AUA president: In uncertain times, urologists must unify

J. Brantley Thrasher, MDNewly elected AUA President J. Brantley Thrasher, MD, says urologic subspecialty societies need to come together as one voice for urology to remain strong. In this interview, he also discusses the AUA’s expanded efforts in advocacy, research, and education. Dr. Thrasher is professor of urology at the University of Kansas Medical Center, Kansas City. Dr. Thrasher was interviewed by Urology Times Editorial Council member Jeffrey E. Kaufman, MD, a urologist in private practice in Santa Ana, CA. 

It’s been a number of years since you served on the AUA Board of Directors. What do you find has changed in terms of themes and challenges since then?

Research is one thing that has changed significantly. The AUA now has approximately $50 million dedicated to research, which includes about 750 endowments and scholarships. That’s one big area of change. The AUA Quality Registry, or AQUA Registry, also was not in place when you and I were on the Board. As a certified data registry now recognized by the Centers for Medicare & Medicaid Services, it will ultimately help our membership move forward with some of CMS’s new quality initiatives, and it may even help with maintenance of certification (MOC) in the future. There are approximately 480 practices participating in the AQUA Registry right now.

Also see: First national urology-wide registry gathers steam

Advocacy is also expanding, and that includes the new Urology Advocacy Summit that will occur in Washington in March of 2018. There are already 12 subspecialty societies that would like to partner with us for that summit. We’d really like to see a big turnout. Additionally, our international outreach and international programs have changed tremendously. When I first started on the Board, Dr. Bob Flanigan started a lot of that outreach, and the person in charge now is Dr. Inderbir Gill. Dr. Gill has done a fantastic job, and he’s focusing more now in the Middle East. We now have about 50 programs in 109 countries.

I think the AUA Office of Education has changed with the times by moving more toward a digital format. AUA University now includes 6,000 abstracts, 400 live surgeries, and many presentations. There’s a lot at members’ fingertips now, and I think Dr. Victor Nitti has done a great job heading up the Office of Education.

Next: "A lot of networking opportunities and subspecialty meetings occur at the [AUA] annual meeting that you can’t get any other time."

If more AUA members are accessing educational materials online, are we going to see attendance at the AUA annual meeting drop off?

I don’t think so. In surveys and the AUA Census, urologists tell us often that they come to the meeting not just for the education but also for networking. A lot of networking opportunities and subspecialty meetings occur at the annual meeting that you can’t get any other time. Fifty-four percent of attendees are actually international; you don’t see that many international urologists at any other meeting.

Talking about other projects at the AUA, is the association getting involved at the state level?

We always have, and we remain involved in the State Society Network. As we’ve gotten bigger and more complex, our advocacy effort also has a lot more branches and we’re decentralizing some of the command. We are putting our major focus on the Urology Advocacy Summit, but our advocacy efforts-lobbying, supporting state society networks, working with the state societies-are ongoing.

What excites you about being AUA president?

Two things in particular excite me. Of course, it’s an honor and a privilege to lead an organization of 21,000 people. Another thing that excites me is the change I’d like to see, which is a call to unite. That is one of my big goals, and I think we can accomplish that. We can start bringing our subspecialty societies together as one voice. But we need to listen more. We’re a big gorilla, and we are trying to listen a lot more, including to the members of the subspecialty societies.

What are the challenges we face on the horizon?

There is a lot of uncertainty about health care reform and where it’s headed. Nobody knows. But as an organization and as a specialty, we have been very adaptable. It’s amazing how we’ve taken on new technologies, for example, and made it all work. We’ve adapted to a changing work environment. We don’t really know whether to bob or weave right now. We keep a finger on the pulse all the time, and if we have to bob, we will; if we have to weave, we will.

Urology is a small specialty, and we don’t fill as many spots with new residents as we should. One way to expand the work force is with nonphysician providers-advanced practice nurses and physician assistants. What are we doing to educate these individuals and bring them into the fold?

Together, nurse practitioners (NPs) and physician assistants (PAs) have become one of the fastest growing segments of the AUA. They have their own committees and their own big meetings. Their didactics are very strong. We’re starting to delve into how we not only educate them on the basis of how to work within a practice, but also potentially procedurally. I believe there will be another survey of practicing urologists that asks about this because the times have changed a bit.

Read: Urologists show low adherence to value-based care pathway

I do believe urologists need to be the quarterback, and proper supervision is the right thing for urology, for the PA and NP, and for the patient and his or her safety. There are urologists with nonphysician providers working within their practice who are saying, “We’d like to have a formative way of teaching them and maybe even teaching them procedures.” That’s being looked at again. I think we will be heading in that direction but we are also being cautious about the move.

There are currently very few fellowships for PAs who come out of their basic residency training for urology. Does the AUA Board of Directors foresee a formal program developing?

I don’t know, but I can tell you the idea of training that might allow the practitioner to earn a certificate or something similar has been discussed. The concept is not necessarily certification, but something that says, “This individual has been through a formal course. We feel this meets the needs of the specialty, and it’s safe.” Whether you call it a fellowship, an added qualification, or certification, that’s been talked about and may be what the future holds.

Next: "I don’t think hospital employment changes the stripes of the tiger."

Health policy is in evolution, and the landscape is changing. More physicians coming out of residency are taking employment, academic, or government positions, and some say that groups of three or fewer doctors are dead. How does that impact AUA membership and member involvement in advocacy?

I don’t think hospital employment changes the stripes of the tiger. Urologists are viewed by hospital systems and other employers as a very bright group of surgical subspecialists who are very mature, easy to work with, and have good financial sense. But I honestly don’t believe we’ll see a huge migration away from AUA membership. So many people value that membership. Since 1902, the AUA has been physician run and physician led, we have been advocates for our constituents, and we will continue to be.

Also see - Burnout: How can it be prevented?

Now, we have turned a little bit. We do more now for practices, which I think is very important. The AUA Coding Hotline, for example, is very important, and coders call the hotline regularly for help. We’ve tried to change with the shifting tides and make sure we’re supporting practices as well as individuals.

In any organization, you have a limited amount of manpower, resources, and finances. How do you see the AUA balancing health policy, education, and research? Can we do all of them?

Yes, we can do them all. But the real question is, how do we do it with a similar amount of resources for each? The answer is, you don’t. Some are going to be cost centers and others are profit centers. We realize, for example, research will never be a profit center for us. But if you ask membership how important research is, most everyone will say it is extremely important and it’s how we end up taking innovation from the bench to the bedside. We’ll make a profit on some things, and we’ll take a loss on others. We have to make sure we weigh the benefits to the overall membership. It’s a very delicate balancing act.

Many members are concerned about MOC and whether they can fulfill the requirements, and some question the value of certifying when they’re near the end of their careers. What is the AUA doing to support that?

In February, I attended the most recent American Board of Urology (ABU)/AUA leadership meeting in Dallas, and I thought it was outstanding. The ABU and AUA have different missions, but I was encouraged that both organizations see it as very important to make MOC a less arduous process for AUA members but still protect that certificate. Every diplomate will tell you that the certificate is something very important to them. It protects your practice.

Read: Burnout rate lower than believed, but still too high

I think the leadership talks and the open lines of communication between the ABU and AUA are very important. Certification can’t be done otherwise. The educational products from the AUA are very important in helping the ABU meet the expectations not only for knowledge assessment but also for CME and the rest of continuing accreditation.

It sounds like you’re saying board certification is not an economic policy but a quality process.

That’s absolutely right. We just want to make it the least arduous process possible for the diplomate.

Next: What is the current status of the Urology Care Foundation, and where is it going in the future?

What is the current status of the Urology Care Foundation, and where is it going in the future?

I think the current leadership has been great. Dr. Rich Memo has done an outstanding job trying to make the foundation as independent as possible, and he’s done great on the patient education side. Dr. John Lynch has done a really good job there in terms of increasing funds, philanthropy, and outreach. On the research side, Dr. Aria Olumi is doing an excellent job as well.

Is the AUA Board of Directors comfortable standing back a little and letting the foundation have more independence and self-direction?

The Urology Care Foundation is not ready for financial independence, but it continues under strong leadership to grow and expand its philanthropy, patient education, and support for research. We have a lot of confidence in what the foundation has done, and it will just get better.

What take-home message do you have for the members of the AUA?

I really want to unite urology. I want to increase the lines of communication. We have already started setting up meetings with the larger subspecialty societies. We are listening more than we’re talking. We want to know what we are doing well, how we can do better, and how we can support you and your society.

I don’t think we should be rowing in different directions. We’re a very small specialty, and we need to unite to maintain our strength and our voice. Opening the lines of communication and doing a better job of uniting the specialties are my primary goals. If I can accomplish that by the time I finish my term, I would feel great about it.

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