APP procedures in Urology

[akuko2]

A recent episode of the AUA’s podcast Inside Tract (link below) mentions that APPs may be trained to perform cystoscopies, TRUS, prostate biopsies, and even vasectomies. Do you think that the expanded use of APPs in procedures would be a net benefit for urologist’s scope of practice and bottom line?

AUA Inside Tract Podcast - Episode 75 - American Urological Association

Today's episode of the AUA Inside Tract podcast is based on a section of the "Transitioning from Residency to Practice Manual." This manual is now in its 4th Edition and has been prepared by the AUA's Young Urologists Committee (YUC). The Young Urologists Committee has prepared this manual to...

www.auanet.org

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[armybound]

Bottom line, sure, if you're private practice employing an APP and you have more procedures than you can fit in to your schedule.

I've seen places like MD Anderson use PAs to do prostate biopsies, which leaves the MDs to focus time on more level-appropriate skills. I think it's a great thing.

Trusting someone's cysto findings can be very difficult, especially someone who has not had the training and experience an MD has.

 

[deleted480308]

take a cruise through anesthesia forums when considering to train midlevels to do your procedures

 

[cpants]

Personally, I don't want our APP's doing many procedures aside from catheter placements and irrigations and maybe priapism takedown. I'd rather use them to extend me to be able to do more procedures by seeing routine follow up patients and simpler consults in the office and taking those things off my plate.

In office procedures are lucrative, fun, and break up my day. I'm also employed so giving my procedures to other people hurts my reimbursement.

 

[DoctwoB]

My office doesn’t use APPs for most procedures. I know some that do. If you have so much procedure volume that you need APPs to handle them more power to you I guess, but that isn’t typical. I also would be concerned about APPs in diagnostic cystos. It’s one thing in a bladder Ca patient where you’ll be looking again 3 or 6 months later, it’s another in a gross hematuria patient where if you miss something you may not see them back until it’s too late.

Our office nurses do most minor things, catheters, SPT exchanges, etc. That said I wouldn’t mind an APP that could scope in a foley . . .

 

[akuko2]

Bottom line, sure, if you're private practice employing an APP and you have more procedures than you can fit in to your schedule.

I've seen places like MD Anderson use PAs to do prostate biopsies, which leaves the MDs to focus time on more level-appropriate skills. I think it's a great thing.

Trusting someone's cysto findings can be very difficult, especially someone who has not had the training and experience an MD has.

Bottom line, sure, if you're private practice employing an APP and you have more procedures than you can fit in to your schedule.

I've seen places like MD Anderson use PAs to do prostate biopsies, which leaves the MDs to focus time on more level-appropriate skills. I think it's a great thing.

Trusting someone's cysto findings can be very difficult, especially someone who has not had the training and experience an MD has.

Do they just do sextant biopsies or uronav? I guess it makes sense to do template bx for elevated PSA consults but are more complicated pt and those on active surveillance done by MDs?

 

[mmag]

NP's can already legally perform vasectomies in 3 states: Washington, Alaska and Oregon. And apparently according to this article in Washington state, they can do colonoscopies and breast biopsies,

Oregon nurse practitioners can now perform vasectomies

Vasectomies are generally safe, but complications happen in an estimated 1 to 2 percent of cases. When they do, Dr. Andrew Neeb, a urologist with Urology Specialists of Oregon in

www.bendbulletin.com

 

[mestielest]

The real problem is: things can go really fckng bad in urology. Even cystoscopy can turn into a nightmare. It's hard to find someone who can make even catheter things safe. Most of the nurses I have seen are lacking self-control. I also learned *not to harm* after being a consultant.

 

[DoctwoB]

The real problem is: things can go really fckng bad in urology. Even cystoscopy can turn into a nightmare. It's hard to find someone who can make even catheter things safe. Most of the nurses I have seen are lacking self-control. I also learned *not to harm* after being a consultant.

Likewise vasectomies can be a hair raising experience on an awake patient. I know urologic oncologists who wouldn’t bat an eye at losing a liter of blood in a kidney case get nervous on a difficult vasectomy.

 

[mestielest]

Likewise vasectomies can be a hair raising experience on an awake patient. I know urologic oncologists who wouldn’t bat an eye at losing a liter of blood in a kidney case get nervous on a difficult vasectomy.

Very much like performing a circumcision under local anesthesia on a crying baby 🙂