Bringing APPs Into Your Practice

In this episode of BackTable Urology, Brad Hornberger, PA in UT Southwestern’s Urology department, joins Dr. Aditya Bagrodia and Dr. Jose Silva to discuss how to successfully incorporate advanced practice providers (APPs) like physicians’ assistants and nurse practitioners into your urology practice.

First, Brad shares tips for onboarding new APPs. He emphasizes that onboarding depends on the experience of the new hire, as there is a difference between training a new graduate versus an experienced APP. He suggests a time period of 6 months for onboarding, which includes 6-12+ weeks of shadowing. He also notes the need to identify a champion who can take responsibility and set expectations for the new hire. Additionally, Brad explains two models of clinical supervision for APPs--the shared visit model, where the APP presents the patient to the urologist, versus the independent provider model, where the APP sees the patient autonomously. Determining which model works best depends on the experience of the new hire, state laws, and billing logistics.

Brad also briefly explains how to train APPs to assist in the operating room. He recommends a gradual apprenticeship system, where APPs are able to scrub in one-on-one with an experienced APP or a urologist. OR onboarding often depends on whether the APP has laparoscopic or robotic operating experience. Brad emphasizes that exposure to both clinical and surgical environments may be very professionally and intellectually enriching for APPs, who in turn will be more likely to stay at a practice for longer.