(85) Is There a Role for an APP in Your Surgical Practice? The Michigan TMJ and Orthognathic Surgery Experience

Abstract:
Statement of the Problem: An Advanced Practice Provider (APP), eg a nurse practitioner (NP) or physician assistant (PA), is a medical practitioner with specialized training to diagnose and manage various conditions. APPs have been increasingly incorporated into the care models for surgical subspecialties such as Plastic Surgery, where they deliver clinical care and perform noninvasive aesthetic procedures (Das K et al 2024, Khetpal S et al 2021). In an Otolaryngology practice, transitioning from a concurrent to a collaborative clinic increased patient access by 39% (Sharma N et al 2021). APP integration in pediatric surgery was shown to significantly increase procedural productivity for surgeons while preserving patient access to care (Layon SA et al 2024). These examples illustrate multiple benefits of APP involvement in care models and invite the idea of utilizing such a model in other fields, including our own.
Materials/

Methods: The University of Michigan OMS department currently includes 6 APPs across outpatient, inpatient, and intra-operative settings (Chinoy and Shivers, 2023). Two outpatient NPs see most new patients and return visits for TMJ and orthognathic consults, both in-person and virtually. In addition to performing diagnostic assessments and coordinating and managing peri-operative care and education, they also perform biopsies, TMJ arthrocentesis, and intra-articular as well as muscular/tendon/ligament injections. This study analyzed quantitative (eg RVUs, number of encounters) and qualitative (resident survey) data at the University of Michigan from 2023-2025 to describe the integration of APPs into an OMS practice.
Methods of Data Analysis: We report on the impact of an NP’s independent practice on access to care, clinical productivity (RVUs), utilization metrics, conversion of surgical consults to operating room cases, as well as impact on surgical trainees’ education (resident survey). This study also addresses potential disadvantages of this model, eg, cost, time required for reviewing complex cases, and possible reduction of non-surgical case volume for residents.
Results and Outcomes Data: Analysis of clinical activity of 2 outpatient APPs over the course of 2024 revealed that together, they had 4013 procedures and/or visits, 29.7% of which were virtual in nature, generating 3256 RVUs. For one APP, RVUs from 2024 were a 63.5% increase from the year prior, demonstrating an overall increase in access to care.

Conclusions: This study describes the justification used for hiring and training of APPs for specialized care, transition to independent practice, diagnosis-driven guidelines for clinical decisions, and mechanisms for ongoing support. APPs can provide effective and specialized care in a TMJ and orthognathic surgery practice at an academic medical center. They can serve as valuable members of the surgical team, leading to reduced patient wait times, expanded access to care, reliable continuity of care, increased productivity, and greater efficiency.

References
Chinoy A, Shivers PL. Can We Talk About Our APPs? J Oral Maxillofac Surg. 2023 Sep;81(9):1067-1068.

Das RK, Bittles O, Thayer WP, Drolet BC, Perdikis G. Trends in advanced practice providers in plastic and reconstructive surgery, 2013-2021. J Plast Reconstr Aesthet Surg. 2024 Nov;98:211-213.

Khetpal S, Lopez J, Steinbacher D. The Rise of Physician Assistants and Nurse Practitioners in Medically Necessary, Noninvasive Aesthetic Procedures for Medicare Beneficiaries. Plast Reconstr Surg. 2021 Jul 1;148(1):163e-165e.

Layon SA, Marsack K, Parham MJ, Burns HR, Hollier LH Jr. Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity. Plast Reconstr Surg. 2024 Sep 4.

Sharma N, Upjohn D, Donald C, Zoske KE, Aldridge CL, Lal D. Leveraging Advanced Practice Providers in an Otolaryngology Practice. Otolaryngol Head Neck Surg. 2021 May;164(5):959-963.