Recent Trends in the Urology Workforce in the United States

Pruthi, Raj S.; Neuwahl, Simon; Nielsen, Matthew E.; Fraher, Erin

doi:10.1016/j.urology.2013.04.080

Cited by 102 publications

(62 citation statements)

References 9 publications

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“…[18] Ultimately, ABU case logs are one of the most accurate sources of the actual practice patterns of urologists in the United States; indeed, the case logs described covered a period of 10 years and include the complete practice patterns of 6,563 urologists or two-thirds of all urologist in the US based on work force estimations by Pruthi et al and recently corroborated by the AUA census of 2015. [19] Our data, therefore, is one of the largest databases of radical prostatectomies to date and is a representation of the actual practice patterns of urologists in the US.…”

Section: Discussionmentioning

confidence: 99%

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Oberlin

Flum

Lai

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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Introduction and objectives To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods Six month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using CPT codes for open radical prostatectomy (ORP) and laparosopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained A total of 6,563 urologists submitted case logs, of which 68% (4470/6563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013. Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (p < 0.001). 39% of surgeons logging ORP performed two or fewer RP while 19% of surgeons who performed RALP performed 2 or less RP (p < 0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (p < 0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared to general surgeons (47% vs. 25.9% respectively, p < 0.001). Conclusions Robotic prostatectomies are performed five-times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared to general urologists.

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Section: Discussionmentioning

confidence: 99%

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Oberlin

Flum

Lai

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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“…17 Specialists tend to migrate to academic institutions and urban areas, which may explain in part why minimally invasive pyeloplasties were less likely to be performed in the south and central regions compared with the northeast and were more likely to be performed if patients and/ or their providers lived in metropolitan areas. 22 Toward the end of the study period (i.e., 2009-2010), the rate of minimally invasive pyeloplasties was higher than endopyelotomy, which may reflect a start of a change in this trend.…”

Section: Discussionmentioning

confidence: 93%

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

Jacobs

Seelam

Hanley

et al. 2017

Journal of Endourology

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Background and Purpose: Ureteropelvic junction obstruction is a common condition that can be treated with open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy. While all these treatments are effective, the extent to which they are used is unclear. We sought to examine the dissemination of these treatments. Patients and Methods: Using the MarketScan Ò database, we identified adults 18 to 64 years old who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was ureteropelvic junction obstruction treatment (i.e., open pyeloplasty, minimally invasive pyeloplasty, endopyelotomy). We fit a multilevel multinomial logistic regression model accounting for patients nested within providers to examine several factors associated with treatment. Results: Rates of minimally invasive pyeloplasty increased 10-fold, while rates of open pyeloplasty decreased by over 40%, and rates of endopyelotomy were relatively stable. Factors associated with receiving an open vs a minimally invasive pyeloplasty were largely similar. Compared with endopyelotomy, patients receiving minimally invasive pyeloplasty were less likely to be older (odds ratio [OR] 0.96; 95% confidence interval [CI], 0.95, 0.97) and live in the south (OR 0.52; 95% CI, 0.33, 0.81) and west regions (OR 0.57; 95% CI 0.33, 0.98) compared with the northeast and were more likely to live in metropolitan statistical areas (OR 1.52; 95% CI 1.08, 2.13). Conclusions: Over this 9-year period, the landscape of ureteropelvic junction obstruction treatment has changed dramatically. Further research is needed to understand why geographic factors were associated with receiving a minimally invasive pyeloplasty or an endopyelotomy.

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“…3 At the same time, surgical care is a major contributor to health care costs, 4 and older adults tend to utilize these services at a greater rate than the general population. 5 Accordingly, there is reason to believe that the already high cost of healthcare in the U.S. may continue to increase.…”

Section: Introductionmentioning

confidence: 99%

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Hawken

Herrel

Ellimoottil

et al. 2016

Urology

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Structured Abstract Objectives To understand the current role of urologists in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the organizational characteristics of ACOs with participating urologists. Methods Using 2012–2013 Medicare data and the National Provider Identifier (NPI) Database, we classified each urologist in the U.S. and Puerto Rico as either an MSSP ACO-participant or non-participating provider. We then examined the distribution of ACO-participating urologists across the U.S. and among the first 220 MSSP ACOs. We also compared the characteristics of ACOs with and without participating urologists. Results Among 11,084 identified urologists, 1,118 (10%) were MSSP ACO-participants. ACO-participating urologists practiced more frequently in the Northeast and Midwest (p<0.001), and were more commonly female (10% vs. 8%, p=0.003). At an organizational level, only 110 (50%) of the initial MSSP ACOs included at least one urologist; among this group, the number of participating urologists ranged from 1 to 55. ACOs with one or more participating urologist were larger organizations, with respect to both the number of assigned beneficiaries and the number of providers per 1,000 beneficiaries (p<0.001 for each comparison). The patient populations served by ACOs with and without urologists were similar (p>0.05 for each comparison). Conclusions A modest percentage of urologists participate in MSSP ACOs, although many of these organizations still lack any formal involvement by urological surgeons. Without such participation, improving the coordination, quality, and cost of urologic care for Medicare beneficiaries may be more challenging.

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Recent Trends in the Urology Workforce in the United States

Cited by 102 publications

References 9 publications

The effect of minimally invasive prostatectomy on practice patterns of American urologists

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

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