Economic issues have far-reaching effects on urology

By percentage, our greatest concerns are decreasing reimbursement (with 90% saying they are extremely or very concerned), increasing government regulations (86%), and uncertainty about the Patient Protection and Affordable Care Act (79%). A decrease in income from 2009 to 2010 was reported by 43%, while only 18% reported an increase.

Virtually every source of income from patient care to ancillary services is being cut for all specialty physicians, not just urologists. If the proposed 27% cut in Medicare reimbursement actually happens in 2012, many will drastically cut back on the number of Medicare patients they see.

A majority of urologists expect to expand their use of non-physician providers. The "scope of practice" for non-physician providers in urology is not well defined and often governed by state law. In some practices, nurse practitioners and physician assistants perform cystoscopy. A recent AUA survey noted that urologists have strong and opposing opinions about the role of non-physician providers. However, urologists agree that they enhance patient care, expand services, and increase revenue.

One urologist who responded to the survey planned to "ignore health care reform. With so few urologists, we will dictate health care reform as we see fit. Nothing like lack of competition."

Now if someone could figure out how to translate "supply and demand" into increased revenue, we could capitalize on the shortage of urologists and the huge demand for our services.

Dr. Gee, a member of the Urology Times Editorial Council, is in private practice in Lexington, KY.