Urologists still perform major surgery, but have primarilyoffice-based practices

Urologists continue to perform substantial numbers of major surgical procedures despite having predominantly office-based practices, according to data on recent candidates for certification and recertification by the American Board of Urology.

More than one-fourth (27%) of claims reported by candidates for initial certification and 20% of those reported by recertification candidates involved surgical procedures traditionally performed in an operating room. Endoscopy procedures accounted for 64% of the claims in both groups.

The findings have implications for the ongoing debate about the possible need to change urology training programs to reflect a predominance in office-based practice.

"The board wants to study these issues and make recommendations based on very good data," said study author Peter Carroll, MD, of the University of California, San Francisco. "Right now there is a lot of emotion swirling around practice volume changes and changes in residency requirements, but if we make any changes, we have to make them on good data."

The findings also suggest that most urologists still perform a substantial amount of open surgery, he added. A majority of both candidate groups reported performing more than two major surgical procedures per month.

The findings came from a review of 592 candidates seeking initial ABU certification and 1,003 seeking recertification between 2003 and 2005. Practice-related data came from CPT coding on logs submitted by the candidates.

Among office-based procedures, cystoscopy accounted for 55%, followed by prostate biopsy (15% to 16%) and vasectomy (9% to 10%). Prostate ultrasound was the most common office imaging study (40%), and urinalysis accounted for about 90% of testing reported by the certification and recertification candidates.