Related Experiment Video
Updated: Jun 13, 2025
Author Spotlight: Evaluating Clinicians' Adoption of Ultrasound-Guided Vascular Cannulation Through Simulation Training
Published on: August 9, 2024
Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity
Sarah A Layon1,2, Kristina P Marsack1,2, Matthew J Parham1,2
1From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
Insights
Increased use of advanced practice providers (APPs) in pediatric surgery boosts surgeon productivity and patient access to care. Optimizing APP roles is key to enhancing surgical efficiency and care delivery.
Area of Science:
- Pediatric Surgery
- Healthcare Administration
- Surgical Outcomes
Background:
- Advanced practice providers (APPs) are crucial in both nonsurgical and surgical fields, working autonomously with surgeons to improve care continuity.
- Limited literature exists on APP utilization specifically within pediatric surgery.
- This study investigates the impact of expanded APP roles on productivity in a major US pediatric surgery department.
Purpose of the Study:
- To assess the effect of increased advanced practice provider (APP) integration on surgical department productivity.
- To analyze trends in clinical volumes, operating room (OR) cases, and financial metrics in relation to APP staffing.
- To evaluate changes in surgeon productivity and patient access to care following the refinement of APP roles.
Main Methods:
- Retrospective analysis of data from 2011 to 2023, sourced from annual executive committee reports.
- Descriptive statistics used to track clinical volumes, OR cases, gross charges, work relative value units (wRVUs), and provider full-time equivalents (FTEs).
- Secondary analysis from 2016 to 2023 focused on periods after APP roles were redefined within divisions.
Main Results:
- Observed upward trends in total clinic visits, OR cases, and OR cases per physician (MD) since 2012.
- APP patient volume increased from 1:2.2 ratio with MDs in 2016 to 1:1 by 2023.
- MD surgical conversion rates increased by 20.5%, while conversion rate per total clinic volume decreased by 7.3% since 2016. Total wRVUs and gross charges increased department-wide and per provider.
Conclusions:
- Increased APP utilization in pediatric surgery appears to enhance surgeon procedural productivity.
- APP integration supports sustained patient access to surgical care.
- Developing care models that leverage the full capabilities of APPs is essential for optimizing surgical department performance.
Background:
Advanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. Although small-scale studies across various surgical specialties have explored APP use, literature specific to the pediatric population is limited. This study assesses the impact of increased APP use on productivity within one of the largest pediatric surgery departments in the United States.
Methods:
Data were sourced from the Surgery Department Executive Committee annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, operating room (OR) cases, gross charges, work relative value units, and provider full-time equivalents between October of 2011 and September of 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division.
Results:
Since 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per physician (MD). In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, and the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total work relative value units and gross charges increased across the department and per provider, despite fewer overall providers since 2021.
Conclusions:
Increased use of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.
Related Concept Videos
01:21Cancer Survival Analysis
01:26Methods of Documentation II: POMR