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Integration of Advanced Practice Providers into Independent Surgical Groups.

Parth K Modi¹, Samuel R Kaufman², Dawson Hill³

¹From the Section of Urology, Department of Surgery, University of Chicago, Chicago, IL (Modi).

Journal of the American College of Surgeons

|August 1, 2025

Summary

Advanced practice providers (APPs) increased in surgical groups, but their growth did not align with areas of greatest surgeon need. APPs are also less frequently used for surgical assistance across specialties.

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Area of Science:

Health Services Research
Surgical Workforce Analysis
Healthcare Policy

Background:

Advanced practice providers (APPs) are increasingly utilized to augment surgeon capacity and improve patient access.
The specific roles and deployment patterns of APPs within surgical specialties relative to unmet needs remain unclear.

Purpose of the Study:

To analyze trends in the deployment of APPs within surgical specialties from 2010-2020.
To determine if APP growth aligns with areas experiencing shortages of surgeons.

Main Methods:

Utilized Medicare data (2010-2020) to identify patients managed by surgical groups.
Identified APPs and characterized their deployment (outpatient, inpatient, hybrid).
Assessed APP supply growth relative to surgeon supply in 2015 using a two-part model.

Main Results:

APP numbers increased in urology, general surgery, and orthopedic surgery, but decreased in cardiothoracic surgery.
APP deployment varied by specialty and setting; surgical assistance roles declined across all specialties.
APP supply growth was concentrated in areas with moderate surgeon supply, not in those with the greatest need.

Conclusions:

APP growth in urology, orthopedic, and general surgery did not target areas with the lowest surgeon supply.
The utilization of APPs as surgical assistants has decreased across all analyzed surgical specialties.
Findings suggest a misalignment between APP deployment and critical access needs in certain surgical fields.