What do we lose by giving up the general urologist?
Like everything else in life, as things become more complex and more complicated, we are going to have people who understand certain areas very, very well, and it’s going to be important to make sure that the general urologist still exists. That general urologist may not be a urologist anymore. It may be a nurse practitioner or a physician assistant. It may be a primary care doctor who delves into urology. Not so long ago, family practice doctors were doing cystoscopies in their offices. We’re seeing less and less of that now. But it existed in the past and I see a reason at some point it might come back to that.
So in the future, you could have a training path where someone goes through general medicine training and then does a year of urology.
Correct. They would get a basic urology background, which is not such a bad idea; you would have a physician who is trained in other areas, not just urology but in general medicine.
I think as urologists we’re always worried about giving up certain procedures to other specialties, but as these things become more complex, it’s a natural evolution that we just embrace new technologies and new techniques. It’s not that we’re going to lose our specialty, we’re just going to make it better.
Is there anything else you would like to add?
One of the other areas my group has studied is patient travel (2015 AUA annual meeting study). Patients are much more willing to travel for care than ever before. We looked at studies back in the 1980s where if people were offered a really good doctor 5 minutes from their house or a really great doctor 30 minutes from their house, the majority of patients would go to the good doctor who is 5 minutes away because they felt that they would get a basic standard of care and it was more convenient for them to travel those 5 minutes.
It’s very different nowadays. The average patient will travel well over 100 miles to get to wherever they need to go, especially if they have a specialty issue. In our study, even if patients live in the tip of New York State, they would come down to New York City thinking that they’re getting better care there. I suspect this is a travel pattern that we’re seeing not just in New York State but in other areas of the United States. This reinforces the argument for subspecialization and regionalization of care to large-volume surgeons and centers.
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