Patterns of utilization of advanced practice providers in reproductive endocrinology: a 2023 national survey.

Objective: To evaluate the current utilization of advanced practice providers (APPs) within the field of reproductive endocrinology and infertility.

Design: Cross-sectional.

Setting: Web-based.

Patients: A total of 201 APPs surveyed through the American Society of Reproductive Medicine APP Professional Group.

Exposure: Anonymized online survey.

Main Outcome Measures: Demographics, scope of practice and responsibilities, and training and onboarding.

Results: Respondents were primarily Family Nurse Practitioners (26.4%), Women's Health Nurse Practitioners (33.3%), or Physician Associates (29.8%). Two-thirds (67.4%) reported that their scope of practice is limited by their employer or practice, 43.5% by state restrictions, and 25.2% by insurance. Survey respondents reported that 44.4% of their time at work is dedicated to performing procedures and scans and 30.6% to conducting consults and follow-ups. The most commonly reported duties were physical examinations (88.6%), intrauterine inseminations (86.6%), saline sonohysterograms (79.6%), endometrial biopsies (76.6%), ultrasounds (74.6%), and problem visits such as for pain, cysts, and bleeding (73.1%). Most survey respondents (61.7%) reported having autonomy in deciding protocols and treatment options for patients in their practice. Respondents described their onboarding training as including observation/on-the-job training (94.0%), independent reading of texts and journals (66.7%), American Society of Reproductive Medicine online courses (45.3%), formal orientation (34.8%), and practice-organized training programs (29.4%).

Conclusions: Advanced practice providers are highly trained members of the care team, but continue to be underused within the field of reproductive endocrinology and infertility. Improvements in educational resources and/or use of a formalized program to train APPs to their full scope of practice may help increase clinic efficiency and improve patient access to care.