” chronic problems such as pelvic organ prolapse, urinary incontinence, and erectile dysfunction more quickly.
Women, in particular, historically have had to wait too long for relief. Good communication, empathy and listening skills are critical to putting these patients at ease and treating their sensitive medical issues.
Many APPs are members of the American Urological Association and attend regular meetings with supervising physicians to review cases, discuss disease management, and hear informational talks on the latest treatment options. The U.S. Bureau of Labor Statistics projects that by 2030, the growth rate for NPs and PAs positions will be greater than that for physicians in all medical specialties. Urology is well-positioned to take advantage of this rising variety of providers.
In short, teamwork and collaboration between APPs and physicians will be critical to our specialty’s future and the patients who depend on us.
Kristin Austria is the Lead Nurse Practitioner with the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, a division of Urology of Virginia. Over the past two years alone, she has trained 23 new APPs for the practice. urologyofva.net