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    APPs: Collaborators, not competitors

    Richard R. KerrThe number of nurse practitioners (NPs) in the United States has doubled to nearly 205,000 in the past decade, according to a January 2015 report from the American Association of Nurse Practitioners. Also in January, New York state passed a law stipulating that NPs with more than 3,600 hours of experience no longer need a collaborative agreement with a physician. 

    Simply put, NPs, as well as physician assistants (PAs), are growing in both number and power in this country.

    READ: Working with NPs, PAs: What AUA statement means to your practice

    Those realities are not lost on the AUA, which recently issued a comprehensive consensus statement on advanced practice providers (APPs). The AUA statement carefully lays out the need for these providers as the urologist work force shrinks, details legal and reimbursement issues related to their employment, and portrays a future in which the urologist functions as a CEO who uses APPs and telemedicine to direct patient care.

    “The biggest challenge will lie with how we revamp our training for all members of the healthcare team a generation ahead of their arrival to the marketplace,” the statement says.

    Indeed, how to properly train NPs and PAs in urology—and in certain urologic procedures in particular—remains a sticking point. As a urologist and an NP point out in our article, APPs are already performing some in-office procedures. And the statement itself acknowledges that “vasectomies, cystoscopies, prostate ultrasound guided biopsies, and urodynamics… may be delegated to highly skilled, well-trained APPs with the benefit of televideopresence when desired, as with prostate ultrasound or cystoscopy.”

    Whether organized urology feels comfortable providing formal training to APPs in such procedures remains to be seen.

    Urologists are embracing APPs, with nearly two-thirds using them and half expecting their use to increase, according to a Urology Times survey. Concerns remain. About half of urologists are concerned about increased liability when employing a PA or NP. Anecdotally, I think the ability of NPs to practice more independently, as seen in New York and several other states, also worries many urologists.

    But legal victories resulting in increased freedom and calls for more procedural training should not be seen as a power grab by NPs or PAs. Rather, these practitioners should be viewed as skilled members of a health care team who are filling a vital need in a physician-strapped work force.


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    Richard R. Kerr
    Kerr is group content director for Urology Times.

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    • Anonymous
      You sir are ignorant. The goal of the NP organizations is to replace and be equivalent to physicians (with less than a third of an MDs training). As has always been true for physicians: everyone wants to do what you do without going through the training that you did. Look at what is happening with anesthesia now with CRNAs seeking independent practice with NO physician supervision. It is idiotic that academic urologists would even consider having extenders performing cystoscope or prostate biopsies. We should be training more urology residents instead of extenders to do what we do.

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