Limitations in practice reported among Advanced Practice Providers

Limitations in practice reported among Advanced Practice Providers | Image Credit: © goodluz - © goodluz - stock.adobe.com.

Many Advanced Practice Providers (APPs) face limitations in their scope of practice, according to a recent study published in Fertility and Sterility.¹

The adverse impact of the lack of fellowship-trained reproductive endocrinologists at fertility centers may be alleviated by leveraging the experience of AAPs. This practice may also improve care among patients seeking fertility treatment and reproductive health care.

Investigators conducted a study to evaluate APP demographics, training, and utilization in the field of reproductive endocrinology and infertility (REI). From June 10, 2023, to September 30, 2023, participants received a survey online through the American Society of Reproductive Medicine (ASRM) APP Professional Group.

There were 201 participants included in the final analysis, 33.3% of whom were Women’s Health Nurse Practitioners, 29.9% Physician Associates-Certified, and 26.4% Family Nurse Practitioners. Working in private practice was reported by 78.1%, hospitals by 6%, and academic settings by 11%.

A nearly even split of the number of physicians working in the practice was reported, with 35.52% having 3 or less physicians, 37.81% having 4 to 10, and 26.97% having more than 10. However, most respondents worked in a practice with 3 or less APPs.

Observation or on-the-job training during the onboarding process was reported by 94% of respondents, independent reading texts by 66.7%, ASRM online courses by 45.3%, formal orientation by 34.8%, and practice-organized training programs by 29.4%. Onboarding training most often lasted for 3 to 4 months.

Being the primary provider of new patients was reported by 30.4% of respondents and performing new patient evaluations before transferring the patient to a physician by 19.9%. Of respondents, 15.4% reported co-managing new patient consults with a physician, while 23.4% did not report seeing new patients.

Autonomy in deciding patient protocol and treatment options was reported by 61.7% of respondents, with 43.7% of time spent on procedures and scans, 30.3% on consults and follow-ups, 14.9% on patient administration, 7.8% on management responsibilities, and 3.4% on research.

Physical exams and intrauterine insemination were the most common duties, reported by 88.6% and 86.6% of respondents, respectively. These were followed by saline sonohysterograms by 79.6%, endometrial biopsies by 76.6%, and ultrasounds by 74.6%.

Being limited by an employer was reported by 67.4% of respondents, while 43.6% reported limitations caused by state restrictions and 25.2% by insurance. This highlighted limitations by a majority of APPs despite variations in the utilizations and autonomy within REI practices.

Differences in the duration and methodology of onboarding training were observed, indicating a need for improvements in educational resources to help APPs practice at the top of their licensure. Investigators also noted an “underutilized opportunity to meet increasing demand in REI,” indicated by limitations in APPs’ scopes of practice.

This data supports a previous study evaluating differences in collaboration with APPs based on familiarity with APP skill sets.² The survey was sent to ASRM members and data was compared between REIs using descriptive statistics and Chi-square.

Of respondents, 60.15% were REIs and 11.39% were APPs. Collaboration with APPs in REI practice was reported by 77.93% of respondents. Among REIs using APPs in their practice, 60% stated that low complexity REI-medical decisions could be completed by APPs, vs only 35% of those not using APPs in their practice.

These results indicated increased comfort collaborating with APPs among REIs currently employing APPs in their practice vs those not employing APPs. Investigators concluded familiarity with APP skill sets improves confidence in APP partnerships within REI practices.

References

1. Tobias TT, Callahan NK, Augustine L, Tanaka B. Patterns of utilization of advanced practice providers in reproductive endocrinology: A 2023 national survey. Fertility and Sterility. 2024;122(4):E76.
2. Marie Brown A, Devine K, Clain E, Flyckt R. Perspectives on advanced practice providers (APPs) participation in reproductive endocrinology an infertility (REI) differs based on practice experience. Fertility and Sterility. 2024;122(4):E22.