Recent Trends in the Urology Workforce in the United States
ABSTRACT The present study examines the current status of urology physician manpower in the United States, in the context of trends in the demographics, geographic distribution, and practice make-up of urologists. Physicians were identified as surgeons and classified into surgical groups using a combination of American Medical Association primary and secondary self-reported specialties and American Board of Medical Specialties certifications. From these groups, urologic surgeons were isolated for analysis. The supply of urologists per capita has declined since 1981 - most dramatically since 1991. With an average age of 52.5 years, urology is one of the oldest surgical specialties. Over 7% of urologists are older than 70 years and 44% are older than 55 years, suggesting an aging urology workforce. The number of female urologists has grown almost a 1000-fold and represents a growing and younger cohort of the workforce. The number of rural urologists and the number of international medical graduates have continued to decline since 1981. Over the past 10 years, an increasing number of urologists are now in group practices (over 60%), and these tended to be younger and in urban settings. In contrast to most other surgical specialties, there has been a decrease in the supply of urologists relative to population growth, which is expected to be exacerbated by an aging and relatively older urology physician workforce, particularly in rural areas, a slight increase in female urologists, and the gravitation of younger urologists toward group practice in urban areas.
Article: Editorial Commentary09/2014; DOI:10.1016/j.urpr.2014.05.008
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ABSTRACT: Introduction Preconsultation exchange is a method to promote expedited care among health care providers through communication between primary care providers and specialists before a clinic visit. We evaluated the efficacy of a preconsultation exchange in streamlining patient visits to the urology clinic with an emphasis on resource efficiency in a safety net hospital. Methods Between April 1, 2011 and March 31, 2012 there were 1,705 electronic referrals to our urology department. A random sample of 500 referrals was selected for evaluation, of whom 487 patients met study inclusion criteria. Scheduling outcome and preconsultation exchange were evaluated for each chief complaint. Results Patients with operative or procedural chief complaints, or potential oncologic diagnoses were most likely to be scheduled directly to the urology clinic. Of the 487 patients 36 (7.4%) were treated for benign urological conditions by primary care providers and did not need to be seen in the urology clinic. For 13.5% of patients recommended laboratory and radiological tests were obtained before the initial urology clinic visit as a result of preconsultation exchange. Conclusions Electronic preconsultation exchange served as a method of quality improvement by promoting urology clinic efficiency. Unnecessary appointments were limited and the completeness of appropriate laboratory and imaging studies at the initial visit was increased. Health care was streamlined by increased access to urological care and by management of benign urological conditions without a formal clinic visit in appropriate cases.08/2014; DOI:10.1016/j.urpr.2014.06.005
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ABSTRACT: Introduction The Affordable Care Act is expected to provide coverage for nearly 25 million previously uninsured individuals. Because the potential impact of the ACA on urological care remains unknown, we estimated the impact of insurance expansion on the use of inpatient urological surgeries using Massachusetts health care reform as a natural experiment. Methods We identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from Massachusetts and 2 control states. Using July 2007 as the transition point between pre-reform and post-reform periods, we performed a difference-in-differences analysis to estimate the effect of insurance expansion on overall and procedure specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. Results We identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the Massachusetts population as a whole. However, we saw an increase in the rate of inpatient urological surgery for nonwhite and low income patients. Our difference-in-differences analysis confirmed these results (all patients 1.0%, p=0.668; nonwhite patients 9.9%, p=0.006; low income patients 6.6%, p=0.041). At a procedure level insurance expansion caused increased rates of inpatient benign prostatic hyperplasia procedures but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or percutaneous nephrolithotomy. Conclusions Insurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for nonwhite patients and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care.09/2014; DOI:10.1016/j.urpr.2014.05.002