ANAHEIM, CA (UroToday.com) - Drs. Stuart Wolf presented a State-of -the-Art lecture "The Expansion and Contraction of Urologic Practice" at the Sunday Plenary session of the AUA in Anaheim, May 20, 2007.

Dr. Wolf reviewed the current, changing and future states of urology. He stated that there are 8,500 urologists in the US, mean age 54 years, 85% generalists, seeing an average of 89 patients per week. Most work is office based with only 20% of billing coming from surgical cases. Only 26% performed a high volume of surgical procedures. The median income was $350,000, of which most comes from office clinical procedures. 20% comes from non-medical sources, such as lithotripsy center investments. Presently, however, most resident case load is cystoscopy (30%) and female incontinence accounted for only 2% and radical prostatectomy 6%.

In 2006, 240 residents completed residency, a ratio of 1 urologist to 35,000 people. This will change to a 1:48,000 by 2020. This is due to an AUA "National Supply and Demand Forecast" from 1995. This recommended decreasing the number of trainees. Primary care physicians were expected to take care of much office urology. It is anticipated that there will be a shortage of urologists by 2020. A pay for performance with a bonus may help to correct this as may regionalization of health care and pay directed by payers.

Urology had lost adrenal and renovascular surgery to other fields, but picked up stone and ultrasound management. Office based imaging is a potential area for urologists to acquire more ground. Most image based imaging and renal tumor ablation is done by or with radiologists. Urologists perform 5 female stress urinary incontinence procedures per year and gynecologists perform 4-5 times more. Urologists also play a marginalized role in male infertility. Only 2-3% of urologists have subspecialty interest in this area accounts for part of the problem.

For the future, the AUA does not favor 2-tiered training for office-based and operative urology. Sub-specialization is important and the emphasis is on quality. There is a balance between our medical and surgical training and ability to do both well. The limited numbers of urologists then affects hours available to do everything envisioned. Losing ground to other specialties may be problematic for our future. Increasing our numbers may correct some of this, but increasing residency sizes is not easily done. Furthermore the clinician-scientist is becoming scare and we must foster this career tract, he argued. Discover and research drives the evolution of our specialty. He compared publication numbers for urologists compared to other specialties in shared fields and we are behind the other fields. To continue discovery and research will avoid the contraction of our field and rather provide opportunities for expansion.

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Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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