Advanced Practice Providers in Pediatric General Surgery: A Single-Institution Analysis of Impact on Clinical and Surgical Productivity

Abstract

Introduction: Advanced practice providers (APPs) were initially introduced to the healthcare system due to primary care provider shortages but have since broadened their scope of practice across surgical and non-surgical specialties. There is a paucity of literature regarding how APPs can improve divisional productivity within pediatric general surgery. This study aims to explore the impact of increased APP implementation within the division of pediatric general surgery at a tertiary children's hospital.

Methods: Retrospective review of clinic administrative data and data from the Surgery Department Executive Committee (SDEC) annual report, from fiscal year October 2012 to September 2024, was performed. SDEC is an institutional committee and is composed of the surgical division chiefs and administrative leadership. Descriptive analysis was conducted, and productivity trends were examined, including clinical encounters and surgical volume by provider type, clinic visit-to-surgery conversion ratio, and work relative value units (wRVUs).

Results: From FY 2013 to 2024, the number of APP cFTEs has increased 373 %, which has been associated with increased division clinical productivity. APP clinic visits increased from 253 in 2013 to 8,161 by 2024. The MD clinic visit to surgery conversion rate improved from 1 OR case per 2.08 MD clinic visits in FY 2013 to 1 OR case per 1.14 MD clinic visits in FY 2024. Annual clinical productivity metrics, after adjusting for inflation, have increased since FY 2013.

Conclusion: The implementation of APPs within a pediatric general surgery division can expand clinical access to care and improve divisional productivity.

Keywords: Advanced practice providers; Pediatric general surgery; Pediatrics; Productivity; Surgery.