In 2012, only a handful of APPs worked in the Texas Children’s Department of Surgery when the Surgeon-in-Chief recognized that resident coverage would not keep up with the department's growth. As a result, each division began hiring APPs (Physician Assistants and Nurse Practitioners) to fill the gaps. Initially, the APPs were not practicing at the top of their license as many surgeons and administrators were unclear of their role.

In 2017, a formal APP divisional leadership model was developed that led to a concerted effort to increase APP scope of practice and reduce hidden providers. This resulted in a more effective patient care model across the surgical divisions. 

The addition of local leadership facilitated APP practice in nonsurgical, high-volume specialty clinics (including Fracture Clinic, Voiding Improvement Program, Pectus Program, Bowel Management Program, Traumatic Brain Injury Clinic), pre- and post-op management, inpatient care, EC consults and OR coverage.

In 2021, the APP leadership structure was realigned by campus instead of divisional leadership. 

Today, nearly 200 Department of Surgery APPs practice at the top of their license by running independent clinics, performing independent procedures, first assisting in the OR, and providing 24/7 patient care in the EC and community inpatient settings, including Austin.