Use of Advanced Practice Providers to Improve Patient Access in Urology

Introduction: Increasing the use of advanced practice providers in urological practices is a potential strategy to decrease the effect of national urologist shortages. Advanced practice providers may fill various roles in urological practices including the evaluation of new and established patients, thereby improving patient access to specialty care. The metric "next third available appointment" has been established as a reliable benchmark for patient access. We hypothesized that the addition of advanced practice providers to a urological practice would improve patient access and we sought to determine if patient access benchmarks could be included in an evaluation of overall advanced practice provider productivity. Methods: We examined patient access and productivity data for physicians and advanced practice providers in a single academic urology department from 2013 to 2017. We evaluated various access markers including new patient appointment wait time and third available appointment, and productivity data including appointment booking ratios to determine if hiring advanced practice providers helped improve patient access while maintaining adequate booking ratios. Results: We identified 2 advanced practice providers hired in 2014 to 2015 who worked in the outpatient setting. The addition of these advanced practice providers helped decrease the median new patient appointment wait time by 15 days and improved the department's time to third available appointment by approximately 5 days. Our department's advanced practice providers have an average booking ratio of 80.2% compared to 82.0% for our physicians. Conclusions: Advanced practice providers can help improve patient access to urological care by decreasing the lag time for patients to see a provider in a subspecialty clinic while maintaining adequate booking ratios for our providers.