Burden of care for recurrent UTI is higher for female urologists

In this interview, Debra L. Fromer, MD, highlights the background and key findings from the study, “The Operational Burden in the Management of UTIs in an Outpatient Academic Practice,” which was presented at the 2024 American Urological Association (AUA) Annual Meeting in San Antonio, Texas.¹ Fromer is the chief of female pelvic medicine and reconstructive surgery at Hackensack University Medical Center in New Jersey.

Debra L. Fromer, MD

Could you describe the background for this study?

Recurrent UTI is a condition that is very common among female patients in particular. It's a condition that is common for urologists to take care of. And it's problematic for both the patient and the physician because we don't know what causes them and we don't have a cure for them. We can often reduce the frequency of UTI, but very frequently UTIs can recur despite treatment and despite preventative measures–oftentimes, because of the nature of UTIs and how they occur–on a very unexpected and sudden basis. It requires a lot of phone calls to the office from the patients and messaging from the patient to the office, and from the office to the patient. And a lot of these events are not billable. Because of the fact that these are mostly female patients that are experiencing this and because we know that female patients like to see female urologists, oftentimes the burden of this condition falls upon the female urologist.

So, this study was designed to look at the burden of recurrent UTIs on the urologists in our practice, particularly when we compare the female urologists to the male urologists in terms of how much time is spent taking care of patients during non-billable events. This is in the context of understanding that there is a pay gap in urology–as there is in medicine, as there is across the world–that is gender-based.

What were the key findings that were presented at this year's AUA meeting?

We were able to calculate a burden ratio, which is calculated by the non-billable events vs the billable events. What we found was that the burden of the care of these patients fell on the female urologists. The burden was higher in female patients vs male patients and higher among female urologists vs male urologists.

Again, we think the reason for this is because female patients seek out female urologists, and recurrent UTI is much more common in women than in men. That was the case in this particular study. What we believe is happening is women are seeking the help of female urologists, and therefore, because of the nature of the condition, the female urologists are absorbing the burden of the care of these patients, particularly the non-billable burden.

What next steps are planned for this study?

Once we identified this, our practice has adapted to this by hiring a female nurse practitioner specifically for the care of our patients with recurrent urinary tract infections to help offload the non-billable events and help our female urologists be more productive with other areas that we specialize in. I think that a study like this can be performed for other disease conditions like overactive bladder, which are also more common in women than in men, where women might seek the care of female physicians and where the care is often based in non-billable events. I think that those are the next steps for our research that is more geared toward practice management. It definitely brings up some questions in the way we practice from a gender-based conversation.

Reference

1. Udaiyar A, Lembrikova K, Slavin A, Fromer D. The operational burden in the management of UTIs in an outpatient academic practice. Presented at: 2024 American Urological Association Annual Meeting. May 3-6, 2024. San Antonio, Texas. Abstract MP69-06