AUA balances three priorities amid changing landscape

Richard K. Babayan, MD

A changing health care landscape has led to multiple changes among U.S. urology practices, including a shift to employment positions or large groups. As a result, the AUA-and the involvement of AUA members-is more important than ever, says Richard K. Babayan, MD, whose term as AUA president began in May. In this interview, Dr. Babayan discusses his goal to increase member participation in the AUA, the association’s efforts to balance three main priorities, and how the AUA will work with other organizations. Dr. Babayan is professor and chair of urology, Boston University School of Medicine and chief of urology at Boston Medical Center. He was interviewed by Urology Times Editorial Council member Jeffrey E. Kaufman, MD, a urologist in private practice in Santa Ana, CA.

You were on the AUA Board of Directors for two terms, then came off for several years before re-joining as president-elect. What do you see that has changed in the intervening term, and what excites you about the future?

What I’ve seen over the last 10 years is an evolution of the Board of Directors and an expansion of its agenda to meet the needs of the AUA membership. I’m excited by the fact that the AUA is proactive and is constantly looking at how we can make the organization better for our members. I’m passionate about the field of urology, I want to see it grow, and I want to see it provide expanded opportunities for its membership and be the advocate for the world of urology.

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I’ve always been a believer in jumping in with both feet, and I would like other members of the AUA to get involved in whatever area they’re comfortable with. This organization belongs to the members. We’re here to serve them, and we need their input and involvement.

The AUA is very fortunate. There are over 400 volunteer urologists who participate in AUA committees that range everywhere from education to public policy to research. They’re the lifeblood of the organization.

Next: "This is our field; I don’t want the government and non-urologists telling us what to do."

Because of the changing health care landscape, many new residents or new urologists are looking at employment positions or joining a big group. As a result, are you concerned that AUA membership or participation might decrease?

I think it’s even more important for this group to stay involved because of the economic constraints that are being put on them. As a program director and a department chairman for 16 years, I’m seeing the difference in residents now versus 36 years ago when I was a resident. They face many more challenges today. As a result, they need to be involved and need to be part of decision-making because it’s going to influence their lives.

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I feel like a father figure in a sense because I know that what I’m doing is for future generations. I want them to be as involved as I’ve been and as passionate as I am about our field. This is our field; I don’t want the government and non-urologists telling us what to do. I want urology to be proactive and at the forefront.

How can the AUA balance education, research, and socioeconomic priorities with an equitable allocation of resources?

Each year, hundreds of AUA members work hand in hand with AUA staff to develop and contribute to the work of the Association. This allows us the ability to prioritize our efforts and activities, as we understand not everyone has the bandwidth to be fully involved in all three of the organizational priorities you mentioned-education, research, and advocacy. This dedicated volunteerism is critical to the success of the AUA and all of its accomplishments.

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We also strive to ensure all available resources are on hand for members and they are easily accessible. For example, while I love the AUA annual meeting for developing relationships and one-on-one contacts, I also understand the constraints on the urologist in community practice who has to meet their RVU levels and work-life balance. That’s why we have online education and we make the annual meeting plenary sessions available online. It’s our way of making our resources available and people feel involved, even when they can’t attend the meeting in person.

Next: "I see positive changes in the future for urologists and other non-physician practitioners."

A major portion of the AUA’s income is predicated on the annual meeting. With so many urologists having financial challenges and with so much educational material available online, will that hurt the AUA financially in the future?

We monitor the urology landscape closely by listening to our members and asking them throughout the year, what’s essential to them. I don’t anticipate much change for the AUA, but I see positive changes in the future for urologists and other non-physician practitioners. Our goal is to serve our members’ needs and to support their careers from residency to retirement. I believe that our membership landscape will, in time, evolve to one that not only serves the needs of the individual, but also the needs of the practice and practice executives/administrators.

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Furthermore, our education is not only broad enough to represent the needs of all urologists, but it is also nimble enough to focus on the changing demographic landscape and address specific informative needs of the entire urologic community. For example, one of the programs that the AUA put into effect this year was a training program for industry representatives. Representatives traveled to AUA headquarters (using funds from their human resources budget and not their marketing budget), and the AUA provided a training primer about urology. We helped them answer questions like: What is urology? What do we do? What does our day typically look like and what are the dos and don’ts of interacting within our workplace environment? It has been very useful and successful.

I’m sure that you looked at the forecast for attendance at the annual meeting and projected costs for the next couple of years. We’re good at the moment but our return on investment decreases on projections going forward.

This is one of the areas that we are looking into. I am a firm believer that we should explore going outside the Stark laws and the restrictions on pharma and industry, and look into areas that are not covered by those regulations. For example, one of the things I want to do at the Boston meeting next year is to reach out to the Boston financial community and get them involved. This type of resource area could allow for development and financial input from non-traditional sources.

Next: "I think the international program is a vital future venture for the AUA."

In the last couple of years, a significant number of annual meeting attendees have come from outside the U.S., and a significant amount of the AUA’s income is derived from international members. How do you see the next couple of years going in terms of soliciting more international members or encouraging more participation in the AUA?

I think the international program is a vital future venture for the AUA. We’ve grown from being a small, New York-based association to one that is a premier urologic association with more than 22,000 members worldwide. The AUA’s “Best of the AUA” program is held in China, Japan, Spain, Brazil, and other countries. And while we have been communicating with the Sociedad Cubana de Urologia leadership for many years, the AUA, for the first time is going to Cuba to embrace the Cuban community now that the access is available.

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These are important areas for the future. We’ll always stay the AUA, but we are an international organization.

Tell us about the travel and outreach you’ve already made as AUA president-elect and who you plan to meet with going forward.

Either the AUA president or the president-elect attends every section meeting. As far as international meetings, our goal is to seek out the needs of the international community. This also opens up opportunities for research and education, and I think having an executive of the AUA available really has an impact on these international organizations. Dr. Manoj Monga has done a phenomenal job as AUA secretary, going all over the world to boost the educational agenda of the AUA.

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In addition, Dr. Inderbir Gill, who serves as the AUA’s chair of global initiatives, has literally gone around the world to look at opportunities and bring them back to the Board of Directors for discussion. Some are slam-dunk yes votes. Others are more complex and require additional due diligence. We’re always looking for opportunities to partner.

Next: "We work with many urologic societies to advance urology education, research, and health policy, and continue to see these collaborations strengthening."

While the international initiatives focus on education and research, domestic concerns of course relate to how health care is delivered and paid for in this country under the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act. Will the relationship among the AUA, LUGPA, and AACU change with respect to all of the socioeconomic issues we face?

The AUA’s strength is in its inclusiveness of the urologic community. This ability to bring the perspectives and skills of our community together to advocate on behalf of AACU, LUGPA, and our respective memberships will remain constant. We work with many urologic societies to advance urology education, research, and health policy, and continue to see these collaborations strengthening. The AUA has an office two blocks from Capitol Hill, and we have consultants and lobbyists working for us. We should take full advantage of that and continue to partner predominately in advocating for the urologic community. The hope is that in the future we’ll not only have LUGPA, the AACU, and AUA involved, but we’ll have a dozen other subspecialty and advocacy groups working together as one voice of urology.

Although this may not be the AUA’s area to decide upon, many questions have arisen about maintenance of certification (MOC). People are willing to participate in the program to a point. It’s not really up to the AUA Board of Directors, but do you have a message about MOC for AUA members?

MOC is the purview of the American Board of Urology (ABU), which is an independent group. A significant majority of ABU diplomates are AUA members, but the ABU is totally separate and independent from the AUA. The AUA does have ongoing conversations with the ABU, and we have looked at the impact MOC will have, especially on older urologists who are nearing the end of their career.

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The Section Secretaries’ Membership Committee met last year and made some proposals to the AUA Board of Directors regarding how MOC could be modified for urologists at different points in their career. The AUA has passed this information on to the ABU. We received a proposal from all eight sections, it was brought up to the AUA Board of Directors, the Board of Directors ratified the recommendations of the Section Secretaries’ Membership Committee, and passed that on to the ABU.

Next: "The future for [The AUA] Foundation is very bright."

There was a discussion years ago at AUA headquarters about altering urology residency training based on a two-tiered system of office-based urologists and urologic surgeons. Does that topic still percolate today?

That topic comes up periodically. I was recently at a meeting with a German urologist who told me about the German system, in which the office urologists do minor procedures and handle office visits and the academic surgeons do all the major surgery. I don’t think we’re ever going to get to that point here, but we’re always open to the discussion because we know things are changing. We want the opinions of our members so we can deal with concerns before crises develop. That’s why communication is important and why I said members really need to take part in this organization.

Let’s talk about the Urology Care Foundation. Dr. Rich Memo is heading it up and working hard to make it a stand-alone fundraising foundation. How does the AUA Board of Directors see the current function and future goals of the AUA Foundation?

The future for our Foundation is very bright. The last couple of years have seen real growth and success in funding our research initiatives, thanks to individual donors, AUA sections, and several subspecialty societies. We are providing more opportunities than ever for the best and brightest young researchers to have the support they need to pursue new ideas for developing better diagnosis and the most effective treatments through research.

From where we were in the 1970s, when a Foundation didn’t exist and the AUA had to present funding to our first two research scholars, to where we are today with more than $24 million going to support over 625 resident scholars, I would say we’ve made great strides over the last 40 years. And we have exciting endeavors to look forward to.

At the annual meeting in Boston next year, we’re going to hold a gala fundraising event to raise funding for urologic research and the ability to expand our patient education offerings. We’re also working to involve more patient advocate groups in the mission of the Foundation and to make it stronger.

We’ve got a good core of people involved in the Foundation. Drs. Harris Nagler, Sanford Siegel, and Raju Thomas were recently added to the Foundation’s Board of Directors. They will rotate onto the Board as the current Board members rotate off. And Dr. Gopal Badlani, the AUA’s former secretary, was elected to the Board last year.

As you start your presidency, do you have a final message for the members of the AUA?

My message to members of the AUA is, this is your organization. I’m here for a year as president to be a proactive leader, but we need your involvement and your input. Volunteer for committee work. If you don’t have the time for that, talk to your representative, let us know your concerns, keep us informed, and be constructive in your criticism. We’re here to help, and if we know what the needs are, then we can help solve the problems.

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