Integration of Advanced Practice Providers into Independent Surgical Groups

Nurse practitioners and physician assistants are increasingly employed to extend surgeon capacity and access. However, their roles and the extent to which their deployment aligns with unmet needs are unknown.

Medicare data were used to identify patients managed by surgical groups (urologists, orthopaedic, general, and cardiothoracic surgeons) from 2010 to 2020. Advanced practice providers (APPs) in these groups were identified using the Medicare Data on Provider Practice and Specialty file. Trends in deployment of APPs (ie outpatient only, inpatient only, hybrid of both inpatient and outpatient) were characterized. The supply of surgeons per population was measured in 2015 using the Area Resource File. A 2-part model was used to measure the relative growth in supply of APPs between 2015 and 2020 by surgeon supply in 2015.

The number of APPs employed increased for urology, general surgery, and orthopaedic surgery, whereas they decreased for cardiothoracic surgery (all p values for trend <0.01). Deployment of APPs in the outpatient and inpatient settings varied by specialty. However, APP providing surgical assistance decreased for all specialties (all p values for trend <0.01). APP supply increased significantly from 2015 to 2020 in counties in the middle quantiles for the supply of urologists, orthopaedic surgeons, and general surgeons in 2015. In counties with the lowest supply of cardiothoracic surgeons, the supply of APPs employed by independent surgical groups increased by 36.9% (95% CI 1.7% to 72.1%).

In urology, orthopaedic surgery, and general surgery, counties with the lowest supply of surgeons in 2015 saw no significant change in the supply of APPs, suggesting that growth was not aligned with areas in greatest need. Across all specialties, APPs are less commonly deployed as surgical assistants.