What Are the Trends in the Utilization of Orthopaedic Advanced Practice Professionals? A Large Database Medicare Study

Abstract

Background: Advanced practice professionals (APPs), such as physician assistants (PAs) and nurse practitioners (NPs), are expected to have an increasing role in delivering high-quality orthopaedic care in the coming years. Our analysis aimed to determine the current proportion and geographic distribution of APPs in orthopaedics. In addition, we predicted future growth into 2025. Methods: Our analysis was a retrospective, large national database study evaluating services provided by APPs from 2014 to 2019 using the Medicare Provider Utilization and Payment Data prepared by the Centers for Medicare & Medicaid Services (CMS). NPs and PAs were recognized by provider type and aggregated to form the APP group for analysis. Mann-Kendall trend tests were used to evaluate changes in the number of each provider type. Poisson regression will be used to predict the expected number of APPs in the field up to the year 2025. Results: From 2014 to 2019, there was a 34.36% increase in the number of orthopaedic APPs (5,480-7,363), compared with a 5.37% increase in orthopaedic surgeons (22,518-23,728). APPs were located in predominately large metropolitan areas (96%), followed by small metropolitan (3.6%) and rural areas (0.4%). Using data from our study period, we projected that by 2025, there will be 10,484 APPs in orthopaedic surgery [95% Confidence Interval (CI): 9,004-11,964 providers]. This represents an 84% increase over the decade between 2015 and 2025. Conclusion: Our analysis demonstrated that the volume of established patient visits and various nonsurgical services provided by APPs in orthopaedic surgery continues to grow. The number of APPs and surgeons in orthopaedics is increasing, but the proportion of APPs choosing orthopaedics as a speciality is on the decline. Furthermore, we found a greater proportion of PAs in orthopaedics than NPs. Because the demand for services for orthopaedic surgery continues to grow, APPs may serve as one possible solution to increase access to orthopaedic care, and additional programs should be developed to improve the educational access for APPs to train in orthopaedics.