8. WORKING WITH ADVANCED PRACTICE PROVIDERS (APPs

7.2 Peer Reviewer Opportunities

The AUA is always looking for members to serve as volunteer peer reviewers for its world-class journals, including The Journal of Urology®. Learn more about the AUA’s publications and the publishing process by reviewing the work of the most respected urology professionals in the world. Interested in becoming a peer reviewer? Contact Jennifer Regala, AUA Director of Publications/ Executive Editor at jregala@AUAnet.org.

7.3 Additional Opportunities

Each year, the AUA Young Urologists Committee hosts a Speed Mentoring program for trainees at the AUA Annual Meeting. The program, which allows for 25 trainees to meet one-on-one with early-career mentors to discuss a variety of topics including life after training, career advice, surgical education, leadership skills and more, recruits volunteer mentors on an annual basis. If you are interested in serving as a mentor at next year’s Speed Mentoring program, please email youngurologists@AUAnet. org. In addition, the Committee also hosts a "Meet the AUA Leaders" program at Annual Meeting, where early-career urologists can network and connect with established leaders within the organization in a small-group, structured setting. Pre-registration for the event opens each year a few months prior to the meeting. In summary, there are numerous opportunities for young urologists to volunteer and get involved in the AUA. Begin by familiarizing yourself with information on the AUA website and reaching out to established AUA leaders or your AUA Section leadership to gain further insights and/or express your interest in volunteering.

8. WORKING WITH ADVANCED PRACTICE PROVIDERS (APPs)

Content in this section is taken from the AUA’s 2021 “Current State of Advanced Practice Providers in Urologic Practice” paper. The full and most updated version of the paper can be accessed at www.AUAnet.org/guidelines/guidelines/current-state-ofadvanced-practice-providers-in-urologic-practice. A workforce shortage of 65,000 physicians is projected for both primary care and specialty medicine by the year 2025. Similarly, the supply of urologists per capita in the United States continues to decrease, a trend that started in 1991 and continues to accelerate. In 2018, there were 3.89 urologists per capita, which is only a modest improvement from 2009, where there were only 3.18 urologists per 100,000 in the population, which was a 30-year low and amongst the most severe specialty medicine shortages. This is compounded by the fact that urology has the second oldest surgical subspecialty workforce with an average age of 52.5 years and of whom greater than 18% are age 65 years or older. As of February 2014, the AUA recognizes APRNs and PAs as Advanced Practice Providers (“APPs”). The term “allied health professional” applies to nurses (registered nurses [RNs], licensed practical nurses [LPNs], and licensed vocational nurses [LVNs]), technicians, and medical assistants. The AUA endorses the use of APPs in the care of patients with genitourinary disease through a formally defined, supervised role with a board-certified urologist under the auspices of applicable state law.

8.1 Defining the Nurse Practitioner (NP) Role

“APRN” is a term that covers four distinct areas of certification: certified NP, certified nurse midwife (CNM), Clinical Nurse Specialist (CNS), and certified registered nurse anesthetist (CRNA). The 2008 APRN regulatory model established these four categories and denoted advanced graduate nursing preparation specific to each of these areas of certification. Each APRN obtains a Bachelor’s of Science in Nursing (BSN) prior to admission to a graduate program, though some students may have additional undergraduate and graduate degrees. The student APRN then undergoes a population-focused but broad-based education at the graduate level and sits for a national certification examination to assess competencies of their specific core and at least one population focus area (such as adultgeriatrics or pediatrics). After passing the certification examination, individuals are licensed as independent practitioners subject to the specific regulation of a state board of nursing. Licensing implies congruence between certification, licensure, and population focus. An APRN cannot be licensed only in a specialty area, such as urology, but must first be certified in one of the four generalist APRN categories. The academic degree granted is either a Master of Science in Nursing (MSN), a Master of Science (MS), or a Doctorate of Nursing Practice (DNP), depending on the individual program. Initial certification requires evidence of degree status and at least 500 hours of clinical practice, although these requirements vary

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depending on the specific certifying body. NPs are often members of a larger team that provides comprehensive health and medical care to specific populations or in specific care environments. This model emphasizes health education, promotion of optimal health, and the facilitation of patient participation in self-care. The NP provides care for patients across the health continuum and functions in diverse settings, such as geriatrics, women's health, pediatrics, and specialty practices. The role of the NP includes diagnosis and treatment of both acute and chronic conditions. This extends to comprehensive history and physical examination; preventative screening and health assessment; ordering and interpreting laboratory and imaging studies; and prescribing medication, physical and occupational therapy, and durable medical equipment. This role often includes health education and teaching individuals, families, groups, and other members of the health care team. Many NPs practice in primary care settings, but others have roles within specialty and subspecialty practices.

8.2 Defining the Physician Assistant (PA) Role

Prior to admission to a PA program, students must at minimum complete an undergraduate degree, with a minimum of two years of college courses in basic or behavioral sciences. PAs are medical professionals who have graduated from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), of which there are approximately 235 in the United States, and who are also nationally certified and state licensed to work with the supervision of a physician. PAs undergo training based on the medical model with a focus on primary care programs which typically extend over about 27 continuous months or three academic years, compared to about 38 months for medical school. The first phase of PA school (the didactic or classroom phase) covers basic medical sciences, including anatomy, physiology, pharmacology, physical diagnosis, behavioral sciences, and medical ethics. In total, PA students complete more than 75 hours in pharmacology, 175 hours in behavioral sciences, more than 400 hours in basic sciences, and nearly 580 hours of clinical medicine. In clinical practice, the role of a PA is as part of a team practicing medicine with physician supervision and is frequently described as delegated autonomy. The PA model of education emphasizes disease prevention, elimination of health disparities, and promotion of health and healthy behaviors. PAs provide care for patients across the health continuum and function in diverse settings that can include internal medicine subspecialties, acute care environments, general surgery, and surgical subspecialties. This extends to comprehensive history and physical examination skills; preventative screening and health assessment; ordering and interpreting laboratory and imaging studies; prescribing medications; and assisting in surgery. Although PAs do not specifically specialize with a population focus within their training program, PAs can obtain additional post-graduate fellowships in urology, general surgery, emergency medicine, or orthopedics.

8.3 Supervisory/Collaborative Model

Supervision/collaboration is a process in which an APP works with one or more physicians to deliver health care services within the scope of the practitioner’s expertise with medical direction and appropriate supervision as supported by jointly developed guidelines or other mechanisms as indicated by the law of the state in which the services are performed. This requires that each party share responsibility for care. Supervision/collaboration is an interactive process involving trust, excellent communication, mutual goals, and common direction in practice as well as a dynamic process dependent upon the skills and competencies of both the APP and physician. An important component of collaboration requires professional relations that foster the best patient outcomes and the optimal use of individual skills. This team model is an efficient way to provide high-quality medical care. The official position of the AUA is that APPs work in a closely and formally defined alliance with a urologist who serves in a supervisory role. This physician-led, team-based approach provides the highest quality urologic care. As the physician-led, team-based approach evolves, so do the definitions of supervisory and collaborative models of care between physicians and APPs. The role of APPs in a urology practice is dependent upon many factors, including academic vs. private practice, large vs. small group, APP experience, facility and practice needs, physician comfort level, and state laws. The supervisory/collaborative model may be described as delegated autonomy. This model fosters an appropriate growth in autonomy time as the physician and the APP become accustomed to working together.