Integrating advanced practice providers in kidney stone prevention: patterns, barriers, and opportunities

Amid rising demand for urologic care and a projected workforce shortfall, advanced practice providers (APPs) are increasingly vital partners. Kidney stone prevention (KSP) represents a setting where APPs may improve access, efficiency, and continuity of care, yet data on their outpatient utilization remain limited. This study evaluated APP roles in KSP clinics and barriers to integration. An IRB-approved 12-question survey was distributed to Endourological Society members (January-March 2024). It assessed provider characteristics, practice settings, APP roles in KSP care, oversight models, satisfaction (5-point Likert scale), and perceived barriers. The response rate was 17% (69/413); 49.3% reported using APPs. United States (U.S.)-based urologists were more likely to employ APPs than international peers (76.3% vs. 16.1%). APPs were primarily in academic settings (85.3% overall; 93.1% in the U.S. cohort), performing metabolic urine interpretation (93.9%), serum lab review (90.9%), imaging review (87.9%), medication management (84.8%), and nutritional counseling (78.8%). Satisfaction was highest for serum lab monitoring (86.2%) and urine testing (83.3%), lower for imaging (63.3%). Half reported no formal physician oversight. Endourology fellowship training was associated with greater APP use on univariate analysis (OR 3.11, CI 1.06-10.1, P = 0.045), though not within the U.S. cohort (OR 2.40, CI 0.40-13.0, P = 0.300). Barriers included availability (41.2%), organizational constraints (41.2%), and cost (38.2%). APPs are increasingly integrated into KSP clinics, particularly in U.S. academic practices, with high satisfaction and broad clinical responsibilities. Persistent geographic disparities and variable oversight highlight the need for standardized competencies, clearer guidelines, and further study. Thoughtful APP integration may enhance access, quality, and sustainability of urologic care.