Aging Urology Workforce Could Limit Care to Aging Population

Alicia Ault

May 16, 2015

NEW ORLEANS — More than half the urologists practicing in the United States are older than 53 years, and 23% are older than 65, according to a first-of-its-kind survey conducted by the American Urological Association (AUA).

The aging workforce, combined with limited funding for urology residencies, "means that over time, we'll have fewer urologists available to take care of an aging population," said AUA data committee chair Quentin Clemens, MD, from the University of Michigan at Ann Arbor.

Almost three-quarters of the 2204 survey respondents reported that they plan to retire when they are 60 to 70 years of age, although the age of planned retirement seemed to go up as the age of the respondent increased.

"Certainly, the aging urologist speaks to the potential crisis for access in the future," said Stuart Wolf Jr, MD, from the University of Michigan, who is chair of the AUA science and quality council. He pointed out that only thoracic surgeons have an older workforce.

The survey was conducted to help identify research needs and to create a definitive source of data on the demographic characteristics, geographic distribution, education, training, subspecialization, employment status, and practice patterns of the 11,703 urologists practicing in the United States.

Survey responses will be presented during a plenary session here at the AUA 2015 Annual Meeting, but data from the State of the Urology Workforce and Practice in the United States were released in advance.

Overall, 92% of clinicians are men; however, 18% of those younger than 45 years are women. In addition, 83% of practicing urologists are white, about 13% are Asian, and just over 2% are black.

Nationally, the urologist-to-patient ratio is 3.7 per 100,000 people, but ratios vary, depending on location.

Table. Areas With the Highest and Lowest Urologist-to-Patient Ratios

Area Ratio
Highest  
   Washington, DC 8.82
   New Hampshire 4.99
   Rhode Island 4.95
   Vermont 4.95
   New York 4.79
Lowest  
   New Mexico 3.02
   Texas 2.98
   Wyoming 2.57
   Nevada 2.47
   Utah 2.41

 

Most — 90% — of urologists practice in metropolitan areas, which means that even in urologist-dense states like New York and Vermont, there are fewer clinicians in the rural areas. Although almost 17% of Americans live in nonmetropolitan area, only 10% of practicing urologists maintain primary practices there.

In the United States, 62% of counties do not have a single urologist. And many of those practicing in less-populated areas are older than 55 years. "As they retire, we may face a significant shortage in rural areas," said Dr Clemens.

More urologists work in private practices, such as solo practices, single-specialty urology groups, and multispecialty urology groups, than in institutions, such as academic medical centers and public or private hospitals (64% vs 34%).

However, physicians 45 years and older are more likely than younger physicians to be in private practice.

The growing trend toward employment is "a huge change in the way we practice medicine," Dr Wolf reported. This change is "potentially a really great thing for urology," and could help physicians transition faster to a value-based practice, he told Medscape Medical News.

Only about 12% of those in private practice have a solo practice; about one-quarter are in groups with 10 or more urologists.

About half of all practicing urologists own their own practice or are partners in a private practice. The other half are employed, and 56% of those employed work for hospitals. Another one-third are employed by healthcare systems, and just under 13% are employed by private practices.

Oncology Most Popular Fellowship

One-fifth of current urologists completed their residency training in 1980 or before, and about 60% chose not to complete a fellowship. This reflects data showing that most practicing urologists do not have a primary subspecialty.

The 40% who did go on to a fellowship tended to be younger; fellowships are especially popular among women younger than 45.

Oncology has been the most popular choice for a fellowship, selected by about 13% of urologists, followed by endourology, stone disease, robotic surgery, and pediatrics. These also are the most common subspecialties.

Dr Clemens has disclosed no relevant financial relationships. Dr Wolf reports that he is on the editorial advisory board for Urology Times.

American Urological Association (AUA) 2015 Annual Meeting. To be presented May 19, 2015.

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