Urologist shortage or identity crisis?

Kerr is group content director of Urology Times.

Hitting all the highlights of an event as large as the AUA annual meeting is nearly impossible. But since returning home from San Diego, three topics have stuck with me as especially relevant.

First, there was much discussion about the future supply of urologists in this country. There’s little doubt that the need for urologic services will jump with 30 million new patients entering the health care system under the Affordable Care Act, as articles in this issue point out. Many of these patients will need urologic care due to their advanced age.

However, questions remain about the nature of that care and who will administer it. Already, advances in medical therapies have seen management of erectile dysfunction move largely to primary care doctors. (Pfizer and GlaxoSmithKline-two leaders in the ED market-were noticeably absent from this year’s exhibit hall.) Similarly, the increasing role of active surveillance in low-risk prostate cancer will likely shrink the demand for radical prostatectomy.

How much urologic care will be provided by urologists going forward, and what will urologists’ “identity” be? Will they serve as proceduralists? Or will they oversee the care of all urologic diseases and disorders, with some urologists focusing on office-based care and others on surgery? The specialty’s labor needs require a careful look at these questions.

The biggest story of this year’s meeting was not the work force but the launch of the AUA’s new prostate cancer screening guideline. The mainstream media’s coverage of this news became a story of its own. Even physician-targeted media outlets used misleading headlines like, “PSA Testing Not Recommended by AUA.”

Two tests-one to determine which prostate cancer patients are candidates for active surveillance and another to predict recurrence and mortality-showed promising results in San Diego. These tests, however, are diagnostic and prognostic in nature. What is sorely needed is a sensitive, specific screening test to replace PSA. Unfortunately, such a test is still not close to prime time.

Finally, this meeting saw social media, Twitter in particular, take off. The hashtag #aua13 was used in more than 1,000 tweets daily on the meeting’s second, third, and fourth days. The AUA embraced this new media outlet by installing Twitter feed screens throughout the convention center and placing a link to its Twitter feed on its revamped website. An AUA social media work group has been formed. Like it or not, the era of social media is here to stay.UT