Advanced practice providers in pediatric otolaryngology/head and neck surgery: A single-institution analysis of clinical and surgical productivity

Abstract

Introduction: Advanced practice providers (APPs) initially delivered primary care amidst physician shortages; however, they have since expanded their practice across various specialties. While benefits of APPs are known, there is a paucity of literature regarding how APPs can increase productivity within pediatric otolaryngology/head and neck surgery (OHNS). This study aims to identify the impact of APP integration within pediatric OHNS at a level I pediatric hospital in Houston, Texas.

Methods: Retrospective review of data from the Surgery Department Executive Committee annual reports from October 2011 to September 2024 was conducted. Descriptive analysis was completed with productivity in clinic and operative volumes, surgical conversion rates, and work relative value unit (wRVU) trends.

Results: Since fiscal year 2012, the ratio of APPs to MDs nearly doubled from 1 APP per 4.5 MDs to 1 APP per 2.45 MDs in 2024. The largest observed APP clinic volume was in 2024 at 16,881 visits, over 3.5x greater than in 2012. Operative volume increased by over 300 % from 2012 to 2024. APPs have significantly increased the number of inpatient consults, subsequent visits, and common OHNS procedures completed since 2012. Division wRVUs were observed to increase nearly four-fold from 2012 to 2024.

Conclusion: APPs promote surgeon scope of practice, producing clinical and financial benefits for pediatric otolaryngology/head and neck surgery practices. Structured training programs adequately prepare APP trainees to increase access to care, improve perioperative flow, and allow surgeons to function at the top of their licensure.

Keywords: Advanced practice providers; OHNS; Otolaryngology; Pediatrics; Productivity.