Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity

Abstract

Background: Advanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. Although small-scale studies across various surgical specialties have explored APP use, literature specific to the pediatric population is limited. This study assesses the impact of increased APP use on productivity within one of the largest pediatric surgery departments in the United States.

Methods: Data were sourced from the Surgery Department Executive Committee annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, operating room (OR) cases, gross charges, work relative value units, and provider full-time equivalents between October of 2011 and September of 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division.

Results: Since 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per physician (MD). In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, and the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total work relative value units and gross charges increased across the department and per provider, despite fewer overall providers since 2021.

Conclusions: Increased use of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.