Integrating Advanced Practice Providers into Oncology Settings for Managing Urothelial Cancer

The American Urological Association (AUA) recently published a white paper supporting the use of Advanced Practice Providers (APPs) in caring for patients with genitourinary disease to improve access to care. There is a workforce shortage of 65,000 physicians projected for primary care and specialty medicine by 2025, and APPs could meet up to 70% of patient needs in clinical practice. Additionally, the supply of physician assistants (PAs) and advanced practice registered nurses (APRNs) are expected to continue increasing.

According to the AUA Census, 72.5% of urologists used an APP in their practice and these healthcare providers performed a variety of procedures such as a cystoscopy (procedure examining bladder lining), which assists in the diagnosis of bladder cancer. Evidence shows that patients have demonstrated a growing acceptance of APPs in urology practice settings.

The white paper discusses that most APPs usually work in general urology, and APRNs are more likely than PAs to practice in urology specialty areas such as oncology. Collaborative models involve an APP working with one or more physicians to deliver healthcare services that are supported by jointly developed protocols and practice guidelines. This partnership can also aid in improving workflow and enhancing patient care. The AUA Education Council identified urologic oncology as one of the 6 topic areas to develop training modules for APPs.

APP compensation is also discussed in the white paper through the following 4 payment methods to consider:

• Annual base salary: payment based on job description of clinical role
• Annual base salary plus productivity bonus: guaranteed salary plus additional payment based on agreed upon calculated amount
• Percentage of net receipts: payment based on amount billed minus accounts received minus overhead
• Hourly rate: payment based solely on hours worked

APPs can also play an important role in patient care through telehealth through virtual visits after an initial consultation with the urologist. Additionally, telesurgical streaming can enable APPs to virtually scrub in for surgeries for patients they will be providing postoperative care. This also provides valuable training experience for APPs and critical information for the patient’s recovery process.