Do you think that area of expertise is more important than your boarded specialty?
We probably have to look at board certification again. There are certain specialties, such as anesthesia, that have gotten rid of board recertification. Why would we continue to demand that urologists are proficient in all areas of urology like pediatrics or infertility when they will never practice or see these types of patients in the future? Perhaps we need to be thinking about recertification or boards that are subspecialty specific.
Has this subspecialization change been driven more by patients and social media or by urologists who want each patient to see the person best suited to treat their individual problem?
I think it’s a combination of the two. We know very well that the higher volume surgeon and the higher volume center tend to have fewer complications and fewer issues with morbidity and mortality. This has been shown over and over again, not only in urology but in other medical specialties as well. It’s just the evolution of health care.
As we have grown, so the days of the individual physician working as a private practitioner with a shingle on the door are numbered, if not already dead at this point. It behooves you to be part of a large group, and so there are large practice groups and large academic groups. Because of that, we now have groups of anywhere from 20 to 40 or 100 or more urologists. It would make sense then to have a few individuals do certain things and those urologists would elevate a standard of care that is well above what was previously being done.
The other side of this is that as physicians are finding ways to compete against each other, social media certainly has played a role and patients are much savvier about trying to find physicians by looking at their Press Ganey scores and learning about their reputation online, so we have certainly become much more of a customer service-oriented industry than we’ve ever been before.
That makes it much harder for the person just going into practice who doesn’t have that backlog of cases when a patient asks: How many have you done?
Correct. It’s amazing how often we hear that in New York City, where patients can find experts within 20 blocks of each other. It’s one of the first questions we get from patients. That by itself has already created a situation where physicians really need to focus on one area in particular that they do well.
What advice would you give to a urologist who’s been in practice for 1 year and is asked that question?
I think you just need to be honest and say, “I’ve trained in this area, my mentor is so and so, and I’m in a high-volume center where we do ‘X’ amount of cases per year. I’m very comfortable doing this procedure and if there is a situation that arises, I have lots of back-up to help me out.”