Docs’ frustration may hinder access to care

William F. Gee, MDThe 2014 Urology Times“State of the Specialty” survey shows that urologists remain frustrated with over-regulation by government, control of fees, meaningful use (meaningless use?), and a host of other rules that many argue add nothing to the quality of patient care.

We do fewer and fewer open procedures, the majority being done in academic centers. Physicians in all types of practices are doing most surgical procedures on an outpatient basis, either in the office or at an ambulatory surgery center. The majority of urologic procedures are now done endoscopically or percutaneously.

The electronic medical records battle is over, with 100% of academic urologists and over 90% of all urologists under age 60 using an EMR. The urologist in solo practice is about gone. Most of those in solo practice are now well over age 60; only 8% are under age 45.

Non-academic urologists continue to be involved in revenue-producing partnerships: 61% are in a lithotripsy partnership, 34% are involved in ASC ownership, and 14% are in intensity-modulated radiation therapy (IMRT) partnerships. Is ownership of an IMRT facility a conflict of interest? Urologists remain equally divided at 50% yes and 50% no.

The retirement of a large number of urologists looms as a real threat to access to quality urologic care. Up to 26% of urologists report they will retire within the next 5 years. In numbers, that means a loss of about 2,500, with only about 1,250 new urologists entering practice. The greatest motivators to retire are the growing burden of government influence, declining reimbursement, and the influence of managed care. Of concern, 22% of academic urologists-those training the future of our specialty-say they would not choose medicine as their career if they had it to do over.

A new question this year asked if urologists planned to take the ABU recertification exam when they were age 60 or older. Fifty-eight percent said yes but 41% said no, a potential further reduction in our work force.

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