As we enter 2009, are you optimistic or pessimistic about urology in the new year?

"I am optimistic about urology, regardless of what the president does. Our politics are local. Eighteen million people in the Los Angeles area need medical care. If you can't pee, it's an emergency. People will get treated, even if insurance goes away.

Down the road, the future of Medicare and insurance concerns us. As long as Medicare stays relatively solvent without drastic cuts-perhaps even with increases because other insurances peg their reimbursement on Medicare and if they expand single-payer coverage to all people who are uninsured, it may reduce administrative costs-it could even be better for us.

In general, doctors have done better under Democratic regimes. Republicans have pushed managed care, which has hurt us in California."

"For the country as a whole, I'm optimistic.

Whether they're going to be able to accomplish radical changes to our health care system is unclear. The idealism is there, but I don't know if some things our president-elect wants to do are doable.

I don't know if he realizes the forces he is up against: the pharmaceutical lobby, the insurance lobby, and, for that matter, the physician lobby. He might underestimate how much those players have and how far they'll go to protect their interests.

The sustainable growth rate of physician salaries is a major issue that needs to be addressed. The problem of the uninsured is not an easy fix.

As a young urologist looking for a job, I chose stability and security over high-risk/high-reward. I'm employed in a large institution, so we're somewhat insulated. If I were in a small, private practice, I would be pretty scared about how potential change might affect me."

Kristofer R. Wagner, MD
Temple, TX

If I were just starting out, I would be concerned about what's going to happen with reimbursements.

Financially, I'm ready for retirement, but responsibility to my patients keeps me in practice. The closest urologist is 15 miles away, and he's getting closer to retirement also, so in a few years, we're really going to be dealing with a shortage.

Medicare keeps going down and, in Pennsylvania, malpractice keeps going up, so I'm not very optimistic."

Walter P. Beh, MD
Greenville, PA

"I 've found prayer to be helpful. That's pretty much my usual solution.

I have concerns about manpower issues, liability reform, and state issues as well as national issues. The closest model I've seen for health care reform is Massachusetts, which has been a disaster, with physician shortages and longer wait times.

I'm somewhat pessimistic, at least in the short term. I don't particularly think we're looking at a favorable climate for urologists' concerns. We're looking at a new administration that is probably going to be more favorable to trial attorneys, so I don't think it's a good outlook."

Richard W. Puschinsky, MD
High Point, NC