Is there a urologist shortage in your area? What should be done about it?

“Most certainly there’s a shortage of urologists in the rural areas. In my area, there are two urologists that serve the western portion of Minnesota. It’s extremely difficult to recruit new urologists. We haven’t been able to afford a robot; I think that is a huge part of being able to recruit and retain urologists, especially the young urologists coming out of residency. That’s what they know; that’s what they’re comfortable with. This is really going to determine how we can get these younger urologists to come out to a rural area. But they want to have a lifestyle. They’re used to that 80-hour workweek that they have in residency. In a rural practice, you’re going to be on call more, you’re going to be coming in more, and you’re going to be working later. And I think that’s another part of it.”

Sheila K. Gemar, MD

Willmar, MN

“I don’t think that there’s any question that we’re seeing a real tension in our ability to recruit new urologists to clinical practices. One of the things that we have to grapple with is that urology is one of the oldest surgical disciplines. When we’re dealing with the fact that many clinicians are toward the latter end of their career, and also given the tremendous administrative changes in the Affordable Care Act, physicians that may have been in practice for a longer period of time may well look to retire earlier. I think the most important thing that urology can do is gather accurate data. We can’t advocate with policymakers unless we have very strong and very accurate data. You need to measure how productive are clinicians, how long are they going to be in practice, what the factors are that are going to keep them in practice versus having them retire, what the motivations are of residents that come out of training. Until we have accurate answers to those questions, we actually can’t formulate a proper legislative strategy to address them.”

Deepak Kapoor, MD

New York

“People practice where they want to practice. Overall, there is a lot of demand for urology, and so probably urologists don’t diffuse out into some of those more rural areas. If there’s going to be an increase in demand with a decrease in supply, then you’re going to wind up with more areas that lack a urologist and lack a urology presence. I think [addressing the work force problem] is a tough issue, because even if you increase the supply, people are still going to want to practice in the areas where they want to live and practice, and that’s the way it is. There’s no way to force people, unless maybe through other programs like they’ve had on the primary care side, where people get loan repayments and other things to try practicing in a more underserved rural area for a time period.”

Seth Strope, MD, MPH

St. Louis

“Specifically in Charlotte, a larger metropolitan city, I wouldn’t say there’s a urologist shortage. But in rural areas outside of that epicenter, there seems to be quite a bit of a urologist shortage. I think one of the ways to combat that is, we’re going to have to bring out and train more urology residents and entice them to enter the more rural areas so that the clustering into large cities [is reduced], which really will affect the access to care. Obviously, the projected growth in the aging population over the next 20 to 30 years is certainly going to be a big issue that we’re going to have to think about now instead of 20, 30 years from now.”

Stephen B. Riggs, MD

Charlotte, NC

“With the Affordable Care Act and what’s to come in the future, I think there are definitely going to be more patients, and there’ll be a greater need for APNs in that role. Personally, as an APN, I think it just makes sense for us to help fill that role. We have the background; we have the knowledge. It just seems like the logical next step. I’d like to see more discussion about it at the AUA annual meeting… because it’s a very prominent topic.”

Advanced Practice Nurse, California (name withheld by request)