Urology outpatient procedures by physician associates and nurse practitioners

Physician associates (PAs) and nurse practitioners (NPs) are distributed across 70 medical and surgical specialties. A central role is to provide outpatient care. Urology is a significant employer of PAs and NPs, but their scope of practice in the ambulatory setting needs to be better delineated.

We conducted a retrospective cohort analysis of frequently performed ambulatory urological procedures identified by the American Urological Association, drawing on Medicare Procedure Summary master files.

We analyzed Part B Medicare outpatient urology procedure claims from 2014 through 2021. The analysis compared the procedural reimbursable claims filed by urologists, PAs, and NPs.

From 2014 to 2022, urologists, PAs, and NPs filed over 35 million outpatient urology procedural claims. In 2021, ultrasound measurement of bladder capacity after voiding, endoscopic examination of the bladder and urethra, and electronic assessment of bladder emptying were the most performed procedures. The number of urologists filing claims for the 15 most common outpatient procedures decreased slightly by 0.66% between 2014 and 2021, while the number of PAs and NPs who did so increased by 109% and 156%, respectively. Although urologists performed nearly 13 times as many commonly performed outpatient procedures, the number performed by urologists declined by 15%. In contrast, the number of urologic procedures performed by PAs and NPs increased by 130% and 162%, respectively.

This analysis of mostly older Americans receiving urological care illustrates a broadening scope of practice for PAs and NPs in this specialty. The results exemplify team-based care and the economic principle of task transfer in urology. This shift in ambulatory proceduralist roles occurred as the demand for urological care increased while the supply of urologists lagged.