Document Type


Publication Date



Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Urology, Center for Outcomes Research & Evaluation

MeSH Headings

Job Satisfaction, Humans, Urology, Patient Satisfaction, Physicians


Introduction There 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 has been limited research addressing the effect of increased utilization of APPs in the urologic setting and available research about patient satisfaction with APPs is mostly limited to primary care and non-surgical specialties. We are seeking to understand patient satisfaction with APPs in a urologic setting. The subspecialty nature of urologic practice leads us to believe that there may be measurable and meaningful differences in patient satisfaction.

Materials & Methods We performed a retrospective assessment of patient satisfaction surveys administered over a 3 month period at a single high-volume academic urology practice in Maine. Patients were queried shortly after an encounter with one of 8 APPs or 8 physicians. Seven survey questions, relating specifically to patient satisfaction, were abstracted for analysis. These were derived from the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). Responses to individual survey questions were assessed between provider category. The independent effect of provider type on patient satisfaction was assessed with multivariable analysis, controlling for available patient characteristics (age, race, gender, marital status).

Results We analyzed responses from 1018 patient encounters. Patients seeing APPs (vs a physician) tended to be older (79.9% of APP patient encounters were with patients over age 60, while 76.5% of physician encounters were with patients over age 60), more likely female (25.7% vs 17.5%), non-white (4.1% vs 2.5%), and less likely to be married or with a partner (69.1% vs 74.6%). On univariable analysis there were no significant differences between APPS and physicians in any of the 7 metrics measuring patient satisfaction. Following adjustment for covariates, there were still no differences in patient satisfaction as demonstrated in the Table.

Conclusions Despite the subspecialty nature of urologic practice, use of APPs is not associated with diminished patient satisfaction. While this finding suggests that patient satisfaction will not be reduced by increased utilization of APPs, more broadly, further research needs to clarify the most appropriate role for APPs within an outpatient urology practice. We plan further research to examine specific diagnoses and investigate the most appropriate role for outpatient urology APPs. Further, our study does not assess other clinically relevant patient outcomes, and more research needs to be done to examine the safety and efficacy of APP integration. Finally, 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 integrated into urologic care without decreasing overall patient satisfaction.


2020 Costas T. Lambrew Research Retreat