An Examination of Patient Satisfaction According to Diagnosis between Urology Physicians and Advanced Practice Providers
Erin Santos, PA, MPH, Evelyn James, MPH, Kelly Ernst, FNP, CUNP, Matthew Hayn, MD, Jesse D. Sammon, DO.
Maine Medical Partners Urology, South Portland, ME, USA.
AbstractIntroductionThere is a projected national shortage of urologists in the coming decade. The American Urological Association supports the incorporation of advanced practice providers (APPs) into urologic practices. However, there is limited research addressing the effect of increased utilization of APPs in the urologic setting. There has been research to suggest the use of APPs in the urologic setting is not associated with diminished patient satisfaction. However, it remains unclear if this holds true across the entire spectrum of urologic diagnoses. Given the wide variety of possible diagnoses new patients are assessed for, we hypothesized that there would be measurable and meaningful differences in patient satisfaction.
Materials & MethodsWe performed a retrospective assessment of patient satisfaction surveys administered over a 2 year period at a single high-volume urology practice in Maine. Patients were queried shortly after an encounter with one of 13 APPs or 11 physicians. Patient satisfaction was assessed by the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). Responses were analyzed across specific diagnoses between provider category (APP vs physician). The independent effect of provider type on patient satisfaction for 17 different diagnoses was assessed with multivariable analysis, controlling for available patient characteristics (age, race, gender, marital status).
ResultsWe reviewed 8639 new patient visits from July 2020 to June 2022. The final study cohort included 2831 patients who responded to the survey and had a diagnosis of interest. Patients seeing APPs (vs a physician) were more likely female (31.4% of APP patient encounters were with female patients while 22.7% of physician encounters were with females) and non-white (4.7% v 3.7%). Multivariable analyses for each diagnosis population, controlling for covariates, found there were no significant differences in patient satisfaction between APP and physician excluding the cancer population. This is demonstrated in the Table.
ConclusionsDespite the subspecialty nature of urologic practice, previous research shows use of APPs is not associated with diminished patient satisfaction. However, when analyzed by specific diagnosis patient satisfaction is diminished when being seen by an APP for a cancer diagnosis. In our
patient cohort, patients with a cancer diagnosis are predominantly seen by a physician. In the rare instances that a patient has an initial visit with an APP for cancer there was decreased satisfaction. Therefore, all efforts should be made to schedule these patients with a physician. All other diagnosis analyzed there was not diminished satisfaction. Our findings suggest that with the exception of cancer patient satisfaction will not be reduced by increased utilization of APPs. More broadly our study does not assess clinically relevant patient outcomes, and more research needs to be done to examine the safety and efficacy of APP integration. Further, it is important to examine our study's findings in a more broadly representative population as our patient population does not reflect the national averages. Nonetheless, given the impending national shortage of urologic physicians, our findings support the notion that APPs can be thoughtfully integrated into urologic care without decreasing overall patient satisfaction.
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