Dr. Arpeet Shah
Appearances
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I think patients... want to know what's going on, right? And so by giving them their data, by giving them an analogy that they're very familiar with, and then showing them their own UroCuffs, showing them the pictures, showing them their bladder pressures, their flow rates, telling them what's normal, what's not, is really important. We do the same thing with Cysto, right?
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Before I do a cystoscopy, I will go through pictures of normal and abnormal bladders and normal and abnormal prostates. And if you can show them what the normal and abnormal are, and then you do the cystoscopy, and you tell them, look at the screen, tell me what you see here, it's very clear to them. And then they're the ones who are saying, well, I need to get something done. I do have problems.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I realize this, and I think it's all about patient education.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, and this is why when we look at national Medicare data, we see such high failure rates with BPH procedures. It's because we're intervening too late, right? We're intervening when the bladder has already failed.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And to expect that after somebody's in heart failure, if we stent them, that their heart's going to get back to normal is, you know, a very common sense that it's not going to get better just with that. And so early intervention is important.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
The other thing, you know, we actually published a study on this is that we looked at all of our patients who are following up, satisfied on medical therapy for BPH. And I think medical therapy works for a lot of people. But we did UroCuffs on them and 62% had abnormal UroCuffs. So, you know, even these are patients who are coming in saying they're satisfied on medication.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So getting that objective data to them is just really important.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, for our patients, all of our new patients who have BPH automatically get a, through email, text, get a copy of our BPH booklet, which is just an introductory booklet on all of the tests that we have diagnostic, and then a quick blurb, short paragraph on all the procedures that are out there so they can have some early education on it. But really, we wait until the objective is
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
data is gotten. So until we figure out their size, shape, and flow rates, and then you can introduce the procedures that will actually work, that will benefit a patient. I mean, there's no reason to, you know, offer a Urolift, in my opinion, on, you know, somebody with a very, very large prostate.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And so you don't want to introduce it too early where patients, you know, are tied to a particular therapy that just won't work for them. We don't want to offer, you don't want to, you know, kind of withhold that information either. It's just kind of slowly introducing that concept.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, so we have a... You created that one? Yeah, through our practice. It's all QR code based. It's all virtual. We used to have printouts, but we do have printouts for our patients who just don't want anything virtual or electronic, I should say. But that booklet kind of gives an introduction to our program. It actually has our pathway. written out.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So, you know, you're going to have AUA symptom scores. You're going to have, these are the tests that you could consider. There's going to be a little blurb about each test. And then all the procedures that we offer, whether, you know, green light, urolith, resume, simple prostatectomy, aqua ablation, all the things that we can offer a patient will be listed there.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
We have office, ASC, and hospital. So it's all those things. I also sit on the clinical board of BPH for Solaris, our national group. And Physicians are very passionate about how they feel about particular procedures. There's no way we can convince every physician to say that this is right or this is wrong or this is better. And I don't think that that's the goal of any of this.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
The goal of this is to make sure physicians are doing all the diagnostic tests before they make a decision. We've all seen that patient that's in the hospital that you know, has like a 200 gram prostate, came in with retention and had a procedure that's really not made for that kind of a prostate. Eight clips.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, we see, you know, eight Urolift clips and a 200 gram prostate and the patient's as confused as you are about why they're there. And so it's impossible to say which procedure is better and convince it to all your group. And that's not the goal. We still know that there's still somewhat of an art in medicine.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And, you know, we want the physicians at the end who are going to do the procedure deciding what procedure they feel is right. And that's good. And I think that's what we want. But we want to make sure that they got all the testing, that they have all the information, because that tends to make sure that they choose correctly. And you're a center of XLO of resume. Are you doing them in the office?
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, we do 100% of our resumes in the office. We utilize a combination of local and local anesthesia, just a prostate block and Pronox. which is a patient-controlled delivered anesthetic. The key thing about Pronox is it kind of gets out of your system in a couple minutes after using it.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So we really think it's a drive-in, drive-home procedure, meaning you could drive in, get your BPH procedure, drive home, and
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Specifically for our patient population, where it's difficult for them in terms of getting off from work or, you know, having the support from family necessarily to bring them into the office, this is a really kind of, it's a procedure that really strikes them as an appropriate thing for them.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah. So I'll tell everybody, you know, there's, you know, eight or 10 things we can do from a procedural standpoint for your prostate. Once we get the objective data, we'll bring it down to two or three. And then we talk about it. And, you know, one of the benefits for resume specifically is that it can be done in the office and patients can drive in, drive home. You can do it on blood thinners.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I think I have done many on blood thinners. They're okay. Done for a variety of prostate sizes and shapes. You know, if you see a median lobe, you don't see a median lobe, it's fine. And the biggest thing is it's reproducible despite surgeon skill, right? We're really utilizing the technology to do the work.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
It's not like, oh, I'm very good at doing terps or he's very good at doing, you know, a simple prostatectomy or whatever the case might be. There's really normalization of surgical skills with resume. And I think that makes it very enticing.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Typically three days. If a patient's in retention, I leave it in for two weeks. I think one of the complaints about resume from patients and providers is the irritative symptoms that occur afterwards. And they tend to last longer than your other BPH procedures. And that's the truth. They have irritative symptoms that last longer than the average BPH procedure.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Patients aren't worried about it if you let them know beforehand. You let them know the day of the procedure. You let them know when the catheter comes out that things are going to get worse before they get better. You know, as a physician, it took a little bit to not have that immediate gratification to see an open cavity. And I took every chance I could in getting a cystoscopy.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I have a patient that grows hematuria a year later. I was, you know, I was doing a cysto on them. Because I wanted to see. And sometimes you'd have patients get CAT scans and you could see the defect. The defect is significant. And there's no doubt about it. What's the largest you're doing? I mean, I know off-label, how big will you go?
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So, you know, for particularly comorbid patients who are in urinary retention... I have a 90-year-old who comes in, urinary retention, 120, 130-gram prostate. I'll try it. I think it's worth a try. I usually, for patients with just BPH, not urinary retention, I'll do My average is one stick per 10 grams. So a 50-gram prostate, I would do five sticks.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
When we started with Pronax, patients were so comfortable that we were over-sticking patients. And I think their results were great, but their irritative symptoms lasted longer. But for those patients in retention, like the 90-year-old who comes in, I'll do 120, I'll do 130 gram prostate as long as they know that it's off-label and they know that it might not be successful, but it's worth a try.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, it's certainly difficult and certainly reiterating it over and over again is necessary. There's a great platform actually called Vidscripts. I'm not sure if you're familiar with it, but these are pre-recorded videos that are sent out to the patient on a particular cadence around when a procedure is done. And I think that patients really appreciate it. So when
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
When they're having their irritated symptoms one week, two week, four weeks out from the procedure, if they get a little video saying that you might still be having this and this is normal, it puts them at ease. But yeah, certainly, you know, it's easy for us to say it on our side to say that things are going to get worse before they get better.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
But living through it is obviously a different story.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And if they don't feel that, then they're really happy with you.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Taking things slowly and making sure that things are done right from the beginning is a very important thing, developing good habits. So that's exactly how we do it. And every practice can be unique, but we felt that figuring out how to compliantly document things while you're in parallel, also learning the topics of urology was really important and they kind of went hand in hand.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, I mean, those are difficult to measure always, but there's a variety of ways that we can make sure that it happens. So in terms of clinical excellence, take, for example, Eurocuffs. You know, we spend a lot of time educating our advanced practice providers with Eurocuff. The folks at SRS who developed Eurocuff help with that educational process, and that partnership is really important.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And we'll have periodic maybe the annual Eurocuff test where we're having our advanced practice providers go through Eurocuff studies, answer several questions about them so we can identify those who need more education, right? So that's just one part of clinical excellence. You know, we can talk about prostate cancer and active surveillance and kind of all the things, you know, we can go through.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
But making sure that you have a kind of a robust program, a pathway, and then a way to monitor that pathway compliance. And so there's another thing, you know, we make sure that when patients are seen with BPH that they get an AUA symptom score. And if they have an AUA symptom score above 8, which means moderate to severe symptoms, that at least a discussion is being had about
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
medications, diagnostic testing, right? And if they refuse, they refuse, but we're going to be monitoring that and tracking that with our advanced practice providers to make sure that they are following the pathways.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I wish we had something in our EHR. Right now it's laborious, but we think it's important. So we have clinical navigators who are nurses or MAs who specialize in different disease states. Our clinical navigator will not only talk to patients to make sure that they're following up. Let's say we have a BPH navigator. They'll remind them, hey, you have your Eurocuff next week.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Make sure you drink plenty of fluids before you come. They're the ones who are doing the Eurocuff test, right? So this is somebody that the patient knows they've talked to. Now they see them doing the Eurocuff test. Those are the same navigators who work with our advanced practice providers and our disease state experts.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And they're the ones who are actually checking in and giving us the data on compliance. So It's laborious right now. I think as EMRs get smarter, as AI comes in and really builds into EMRs, we're going to be able to do that more easily.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
When we talk about the other things like compliance, that goes into compliance, but also documentation, doing coding audits, making sure the charts are documented appropriately, giving that feedback back to our advanced practice providers. Say, hey, you're not coding this correctly. We need to change this. We need to make some more educational opportunities in terms of compliance and billing.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And then making sure, you know, the most important thing, we talk about patient attrition in disease states, but there's a lot of attrition with advanced practice providers. You know, a lot of practices say, I hire an advanced practice provider. I get them trained up. They learn urology. And then they leave for another job. And that is a failure on the practice and the program, right?
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
We have to make sure that we're having discussions with the advanced practice providers that we're making sure that we hit their career goals, right? Whether their career goals are to be able to work part-time, spend time with their family, because a lot are mothers. And then once their kids go to school, to be able to go back to full-time, we have to develop a program that fits that model.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
If they start getting bored with their daily run-of-the-mill urology and they want to, you know, be participating in advanced prostate cancer clinic, well, what are ways we can integrate that knowledge and get that to them and build out that program? So we just have to have this constant communication and a real emphasis on the people who are part of the practice.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And so those are kind of all the ways that we look at this. I mean, we can go a million different directions from that. But the four pillars of productivity, they have to be productive. They have to generate income for a practice. They have to see patients. That's how the job exists.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
But if they want to do something in a particular field, we got to make sure they do it in a compliant way and that they're getting the education needed to do that. And question, are there, the APPs are training all our APPs or right now? Yes and no, you know, that's the goal, right?
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
We want, you know, while I sit at the head of our APP program, I would love for me to pass this on to another APP, right? And so that's the goal. Yeah, Nicole, you know, a couple more years. But, you know, that's kind of how we start.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And that's how we set up our onboarding is when a new APP comes, they'll shadow first and they'll start documenting, kind of act as a scribe within the practice and then start seeing patients like when you were a resident, when you would go see the patient and go outside, talk to your attending, kind of figure out a plan together and then both go back in and then slowly developing an independent schedule.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
It starts with me. And then we certainly have our APPs visit. We're not all in one clinic and one site. So we want to make sure that they go through the various locations. If there is an APP that they want to shadow, we make that happen and we make sure that everybody's learning from everybody. And so I'm not in the office every day.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So the days I'm in the office, I really, especially at the beginning, I like to have that hands-on, one-on-one conversation. time with a new app but you know the other days when i'm not in the office we're pretty flexible
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Sure. I think a lot of urology practices are in a very similar situation as we were pre-COVID and really entering into COVID, where there's just been a tremendous shortage of urology providers and an ever-growing patient population. So we were noticing that in our community, And in our surrounding areas that patients were having to wait weeks, months to see a provider.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yes. BPH is always bread and butter. I'd tell her never leave it, but certainly women's health is a big need. The other thing that I think we, you know, I think the evolution of utilizing an APP is going to be with procedures. Pretty soon, we're going to be having so many procedures that a urologist, as a physician, as a surgeon, is not going to have bandwidth to do them all.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So it might be, it might start with cystoscopy, cystostent removal, truss, and then kind of building that. We have a lot of our nurse practitioners will do testopels, they'll do hydrocele aspirations and sclerosis in the office. And I think that continues to engage and grow them as practitioners.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Actually, absolutely. You know, what our rate limiting step at this point is space. It's still how many rooms we have. We can always get more systems, you know, and there's disposable systems if we need to. We try not to utilize disposables, but, you know, it's just just space. And then, you know, there's a shortage of staff across the country.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So we have to make sure that the foundation is there before we really make the program.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
What you get in is what you get out, right? You have to invest in your advanced practice providers and really make them feel like they're They're the level of provider where they're, you know, they're at the level of you in terms of a physician. And they certainly are in the office. I mean, they should be able to do anything that a physician can do.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I don't think so. Four of our APPs were like their jaws dropped when I told them that we're going to be on this podcast. Awesome. They listened to you religiously. And so, I mean, it was like they were like fangirls, you know, they were really excited.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
It has to, right? We can't do it alone. More urologists retiring than are coming in. Patients keep piling up. So we have to harness the power of APPs.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And we felt that we weren't serving our community correctly. And so the only way to kind of catch up and provide the needs of the patients in our community was to increase our providers. And with such a shortage of urologists, we knew we needed to utilize and harness the power of advanced practice providers to help us take care of our patients. We were also having other issues in terms of burnout.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Urologists have a highest degree of burnout compared to any other specialty, according to some studies. And we felt that advanced practice providers could help our physicians stop them from burning out. And when we looked at our patient population even more closely, we were noticing that several, there was high rates of attrition.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And, you know, we're going to talk a little bit about BPH and how we manage our patients, but we looked at our attrition rates for BPH and it was 60 to 70% of patients at that time. And it's much better now. We're not coming for a second visit. And so we felt that there was, you know, just, we just needed all the help we could get.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
When developing a program, though, we wanted to make sure we had a unified mission in terms of what was best for our practice, not necessarily what was the needs of an individual physician. And so having a unified, standardized kind of thought in terms of how we would utilize APPs into our practice was really important.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And then, you know, when we brought them in and we started growing the program, there's a lot of work that goes into running an APP program, whether it comes from onboarding, you know, making sure that they're clinically excellent, that they're following pathways and really up to date with the ever-changing knowledge that's coming out there.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And they're compliant from a documentation standpoint, a billing standpoint. We needed to kind of have somebody in charge and kind of one voice leading that program. And it's almost like leading a company.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
You know, you need to make sure that all of the people in your company are growing and developing, that we're meeting their needs of their career goals and we're meeting the needs of the practice. So that's what the mission was. And We started in 2022 with one full-time equivalent APP.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
There were 16 urologists, and we've gone up to eight full-time equivalents in a short amount of time and feel like we will continue to grow. Good.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
But at the end of the day, we want all of our advanced practice providers on an independent schedule. And I think Making sure that they have that confidence and that autonomy really brings a lot in terms of satisfaction from their job.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Three or six months. Yeah.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I would kind of mirror that. We're trying to build a standardized way of onboarding. And that's not only locally in my practice at AUS, but we're part of the large urology platform called Solaris. And we're working that on onboarding for APPs on a national level. And it You know, we don't realize how fast our advanced practice providers actually catch up and are getting thrown in to see patients.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And sometimes we have to remember that urology residencies are six years with four years of med school beforehand. And so, you know, taking things slowly and making sure that things are done quickly. right from the beginning is a very important thing, developing good habits. So that's exactly how we do it.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And every practice can be unique, but we felt that figuring out how to compliantly document things while you're in parallel, also learning the topics of urology was really important and they kind of went hand in hand.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
and and that's how we set up our onboarding is when a new app comes they'll shadow first and they'll start documenting kind of act as a scribe within the practice and then start seeing patients like when you're a resident when you would go see the patient then go outside talk to your attending kind of figure out a plan together and then both all go both go back in and then slowly developing an independent schedule
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
But at the end of the day, we want all of our advanced practice providers on an independent schedule. And I think making sure that they have that confidence and that autonomy really brings a lot in terms of satisfaction from their job.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
The answer is yes to kind of all of that. So it really depends on the needs of the practice. We want our advanced practice providers at first to be able to work on all disease states with different providers and really have kind of being able to work with every part of our practice.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And then as they grow and once you're a year into the practice, if there is a particular niche that you feel that you want to really dive into, it's our job as a practice to make sure that we give that opportunity to the advanced practice provider.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, so our BPH program is really, I think, robust and I'm really proud of what we've built. It's a combination of utilizing patient navigation services, our advanced practice providers, nursing kind of at every level, and then the physician to drive things home and But we have all new patients are seen by the physician. We really try to make that happen.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I think it starts the patient journey off in the way that a lot of patients want. They want to see a doctor. And then if a patient has significant urinary symptoms based on AUA symptom score, We'll, you know, we'll trial a med if they have not. And then, you know, we really care. And I personally really care about objective testing.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I think the days of saying you have urinary symptoms, we're going to do a TURP are kind of over because we have so many options in terms of the surgical management and all the procedures that are available. And we know that certain procedures work better for certain prostates and certain work better for other prostates. So I am just a huge proponent of objective measuring.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And so objective measurements come with three things, you know, cystoscopy, transrectal ultrasound of the prostate, and then some form of uroflow, urocuff, uroflow, urodynamics, depending on kind of what your practice wants. And we usually start with Eurocuff in our practice. And it's because it's a great non-invasive test that, you know, we don't have to put anything into a patient.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And patients certainly appreciate that to get some baseline measurements. And then, you know, the Eurocuff test is done by our MAs. on a day and then they're interpreted by our advanced practice providers where we've spent a tremendous amount of time educating our advanced practice providers on how to read Eurocuffs. I can tell you A lot of them can read them better than physicians.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
I can tell you, Nicole, if I have, sometimes I will ask her, what does she think about a uro cuff to give me a second opinion or a urodynamics, you know? And so education is important there. And then Nicole will read the uro cuff. And if the patient needs that objective testing, it gets put back onto the physician to do a cystoscopy and trust. We'll usually do that on the same day.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And then at that point, we have all kind of the necessary measurements to make an assessment on how the patient is doing with meds, without meds, if they need surgery, what surgery they need, and we can go from there.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
Yeah, the reason why we picked telehealth is multifold. So one is patients are already coming in for their UroCuff. To have them come in again, I mean, it's a big burden on taking time off from work. So telehealths are just, they seem more easier for the patient. It's easier for the practice as well, where one of our big limitations is just space, having enough rooms to see patients.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
And so you're taking that part of the equation, kind of you're solving it. And then the third point is this allows Nicole a week to review all her Eurocups. And should she have any questions between the time of the Eurocups and when the patient has their telehealth appointment, she can review it with the physician. If the test is not done correctly, we can ask the patient to come and do it again.
BackTable Urology
Ep. 190 Optimizing BPH Care: Insights from Physician-APP Collaboration with Dr. Arpeet Shah and Nicole Hollander
So we have a good test and we have good data. And so all of those things kind of really promote a telehealth visit.