Urology payment, work force trends are troubling

Of top concern to urologists are declining reimbursement (88%), increasing government regulations (86%), Obamacare (73%), and increasing overhead (71%). This finding-from the most recent Urology Times State of the Specialty survey-was consistent for all ages, practice types, and practice sizes. 

Of note, and concern, 28% of respondents plan to retire within 5 years. There are about 9,500 practicing urologists and 28% represents about 2,600. Every year approximately 250 urologists leave training and enter practice-about 1,250 over the next 5 years. That suggests a decrease of over 1,000 urologists against the rapidly expanding number of Medicare patients and the influx of the newly insured under Obamacare.

We are busy; 65% work more than 50 hours per week and 14% work more than 70 hours per week. Academic urologists do three times as much hospital inpatient surgery (11.2 hours per week) as private practice urologists (4.5 hours per week). The EHR/EMR battle is over, as 81% of us now use an EHR. Only 10% have no plans to implement an EHR, and these are mainly solo practitioners with 30-plus years in practice. Are they a dying breed?

Stepping back from the politics and philosophy of Obamacare, one thing is clear: As a result of the law, we will all have more patients with urologic problems to care for. Getting paid fairly for our services is another story. Most of the major insurers have already put themselves far ahead of the mandates of the law by starting to form “narrow networks” of providers, encouraging accountable care organizations, creating alternative payment methodologies, and insisting we follow specialty society treatment guidelines. Changes in how we are paid are under way.

Thankfully, urologists have always adapted well to change. Advances that once seemed revolutionary-percutaneous stone surgery, laparoscopy, lithotripsy, and the robot-are now part of everyday practice. What hasn’t changed, unfortunately, is the pattern of little to no increase in Medicare reimbursement since 2002 amid climbing overhead. It is very important to let your members of Congress know how you feel about this.

Take some time to sit back with a cup of coffee (or other beverage), read through this year’s survey responses, and see where you fit.UT

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