APP Use Grows in Certain Surgical Disciplines but Doesn’t Align with Areas of Greatest Need

Modi PK, Kaufman SR, Hill D, et al. Integration of Advanced Practice Providers into Independent Surgical Groups. J Am Coll Surg. 2025; in press.

Nurse practitioners and physician assistants—collectively known as advanced practice providers (APPs)—are increasingly being employed to extend surgeon capacity and access, especially in independent group practices.

Using 2010–2020 Medicare data to identify patients managed by surgical groups in four disciplines (cardiothoracic surgery, general surgery, orthopaedic surgery, and urology), Parth Modi, from The University of Chicago, and colleagues characterized trends in APP deployment overall, by type of practice setting (e.g., in-patient, outpatient, hybrid), and by supply of surgeons in a particular geographical area. 

Comparing data from 2015 to 2020, the researchers found an increased use of APPs for urology, general surgery, and orthopaedic surgery, but a decreased use for cardiothoracic surgery. Deployment and type of assistance varied by discipline; however, use of APPs to provide surgical assistance decreased for all reviewed specialties. 

Additionally, they found that counties with the lowest supply of surgeons in 2015 saw no significant change in the supply of APPs, suggesting growth was not aligned with areas in greatest need.