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Optimizing clinical productivity: A single-institution analysis of APP utilization in pediatric plastic surgery
Sarah A Layon1, Michelle G Roy, Matthew J Parham
1Sarah A. Layon is a plastic and reconstructive surgery clinical research fellow at Baylor College of Medicine and Texas Children's Hospital in Houston, TX. Michelle G. Roy is a PA in pediatric plastic & reconstructive surgery at Baylor College of Medicine and Texas Children's Hospital, a clinical assistant professor at Baylor College of Medicine, a surgery APP quality and research coordinator at Baylor College of Medicine, and clerkship director of the PA surgical fellowship program at Texas Children's Hospital. Matthew J. Parham is a plastic and reconstructive surgery clinical research fellow at Baylor College of Medicine and Texas Children's Hospital. Heather R. Burns is a plastic and reconstructive surgery clinical research fellow at Baylor College of Medicine and Texas Children's Hospital. Jordan L. Rodriguez is program coordinator, chief administrative officer, and project manager for the Department of Surgery APP Fellowship at Texas Children's Hospital. Larry H. Hollier, Jr . is the President of Health Affairs, surgeon-in-chief and chair of the Department of Surgery at Texas Children's Hospital; vice chair of surgery at Baylor College of Medicine; S. Baron Hardy chair in plastic surgery at Texas Children's Hospital; and a professor of plastic surgery, orthopedic surgery, and pediatrics at Baylor College of Medicine. Kristina Marsack is director of the Department of Surgery Advanced Practice Providers; academic director of PA Surgical, Orthopedic and Community Fellowships; an associate professor; and a practicing PA at Baylor College of Medicine and Texas Children's Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Background:
Advanced practice providers (APPs) are integral to plastic surgery practices due to the frequency of staged procedures, perioperative care, and broad scope of practice. Our study evaluates the impact of APP utilization in one of the largest pediatric plastic surgery divisions in the United States.
Methods:
Descriptive analyses were conducted to describe productivity trends from October 2012 to September 2023. Metrics included the number of clinic encounters, providers, operating room (OR) cases, and surgical conversion rate.
Results:
In 2013, APPs completed one patient encounter for every five completed by surgeons. Since 2020, APPs have matched or exceeded the number of clinic encounters conducted by surgeons. The surgeon surgical conversion rate (surgeon clinic encounters to OR cases) increased from 0.19 in 2018 to 0.26 in 2023.
Conclusions:
Enhanced utilization of APPs in the division of plastic surgery has optimized our patient care model, increasing procedural productivity for surgeons without reducing clinic volume.
