In the United States, we lack enough physicians specialty-trained in urogynecology and reconstructive pelvic surgery (URPS) to care for women with pelvic floor disorders. Despite the influx of newly-trained URPS physicians, patient-to-provider ratios are estimated at more than 27,00 to one, with no expected improvement in the next 20 years, even in physician-dense urban areas [1,2]. Our aging population exacerbates this problem, as women aged 65 years and older and 85 years and older are projected to double and triple respectively over the next three decades [3, 4, 5, 6].

To address the growing need for urogynecology care, the role of advanced practice providers (APPs) who complete advanced training and education, becomes practicable. Other surgical specialties, such as ophthalmology and orthopedic surgery, utilize APPs as initial consultants with promising results in agreement in diagnosis and decision-making, improved access to care, and high patient satisfaction [7, 8, 9, 10]. The American Urogynecologic Society (AUGS) emphasizes the essential role of APPs and offers courses and training guides to enhance APP skill and knowledge. This support allows APP scope of practice within urogynecology to include evaluation, management, and performance of office-based procedures. Despite these factors, there is limited guidance and a lack of published research supporting the integration of APPs in urogynecology.

This study evaluated an outpatient care model wherein APPs functioned as new patient consultants. To establish feasibility, we determined the concordance (agreement) of a recommended care plan for operative intervention between the APP at an initial consultation and the surgeon at a subsequent consultation. We hypothesized that this care model would yield a high concordance (at least 90%) between the APP and surgeon, and that this level of concordance could provide preliminary support for APPs acting in this role.