Objective
To characterize changes in surgical assistance patterns over time for commonly performed
urologic operations.
Materials and Methods
This study used the Medicare Physician/Supplier Procedure Summary Master File to identify
cases performed by urologists from 2003 to 2014. Current Procedural Terminology modifiers
were used to identify operations assisted by second surgeons and advanced practice
providers (APPs). Rates were reported annually for 6 common urologic operations, and
average annual rates of change were determined using least squares regression and
tested using t tests (α = .05).
Results
Of the urologic operations analyzed, 5.0% of cases (n = 33,895) were assisted by APPs
compared with 27.0% (n = 182,842) assisted by a second surgeon. The proportion of
cases assisted by an APP rose significantly for all procedures; 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
for which second surgeon assistance fell from 26% in 2004 to 15% in 2014, whereas
APP assistance rose from <1% to 7%.
Conclusion
Urologists are increasingly using APPs as assistants in surgery, particularly in robotic
and laparoscopic operations. This trend will likely continue as the shortage of urologists
worsens in the coming years.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The state of the urology workforce and practice in the United States.(Available at:) (Accessed October 16, 2016)
- Physician assistant specialty choice.J Am Acad Physician Assist. 2016; 29: 46-52
- Increasing use of advanced practice providers for urological office procedural care in the United States.Urol Pract. 2016; 4: 69-175
- Comparison of procedural complications between resident physicians and advanced clinical providers.J Trauma Acute Care Surg. 2014; 77: 143-147
- Outcomes of tube thoracostamies performed by advanced practice providers vs trauma surgeons.Am J Crit Care. 2008; 17: 357-363
- Experience with physician assistants in a Canadian arthoplasty program.Can J Surg. 2010; 53: 103-108
- Nurse practitioner/physician assistant staffing and critical care mortality.Chest. 2014; 146: 1566-1573
- Projecting the urology workforce over the next 20 years.Urology. 2016; 98: 1-6
- The near-future impact of retirement on the urologic workforce: results from the American Urological Association Census.Urology. 2016; 94: 85-89
- The role of physician assistants in rural health care: a systematic review of the literature.J Rural Health. 2011; 27: 220-229
- Surgical skill and complication rates after bariatric surgery.N Engl J Med. 2013; 369: 1434-1442
- Surgical coaching for individual performance improvement.Ann Surg. 2015; 261: 32-34
- Measuring to improve: peer and crowd-sourced assessments of technical skill with robot-assisted radical prostatectomy.Eur Urol. 2016; 69: 547-550
- AUA consensus statement on advanced practice providers: executive summary.Urol Pract. 2015; 2: 219-222
- Use of advanced practice providers as part of the urologic healthcare team.Curr Urol Rep. 2015; 16: 62
Article info
Publication history
Published online: May 09, 2017
Accepted:
May 2,
2017
Received:
January 10,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
Published by Elsevier Inc.
