Alternative Approaches to Expanding Pediatric Urology Services and Productivity Stephen Canon,* Kyle Basham, Honor Lee Canon, Jody Ann Purifoy and Christopher Swearingen From the Department of Urology (SC, JAP), School of Medicine (KB) and Department of Pediatrics (HLC, CS), University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas Purpose: We critically assessed the outcomes of a new model of pediatric urology delivery using alternative approaches to expand care without increasing the number of pediatric urologists. The approaches included the use of advanced practice nurse practitioners, pediatric physician specialists, part-time contract pediatric urologists from neighboring institutions and part-time contract adult urologists from our university. Materials and Methods: Data were collected from the Division of Pediatric Urology at Arkansas Children’s Hospital during 2009 and 2010. The only pedi- atric urologist at our institution retired in December 2009 with an immediate transition to a new pediatric urologist in January 2010. Comparisons were made in the numbers of clinic visits, inpatient admissions/consultations, surgical vol- ume and patient satisfaction scores. Results: Average clinic monthly visits in 2009 and 2010 were 153 and 271, respec- tively (p 0.0001). Inpatient admissions increased from 43 in 2009 to 162 in 2010. Inpatient initial consultations and followup consultations increased by 115 and 112, respectively, from 2009 to 2010. Surgical volume increased 26.7% in 2010 (p = 0.0832) and Press Ganey® scores were comparable or improved from 2009 to 2010. Conclusions: The use of advance practice nurse practitioners, part-time contract adult and pediatric urologists, and pediatric physician specialists can effectively increase the number of patients treated without adding full-time pediatric urol- ogy staff. The assignment of patient and disease populations to each team member has been an ongoing process of critically defining and updating respon- sibilities in an attempt to expand care, increase productivity and maximize the quality of delivery of these services. Key Words: nurse practitioners, patient care team, physician assistants, pediatric assistants Abbreviations and Acronyms APN = advance practice nurse practitioner PNP = pediatric nurse practitioner * Correspondence: Department of Urology, University of Arkansas for Medical Sciences, 1 Children’s Way, Slot 840, Little Rock, Arkansas 72202 (telephone: 501-364-2614; FAX: 501-364- 3960; e-mail: scanon@uams.edu). ALTHOUGH 20 applicants matched into a pediatric urology fellowship position in 2012, 1 this number is likely behind the curve of the growing need for pe- diatric urology services in the United States. The demand for all pediatric subspecialists is increasing as sur- vival rates increase for premature in- fants, children with previously fatal conditions and those with chronic con- ditions requiring extensive ongoing care. 2 The National Survey of Chil- dren With Special Health Care Needs showed that the inadequate numbers of pediatric subspecialists increased the chance that those patients would be unable to receive adequate spe- cialty care. 2,3 We propose a model of augmenting the care provided by pe- diatric urologists with the addition of 0022-5347/12/1884-1639/0 http://dx.doi.org/10.1016/j.juro.2012.03.043 THE JOURNAL OF UROLOGY ® Vol. 188, 1639-1642, October 2012 © 2012 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. Printed in U.S.A. www.jurology.com 1639