How to cite: Newman, DK. “Education of Urology APPs: A Crisis at Hand?” December 16, 2025. Accessed Mar 2026. https://grandroundsinurology.com/education-of-urology-apps-a-crisis-at-hand/
Summary
Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Senior Editorial Director, Grand Rounds in Urology; Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania, Philadelphia, Pennsylvania; and Adjunct Professor of Surgery, Division of Urology, Perelman School of Medicine, Emerita, describes a growing mismatch between demand for urologic care and the supply of urologists. Her presentation cites an aging US population and a workforce in which urologists are older than those in other surgical specialties, with retirement outpacing the training of new specialists. Most urologists work with at least one advanced practice provider, nurse Practitioner (NP) or physician assistant (PA). Dr. Newman predicts that by 2035, reliance on advanced practice providers will increase, while the number of urologists is expected to continue declining.
Dr. Newman defines the roles of NP and PA, including their training pathways and board certification requirements, and summarizes state variations in scope of practice. Advanced practice providers contribute to care across ambulatory and inpatient settings, including consultations, follow-up care, procedures, rounding, pre- and post-operative care, discharges, telemedicine, education, and survivorship programs.
Medicare Part B data from 2014 to 2021 show an increasing number of procedure claims by advanced practice providers, with a corresponding decline among urologists, followed by a transient pandemic-related dip. Dr. Newman highlights functional urology demand, such as benign prostatic hyperplasia, erectile dysfunction, and urinary incontinence. She shares an example of a testosterone replacement therapy clinic day, run by a nurse practitioner, with charges of $413,000 over six months and net collections exceeding $100,000 after accounting for equipment costs.
Dr. Newman reviews compensation models, turnover and burnout concerns, and proposes on-the-job training, short fellowships, mentorship, and structured online education. She also presents The Grand Rounds in Urology Advanced Practice Provider Learning Center and forthcoming Urodynamics Academy as resources.
ABOUT THE AUTHOR
Dr. Diane K. Newman is an Adjunct Professor of Surgery at the Perelman School of Medicine at the University of Pennsylvania. She is the former Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, Penn Medicine, in Philadelphia. She is a Fellow of the American Academy of Nursing and the Academy of Urologic Nurses and Associates. She is certified as an adult nurse practitioner by the American Nurses Credentialing Center and Board Certified in Biofeedback for Pelvic Muscle Dysfunction by the Biofeedback Certification Institute of America.
Dr. Newman has 35+ years of experience practicing as a urology advanced practice provider and continence nurse specialist. Her clinical expertise involves the evaluation, treatment, and management of urinary incontinence, bladder dysfunction, and related problems, including the use of catheters and other devices in the management of bladder and pelvic floor conditions. Throughout her career, she has evaluated and treated men and women with urologic disorders in multiple settings: acute care, long-term, and home care, with 23 years in an ambulatory practice at the Division of Urology at the University of Pennsylvania.
