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Burton CS, Gonzalez G, Bresee C, Handler S, Yazdany T, Wieslander C, Mendez C, Ward K, Anger JT. Urinary Incontinence Care in the Academic and Safety-Net Primary Care Settings: Opportunities to Improve Quality of Care. Urology 2024:S0090-4295(24)00592-2. [PMID: 39047951 DOI: 10.1016/j.urology.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To compare the quality of urinary incontinence care for women in the safety-net and non-safety-net settings prior to referral to a specialist. METHODS We performed a retrospective review of 200 women from two non-safety-net hospitals and 188 women from two safety-net hospitals who were referred to Urogynecology and Reconstructive Surgery specialists for bothersome UI between March 2017 and March 2020. We evaluated the care that women received 12-months prior to referral, by measuring adherence to a set of previously developed quality indicators (QIs), for example the performance of a urinalysis or pelvic exam. RESULTS Women seen in safety-net hospitals were more likely to receive QI-compliant care than women in the non-safety-net hospitals prior to referral, with 55.53% of appropriate care given in the safety-net vs. 40.3% in the non-safety-net setting (p<0.01). Clinicians in the safety-net hospitals were more likely to adhere to QIs in patients with general, stress, and urgency incontinence. CONCLUSIONS Women were more likely to receive timely, quality-based UI care in the safety net compared to the non-safety-net setting. This may be in part due to aspects unique to the safety-net system, including an eConsult referral system, which guides referring clinicians in appropriate management steps that should be taken prior to the specialist visit, as well as women's health focused primary care clinics.
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Affiliation(s)
- Claire S Burton
- Division of Urology, Department of Surgery, City of Hope, Duarte, CA.
| | - Gabriela Gonzalez
- Department of Urology, University of California Davis, Sacramento, CA
| | - Catherine Bresee
- Biostatistics Core, Cedars Sinai Medical Center, Los Angeles, California
| | - Stephanie Handler
- Department of Obstetrics & Gynecology, University of California Riverside, Riverside, CA
| | - Tajnoos Yazdany
- Department of Obstetrics & Gynecology, University of California Riverside, Riverside, CA
| | - Cecilia Wieslander
- Department of Obstetrics & Gynecology, Olive View Medical Center, Los Angeles, CA
| | - Carmen Mendez
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA
| | - Katherine Ward
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Department of Urology, University of California San Diego, San Diego, CA
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Pellegrino C, Koo K, North AC, Badalato GM, Badlani G, Fang R, Helsel A, Meeks W, Chien GW. An Analysis of American Urological Association Census Trends: Earlier Planned Retirement and Practice Pattern Changes May Exacerbate the Urology Workforce Shortage. Urology 2024; 188:1-6. [PMID: 38677377 DOI: 10.1016/j.urology.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To explore how changes in planned retirement age, practice setting, and physician productivity may impact the workforce shortage in urology. METHODS We compared data between the 2015 and 2022 American Urological Association census, a specialty-wide annual survey which collects data on demographics, practice patterns, and procedures from a representative sample of U.S. urologists. Workforce productivity was measured by the self-reported number of hours worked per week and patients seen per week. A novel formula was developed to demonstrate how planned retirement age and productivity impact the workforce's production capacity. RESULTS The total number of practicing urologists increased during the period from 2015 to 2022 (11,990 to 13,976), while the mean age of practicing urologists decreased slightly (55.0 to 54.5years; P < .002). During this period, the mean planned age of retirement for all urologists decreased from 68.9years to 67.7 (P < .001). Urologists in solo practice had a significantly higher planned age of retirement at 71.9years (P < .001) as compared to all other practice models. The number of patients seen per week for all urologists decreased from 78.7 to 72.9 (P < .001). The amount of hours worked per week remained relatively constant between the study periods. The maximum possible number of patients seen by the workforce prior to retirement increased by only 2.4% during the study interval. CONCLUSION Though the U.S. urology workforce is growing and the mean age is decreasing, decreases in planned retirement age and productivity may offset these gains and intensify the physician shortage for U.S. urologists.
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Affiliation(s)
| | - Kevin Koo
- Mayo Clinic Department of Urology, Rochester, MN
| | - Amanda C North
- Montefiore Medical Center Department of Urology, Bronx, NY
| | - Gina M Badalato
- Columbia University Vagelos College of Physicians and Surgeons, Department of Urology, New York, NY
| | - Gopal Badlani
- Wake Forest University Baptist Medical Center, Department of Urology, Winston Salem, NC
| | | | | | | | - Gary W Chien
- Kaiser Permanente Los Angeles Medical Center, Department of Urology, Los Angeles, CA
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Napolitano L, Maggi M, Sampogna G, Bianco M, Campetella M, Carilli M, Lucci Chiarissi M, Civitella A, DE Vita F, DI Maida F, DI Mauro M, Ercolino A, Fasulo V, Felici G, Gheza A, Guzzardo C, Loizzo D, Mazzone E, Parodi S, Piramide F, Rabito S, Rizzetto R, Romantini F, Scarcella S, Tedde M, Checcucci E, Esperto F, Claps F, Falagario U. A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program. Minerva Urol Nephrol 2023; 75:718-728. [PMID: 37350584 DOI: 10.23736/s2724-6051.23.05257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Martina Maggi
- Department of Urology, Sapienza University, Rome, Italy -
| | - Gianluca Sampogna
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bianco
- Department of Urology, University of Padua, Padua, Italy
| | | | - Marco Carilli
- Unit of Urology, Tor Vergata Polyclinic Foundation, Rome, Italy
| | | | - Angelo Civitella
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Fabrizio DI Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marina DI Mauro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | | | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alberto Gheza
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Davide Loizzo
- Unit of Transplantation, Department of Urology, Andrology and Kidney, University of Bari, Bari, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Parodi
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy
| | - Federico Piramide
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Salvatore Rabito
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Rizzetto
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Matteo Tedde
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, Sassari, Italy
| | - Enrico Checcucci
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Esperto
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Ugo Falagario
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
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Nam CS, Daignault-Newton S, Kraft KH, Herrel LA. The Future is Female: Urology Workforce Projection from 2020 to 2057. Urol Clin North Am 2023; 50:501-513. [PMID: 37775209 DOI: 10.1016/j.ucl.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Multiple estimates have approximated a urologist shortage per capita of around 30% by 2030. In the context of the impending urologic workforce shortage, it is critical to have a nuanced understanding of the degree of workforce shortage in comparison with the US population to mitigate the negative downstream effects in the future. In continued growth and stagnant growth projection models, we found that female urologists make up a significant proportion of the workforce growth over the next four decades. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support and retain female urologists.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA.
| | | | - Kate H Kraft
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA
| | - Lindsey A Herrel
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA
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Sheng M, Chu A, Catic A, Hartsell L, Mehta A. Needs and Experiences of United States Female Urology Residents. Urology 2023; 180:66-73. [PMID: 37437612 DOI: 10.1016/j.urology.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To identify factors influencing residency training program selection by women residents in urology and to evaluate the residents' gender-based experiences during training. Urology remains a disproportionately male-physician-dominated field. Understanding the needs and experiences of women residents is essential for developing strategies to recruit and retain more women urologists in independent practice. METHODS An anonymous, 15-item web-based electronic survey was posted on social media and distributed via institutional email addresses between May and July 2021, targeted to all 461 current women U.S. urology residents. Both quantitative and qualitative data were collected and analyzed using descriptive statistical methods and thematic analysis, respectively. RESULTS 147 complete responses were received. The most important factors influencing initial residency training program selection included geographic location/setting (37%) and institutional reputation (27%), compared to number of women faculty (3.4%) and women residents (0%). However, respondents cited a need for increased presence of women faculty and mentorship (36%), elimination of gender bias/harassment in the workplace (33%), and improved family support/maternity leave policies (15%) during residency to better foster clinical and academic growth of women residents. In interactions with patients, 97% reported not being recognized as a doctor, 84% reported stereotyping of women doctors, and 78% reported experiencing inappropriate treatment/harassment from male patients. CONCLUSION Geographic setting and institutional reputation were the most important factors for residency program selection by women urology residents. Although overlooked as a priority during the initial application process, current women urology residents seek increased women faculty presence, leadership and mentorship during residency to foster clinical and academic growth. Women residents face extremely high rates of gender bias and harassment in the workplace.
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Affiliation(s)
- Michelle Sheng
- Emory Department of Urology, Emory University School of Medicine, Atlanta, GA.
| | - Alice Chu
- Emory Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Almira Catic
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lindsey Hartsell
- Emory Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Akanksha Mehta
- Emory Department of Urology, Emory University School of Medicine, Atlanta, GA
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Haack M, Reisen K, Ghazy A, Stroh K, Frey L, Sparwasser P, Duwe G, Mager R, Haferkamp A, Borgmann H. Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models. Front Surg 2023; 10:1264164. [PMID: 37799119 PMCID: PMC10547869 DOI: 10.3389/fsurg.2023.1264164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. Methods and Participants 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Results Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Conclusion Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Katja Reisen
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Ahmed Ghazy
- Department of Cardiovascular Surgery, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Lisa Frey
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Pandit AA, Patil NN, Mostafa M, Kamel M, Halpern MT, Li C. Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study. Cancers (Basel) 2023; 15:cancers15071939. [PMID: 37046601 PMCID: PMC10093298 DOI: 10.3390/cancers15071939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression. Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures. Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas. Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.
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8
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Nam CS, Daignault-Newton S, Herrel LA, Kraft KH. Can you have it all? Parenting in Urology and Work-Life Balance Satisfaction. Urology 2023:S0090-4295(23)00145-0. [PMID: 36796543 DOI: 10.1016/j.urology.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To evaluate the association between work-life balance satisfaction for practicing urologists who have children <18 years compared to those who do not have children or have children ≥18 years. METHODS We evaluated the association between work-life balance satisfaction based on partner status, partner employment status, child status, primary responsible party for family, total work hours per week, and total vacation weeks per year using 2018 and 2019 American Urological Association (AUA) census data with post-stratification adjustment methods. RESULTS Of 663 respondents, 77 (9.0%) were female and 586 (91%) were male. Female urologists are more likely to have an employed partner (79.vs 48.9%, P <.001), more likely to have children <18 years (75.0 vs 41.7%, P <.0001), and less likely to have a partner as primary caretaker of family (26.5 vs 50.3%, P <.0001) compared to male urologists. Urologists with children <18 years reported lower work-life balance satisfaction than those without (OR 0.65, P = .035). For every 5 additional hours works per week, urologists reported lower work-life balance (OR 0.84, P <.001). However, there are no statistically significant associations between work-life balance satisfaction and gender, employment status of their partner, primary responsible party for family responsibilities, and total weeks of vacation per year. CONCLUSION According to recent AUA census data, having children <18 years is associated with lower work-life balance satisfaction. This highlights opportunities to support young parents, both male and female, in the workplace to prevent burnout and maximize well-being among urologists.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI.
| | | | - Lindsey A Herrel
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Kate H Kraft
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
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Joshi M, Polimera H, Krupski T, Necchi A. Geography Should Not Be an "Oncologic Destiny" for Urothelial Cancer: Improving Access to Care by Removing Local, Regional, and International Barriers. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35471833 DOI: 10.1200/edbk_350478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urothelial cancer care is particularly susceptible to geographical health disparity given its complex nature, requiring access to several specialists such as a urologist, a medical oncologist, a radiation oncologist, a surgical oncologist, and multidisciplinary care teams. Furthermore, other barriers to care access in underserved areas include travel burden, longer wait times, late-stage disease at the time of diagnosis, cost, type of treatment, less enrollment in clinical trials, lack of follow-up among cancer survivors, and less research funding in this area. Here, we discuss the impact of geographical location on access to urothelial cancer care, management decisions, and outcomes and we reflect on how to address geographical disparities in care delivery.
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Affiliation(s)
- Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Hyma Polimera
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Tracey Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Andrea Necchi
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS Ospedale San Raffaele, Milan, Italy
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10
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Kaku Y, Inoue T, Charlie Y, Imai S, Yamamichi F, Fujisawa M. Efficiency of novel shielding curtains combined with pulsed irradiation for reducing radiation exposure in an operating room: Human renal collecting system phantom study. Int J Urol 2022; 29:571-577. [PMID: 35165944 DOI: 10.1111/iju.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of novel shielding curtains combined with pulsed irradiation mode to protect medical radiation workers from radiation exposure during ureteroscopy. METHODS 0.25 mm Pb equivalent novel shielding curtains were mounted to the caudal and bilateral sides of the operating table in the ureteroscopy setting. C-arm was positioned as per normal in the operating room with the X-ray tube under the patient table. A water-filled anthropomorphic renal collecting system phantom was positioned in the standard position on the operating table that was set at a height of 100 cm. The ionization chambers were also positioned at a height of 100 cm and set in eight positions. We took measurements at distances of 50, 100, 150, and 200 cm from the phantom with the focus directed toward the X-ray tube. We measured the spatial distribution of the scattered radiation dose in four combinations: (1) continuous irradiation mode without novel shielding curtains; (2) pulsed irradiation mode (11 films per second) without novel shielding curtains; (3) continuous irradiation mode with novel shielding curtains; and (4) pulsed irradiation mode with novel shielding curtains. Continuous or pulsed irradiation was activated for 30 s each time. RESULTS Pulsed irradiation mode with novel shielding curtains was a significantly more efficient method than other combinations to reduce scattered radiation exposure in this study (P < 0.001). There was approximately a 95% reduction in scattered radiation exposure with the pulsed irradiation mode with novel shielding curtains set up as compared with continuous irradiation mode without novel shielding curtains. CONCLUSION Combining a novel shielding curtain and using a low pulse radiation setting can greatly reduce radiation exposure during ureteroscopic procedures.
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Affiliation(s)
- Yasuhiro Kaku
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takaaki Inoue
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | | | - Satoshi Imai
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Fukashi Yamamichi
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Beale R, Sicilila S, Riestra P, Albala DM. Are robots the future? A case for robotic pyeloplasty as the gold standard treatment in ureteropelvic junction obstruction. Curr Opin Urol 2022; 32:109-115. [PMID: 34798638 DOI: 10.1097/mou.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robotic pyeloplasty is still a relatively novel procedure. Clinically, early studies have shown high success rates, decreased complication rates, decreased length of hospital stay, and better cosmetic results. This goal of this article is to argue for the use of robotic pyeloplasty as the gold standard of ureteropelvic junction obstruction (UPJO) treatment. Results of studies that have compared robotic pyeloplasty with other procedures currently used are reviewed. RECENT FINDINGS Our study, a comprehensive review of published outcomes of robotic pyeloplasty and alternative therapies, consisted of 666 pediatric patients and 653 adult patients. Our review coincided with the previously established studies that robotic pyeloplasty shows equivalent surgical success rates as previous standard of care treatments. Open pyeloplasty has fallen out of favor as standard of care due to the increased length of hospital stay, increased adverse events, and the undesirable aesthetics. SUMMARY The use of robotic pyeloplasty has shown to have clinical outcomes that are consistent with other intervention for UPJO, with a potential decrease in length of stay and morbidity. More work has to be done to develop ways to decrease cost of the robot to help establish it as the gold standard for UPJO treatment.
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Affiliation(s)
- Robert Beale
- SUNY Downstate Health Sciences University, New York
| | | | - Paola Riestra
- Associated Medical Professionals, Syracuse, New York, USA
| | - David M Albala
- SUNY Downstate Health Sciences University, New York
- Associated Medical Professionals, Syracuse, New York, USA
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Abstract
PURPOSE OF REVIEW Residency training is a pivotal educational step on the road to becoming a urologist. It combines both clinical and surgical instruction with the goal of producing proficient and compassionate surgeons and clinicians. In this review, we employ a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) to investigate the current state of urologic residency training. RECENT FINDINGS Urology remains an attractive and competitive residency with varied and complex surgical and medical training. Areas for improvement include standardization of evaluation and feedback, improving resident wellness, and expanding the use of surgical simulation. Workforce issues such as the predicted urologist supply deficit and poor readiness to enter the business of medicine can be addressed at the residency level. Failure to attract and retain underrepresented minorities, increasing burden of student debt, and resident burnout are serious threats to our field. Using a SWOT analysis we identify key areas for expansion, underscore valuable strengths, and provide a working roadmap for improvement of these formative years.
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Affiliation(s)
- Luke E Sebel
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA
| | - Eric G Katz
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA
| | - Lara S MacLachlan
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA.
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Nam CS, Daignault-Newton S, Kraft KH, Herrel LA. Projected US Urology Workforce per Capita, 2020-2060. JAMA Netw Open 2021; 4:e2133864. [PMID: 34783827 PMCID: PMC8596195 DOI: 10.1001/jamanetworkopen.2021.33864] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022] Open
Abstract
Importance Projections to 2035 have demonstrated concern regarding a worsening urology workforce shortage. Objective To project the size and demographic characteristics of the urology workforce per capita into 2060 and to anticipate the timing and degree of the impending urology workforce shortage. Design, Setting, and Participants This population-based cross-sectional study used the 2019 American Urological Association Annual Census data and the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018. The cohort included practicing urologists in 2019. US Census data were used to approximate the projected US population. Data analysis was performed from June 2020 to March 2021. Exposures Continued growth stock and flow model of 13.8% and stagnant growth model of 0% increase of the incoming urology workforce with cohort projection per projected US population. Main Outcomes and Measures The primary outcome was urology workforce projection per the population aged 65 years and older. Urology workforce projections per capita and demographic characteristics of the urology workforce up to 2060 were calculated under guided assumptions with 2 stock and flow models. Results In 2019, there were 13 044 urologists (11 758 men [90.1.%]; 1286 women [9.9%]; median age range, 55-59 years), with 3.99 urologists per 100 000 persons and 311 new urologists entering the workforce. In a continued growth model, 2030 will have the lowest number of urologists per capita of 3.3 urologists per 100 000 persons, and recovery to baseline will occur by 2050. There are 23.8 urologists per 100 000 persons aged 65 years and older in 2020, which decreases to 15.8 urologists per 100 000 persons aged 65 years and older in 2035 and never recovers to its baseline level by 2060. In a stagnant growth model, there will be a continued decrease of urologists per capita to 3.1 urologists per 100 000 persons by 2060. There is a continued decrease in per capita urologists at each time point, with 13.1 urologists per 100 000 persons aged 65 years and older by 2060. Conclusions and Relevance With the impending urology workforce shortage, there will be an exaggerated shortage of total urologists per persons aged 65 years and older in both models. This projection highlights the need for structural changes and advocacy to maximize the available urology workforce.
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Affiliation(s)
- Catherine S. Nam
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Kate H. Kraft
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | - Lindsey A. Herrel
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
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Patel M, Gadzinski AJ, Bell AM, Watts K, Steppe E, Odisho AY, Yang CC, Ellimoottil C. Interprofessional Consultations (eConsults) in Urology. UROLOGY PRACTICE 2021; 8:321-327. [PMID: 33928183 PMCID: PMC8078010 DOI: 10.1097/upj.0000000000000209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An interprofessional consultation (eConsult) is an asynchronous form of telehealth whereby a primary care provider requests electronic consultation with a specialist in place of an in-person consultation. While eConsults have been successfully implemented in many medical specialties, their use in the practice of urology is relatively unknown. METHODS We included data from four academic institutions: University of Michigan, University of California -San Francisco, University of Washington, and Montefiore Medical Center. We included every urological eConsult performed at each institution from the launch of their respective programs through August 2019. We considered an eConsult "converted" when the participating urologist recommended a full in-person evaluation. We report eConsult conversion rate, response time, completion time, and diagnosis categories. RESULTS A total of 462 urological eConsults were requested. Of these, 36% were converted to a traditional in-person visit. Among resolved eConsults, with data on provider response time available (n=119),53.8% of eConsults were addressed in less than 1 day; 28.6% in 1 day; 8.4% in 2 days; 3.4% in 3 days; 3.4% in 4 days; 1.7% in 5 days; and 0.8% in ≥6 days. Among resolved eConsults, with data on provider completion time available (n=283), 50.2% were completed in 1-10 minutes; 46.7% in 11-20 minutes; 2.8% in 21-30 minutes; and less than 1% in ≥31 minutes. DISCUSSION Our study suggests that eConsults are an effective avenue for urologists to provide recommendations for many common non-surgical urological conditions and thus avoid a traditional in-person for low-complexity situations. Further investigation into the impact of eConsults on healthcare costs and access to urological care are necessary.
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Affiliation(s)
- Milan Patel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
| | | | | | - Kara Watts
- Department of Urology, Montefiore Medical Center, New York
| | - Emma Steppe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Anobel Y. Odisho
- Department of Urology, University of California, San Francisco
- Center for Digital Health Innovation, University of California, San Francisco
| | - Claire C. Yang
- Department of Urology, University of Washington, Seattle
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
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Cruz AP, Skolarus TA, Ambani SN, Hafez K, Kraft KH. Aligning Urology Residency Training With Real-World Workforce Needs. JOURNAL OF SURGICAL EDUCATION 2021; 78:820-827. [PMID: 33046414 PMCID: PMC7546236 DOI: 10.1016/j.jsurg.2020.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Research suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce. DESIGN Correlative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al. SETTING: N/A. PARTICIPANTS N/A. RESULTS In 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents' procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence. CONCLUSIONS Optimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.
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Affiliation(s)
| | - Ted A Skolarus
- Department of Urology, University of Michigan, Ann Arbor, Michigan; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Sapan N Ambani
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
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Abstract
The nation's undersupply of urology services disproportionately affects Medicare beneficiaries compared to the general population. Advanced Practice Providers (APPs), most commonly nurse practitioners and physician assistants may be a vehicle to meet this need. The increased use of APPs in urology is hampered by physician discomfort with delegating responsibility to APPs. This discomfort may be compounded by complexities with billing issues and interstate variation in scope of practice regulations. To expand access to urological services while simultaneously ensuring service quality, it is imperative that urologists engage with APPs individually and as a specialty.
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Alasim HI, Arafa MA, Rabah DM, Alrawaf FK, Almanie AA, Alkhamshi AS, Almotairi AI. Factors influencing urology physicians in Saudi Arabia for choosing their subspecialty program. Urol Ann 2021; 12:335-340. [PMID: 33776329 PMCID: PMC7992524 DOI: 10.4103/ua.ua_9_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Aim: The aim of the study was to identify factors that influence urology physicians for choosing subspecialty and to know the most competitive urology subspecialty among residents. Methodology: An online questionnaire was sent to all Saudi Urology residents, registrars, and fellows all over Saudi Arabia, during February 2019–June 2019. The survey included demographic data, level and location of training, a subspecialty of interest, as well as 15 influencing factors that could affect physicians' choice in the form of Likert scale, ranging from strongly disagree = 0 to strongly agree = 4. Results: Of the 193 urology Saudi physicians, 85 replied (44.1%). Their mean age was 29 + 3.2 years. The majority of them were male (98.8%). There were 66 (77.6%) residents, 12 (14.1%) were fellows, and 7 (8.2%) were registrars. Four factors were found to be significantly different across positions, i.e., personal interest in the subspecialty, patient's prognosis, potential to join a private hospital, and family/friend advice. Among residents, the highest score means of the impact factors were the patient's prognosis, potential to join a private hospital and family/friend advice. The most prominent factors that influence urology physicians to select their subspecialty were personal interest in the specialty (88.2%), followed by the patient prognosis and lifestyle (84.7%, 78.8%). About 28.2% of the participants have a desire of endourology, followed by infertility and pediatric urology (23.5% and 20%, respectively). Conclusion: The most influencing factors among urology physicians for choosing their subspecialty are the patient's prognosis and personal interest. Female medical graduates should be encouraged to join a urology residency.
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Affiliation(s)
- Haithm I Alasim
- Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa A Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Danny M Rabah
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cancer Research Chair, Department of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad K Alrawaf
- Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A Almanie
- Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
The future supply of urologists is not on pace to account for future demands of urologic care. This impending urologic shortage sits on a backdrop of multiple other workforce issues. In this review, we take an in-depth look at several pressing issues facing the urologic workforce, including the impending urology shortage, gender and diversity concerns, growing levels of burnout, and the effects of the coronavirus pandemic. In doing so, we highlight specific areas of clinical practice that may need to be addressed from a health care policy standpoint.
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Affiliation(s)
- Ryan Dornbier
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
| | - Christopher M Gonzalez
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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Abstract
The presence of women in genitourinary (GU) specialty training and practice has lagged significantly behind other fields. Current challenges include maternity leave, sexual harassment, and pay disparities. Despite these obstacles, the prevalence of women in GU specialty training has risen rapidly. One consequence of retiring male providers and higher numbers of female graduates will be a notable demographic shift in the percentage of GU care provided by these younger women. It will be essential to anticipate and acknowledge the unique concerns of this workforce, particularly in light of the concomitant aging of the US population and the associated increase in demand for GU care.
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20
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Hougen HY, Goodstein FR, Bassale S, Chen Y, Seideman CA, Isharwal S. Gender Representation in American Urological Association Guidelines. Urology 2021; 156:47-51. [PMID: 33676953 DOI: 10.1016/j.urology.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study patterns and factors associated with female representation in the American Urological Association (AUA) guidelines. METHODS We gathered publicly available information about the panelists, including the AUA section, practice setting, academic rank, fellowship training, years in practice, and H-index. The factors associated with the proportion of female panelists and trends were investigated. We also examined the proportion of female panelists in the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) urology guidelines. RESULTS There were 483 non-unique panelists in AUA guidelines, and 17% are female. Non-urologist female panelists in AUA guidelines represented a higher proportion than female urologists (30% vs 13%, P<0.0001). Compared with male panelists, females had lower H-indices (median 23 vs 35, P<0.001), and fewer were fellowship-trained (77.2% vs 86.8%; P=0.042). On multivariate analysis, non-urologists and panelists with lower H-indices were more likely to be female but there was no association between guideline specialties, academic ranking, geographic section, years in practice, and fellowship training with increased female authorship. Overtime, the proportion of female participation in guidelines remained stable. In the EAU and NCCN guideline panels, 12.2% and 10.7% were female, respectively. CONCLUSION Female representation among major urologic guidelines members is low and unchanged overtime. Female urologist participation was proportional to their representation in the urology workforce. Being a non-urologist and lower H-indices were associated with female membership in guideline panels.
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Affiliation(s)
- Helen Y Hougen
- Department of Urology, Oregon Health and Science University, Portland, OR.
| | | | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Yiyi Chen
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Casey A Seideman
- Division of Pediatric Urology, Department of Urology, Oregon Health and Science University, Portland, OR
| | - Sudhir Isharwal
- Department of Urology, Oregon Health and Science University, Portland, OR
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Solano C, Ortiz AMC, Jaimes LMB, Saavedra DXR, Ospino CO, Basto CS. Estado actual de las mujeres en la fuerza laboral en urología. Análisis bibliométrico. Rev Urol 2020. [DOI: 10.1055/s-0040-1721723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ResumenIntroducción Las mujeres han incursionado y aumentado en todas las áreas médico quirúrgicas y específicamente en la Urología, representando aproximadamente un 10% de esta fuerza laboral.Objetivo Describir el estado actual de las mujeres en la fuerza laboral en Urología a nivel mundial.Métodos Análisis bibliométrico basado en búsqueda retrospectiva de la literatura del año 1969 a 2019, mediante base de datos: MEDLINE, FABUMED y PubReminder®, utilizando términos de búsqueda: (workforce) AND (urology), incluyendo: artículos de revista, artículos originales de investigación, reseñas, ensayos y otros informes científicos. Se obtuvo el factor de impacto (FI) mediante Journal Citation Reports 2017/2018. A través de Scopus se obtuvo el h-index (HI). Las variables analizadas fueron: número total de publicaciones, revistas, autores, instituciones, porcentaje de publicaciones por revista y país, patrón de producción científica a lo largo del período estudiado. Se realizó análisis de mapeo bibliométrico con software VOSviewer®.Resultados Se encontraron un total de 352 revisiones desde el año 1969 hasta 2019. El mayor porcentaje de publicaciones fueron en la última década. Se encontraron en total 131 revistas, de ellas, 28 específicas de urología. La revista con mayor número de publicaciones fue el Journal of Urology. El 90% de los autores provienen de Estados Unidos y del total de artículos solo dos autores principales eran mujeres.Conclusiones El interés por determinar el papel de la mujer en la fuerza laboral urológica es reciente y se correlaciona con el aumento de la representación femenina en esta área.
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Bayne DB, Armas-Phan M, Srirangapatanam S, Ahn J, Brown TT, Stoller M, Chi TL. Low Urologist Density Predicts High-Cost Surgical Treatment of Stone Disease. J Endourol 2020; 35:552-559. [PMID: 32998584 DOI: 10.1089/end.2020.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objectives: Lack of access to urologic specialists is approaching crisis levels as the number of urologists is decreasing, while the demand for urologic care is increasing. The financial implications of this have not been explored. The objective of this study is to examine the impact of access and other patient factors on cost to treat urolithiasis. We hypothesized that markers of poor access would associate with higher costs of surgical encounters for patients presenting with urolithiasis. Methods: A retrospective review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to investigate characteristics of surgical patients treated for urinary stone disease. Univariate analysis was performed using the Welch two-sample t-test. Multivariate analysis was performed using logistic regression. Statistical analysis was performed in R version 3.5. Results: When taking into account age, delayed presentation, procedure type, stone size >20 mm, American Society of Anesthesiologists (ASA) code, gender, race, income, distance, urologist density, body mass index, diabetes, infection, education, language, insurance, and stone complexity, patients undergoing percutaneous nephrolithotomy procedure (p < 0.001; odds ratio [OR] 12.9, confidence interval [CI] 4.05-48.5), urologist density in the bottom quartile (p = 0.014; OR 4.66, CI 1.40-16.9), diabetes (p = 0.018; OR 4.38, CI 1.32-15.6), and infection (p = 0.007; OR 4.51, CI 1.55-14.0) were the only variables statistically significant for association with top quartile of total cost. Conclusions: Surgical encounter costs are largely dictated by patient clinical factors, but low regional urologist density appears to independently predicted for high-cost stone surgery. Increasing patients' access to a urologist may prove to be financially beneficial in the longitudinal reduction in health care costs for stone disease.
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Affiliation(s)
- David B Bayne
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Manuel Armas-Phan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | | | - Justin Ahn
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Timothy T Brown
- Berkeley Center for Health Technology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Marshall Stoller
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Thomas L Chi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
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Nam CS, Daignault-Newton S, Herrel LA, Kraft KH. The Future is Female: Urology Workforce Projection From 2020 to 2060. Urology 2020; 150:30-34. [PMID: 32890624 DOI: 10.1016/j.urology.2020.08.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To project the size and demographics of the female urology workforce into 2060. METHODS We assessed current urology workforce estimates using 2019 American Urological Association Annual Census data. We used the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018 to determine the incoming urology workforce. With these inputs, we calculated urologic workforce projections using two stock and flow models. RESULTS In our continued growth model, the total number of urologists will be lowest in 2025 with 11,600 urologists and recover to baseline by 2040 with 13,377 urologists. The total number of female urologists will grow 3.77-fold from 2020 to 2060 with an absolute increase of 3,792 urologists. Comparatively, the total number of male urologists will grow 1.33-fold with an absolute increase of 3,996 urologists. In our stagnant growth model, the total number of urologists will be lowest in 2030 with 11,354 urologists and will not recover to baseline by the end of our projection. The total number of female urologists will grow 2.18-fold from 2020 to 2060 with an absolute increase of 1,615 urologists. Comparatively, the total number of male urologists will decrease by 21.5% with an absolute decrease of 2,579 urologists. CONCLUSION In the context of the impending urologic workforce shortage, female urologists make up a significant proportion of the workforce growth over the next four decades in both the continued growth and growth stagnant models. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support female urologists.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | | | - Lindsey A Herrel
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Kate H Kraft
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI.
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Cannon S, Ahn J, Shnorhavorian M, Kieran K, Merguerian P. Gender and Invited Authorship in the Journal of Pediatric Urology. Urology 2020; 145:211-215. [PMID: 32712130 DOI: 10.1016/j.urology.2020.05.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the evolving role of gender in invited authorship and editorial positions in the Journal of Pediatric Urology. MATERIALS AND METHODS We recorded editorial board members and first and senior authors for all editorials and invited commentaries for all issues of the Journal of Pediatric Urology from 2005 to August 2018. We also recorded first and senior authors for original research articles from selected years for comparison. Gender was confirmed for each individual by visiting institutional websites and performing internet searches. The same was done for the Societies for Pediatric Urology membership. RESULTS A total of 143 editorials and 162 invited commentaries were identified within the study period, with numbers increasing each year. Overall, these publications had 448 first and senior authorships, of which 10% were female. Of the 898 editorial board positions over the study period, 7% were held by females. The proportion of female authorships increased over time (P = .04), while the proportion of female board members did not (P = .9). CONCLUSIONS Female invited authorship has increased over the past 13 years in the Journal of Pediatric Urology. However, editorial board membership has lagged, indicating an opportunity for improvement.
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Affiliation(s)
- Shannon Cannon
- Division of Urology, Seattle Children's Hospital, Seattle, WA.
| | - Jennifer Ahn
- Division of Urology, Seattle Children's Hospital, Seattle, WA
| | | | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, WA
| | - Paul Merguerian
- Division of Urology, Seattle Children's Hospital, Seattle, WA
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Lee W, Cheung A, Du C, Loeb C, Cohen T, Kapur A, Weissbart S, Kim J. Access to Academic Female Pelvic Medicine and Reconstructive Surgery Providers for New Patient Visits: How Long Are Wait Times? Urology 2020; 150:170-174. [PMID: 32535074 DOI: 10.1016/j.urology.2020.04.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the wait times to see an academic Female Pelvic Medicine and Reconstructive Surgery (FPMRS) urologist or gynecologist and to identify factors that may impact these wait times. METHODS We reviewed all Accreditation Council for Graduate Medical Education accredited urology and gynecology residency programs. Offices of FPMRS providers were called to ascertain the earliest available new patient visit for a fictional female patient with "urine leakage." Programs without FPMRS faculty (18.7%) were excluded. FPMRS providers that did not accept Medicaid (15.6%) were also excluded. Negative binomial regression was performed using SPSS v24. RESULTS Final analysis included 362 FPMRS providers. Median wait time for a patient with Medicaid was 30 days (interquartile range [IQR] 15-51) and 26 days (IQR 14-42) for Medicare. The median wait time to see an FPMRS-trained gynecologist was 28 days (IQR 15-50) while FPMRS-trained urologists had a median wait time of 25 days (IQR 13.8-43.3). Female providers had longer median wait times when compared to male providers (30 vs 25 days). On regression analysis, only female gender of the provider was significant (P < .01). CONCLUSION Our study found that nearly 1 in 5 academic departments did not have an FPMRS-trained provider. We found that new patients with urinary incontinence encountered substantial wait times to see FPMRS providers at academic institutions. As we project increased demand for the FPMRS workforce, our findings reflect a challenging landscape where training additional FPMRS providers may be needed to meet demand.
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Affiliation(s)
- Wai Lee
- Virginia Mason Seattle, WA, United States.
| | - Alice Cheung
- Albany Medical Center Albany, NY, United States, Department of Urology
| | - Chris Du
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Charles Loeb
- University of California Irvine Irvine, CA, United States, Department of Urology
| | - Tal Cohen
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Anjali Kapur
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Steven Weissbart
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Jason Kim
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
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Naik R, Mandal I, Hampson A, Casey R, Vasdev N. A Comparison of Urology Training Across Five Major English-Speaking Countries. Curr Urol 2020; 14:14-21. [PMID: 32398992 DOI: 10.1159/000499265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Urology is a rapidly evolving specialty, although wide variations exist between training programs in different countries. We aimed to compare the status of urology training in 5 English-speaking countries. Materials and Methods Features compared include the training pathway structure, training requirements, competition levels and the process of moving country for international medical graduates. Results Length of training varied considerably across countries, ranging from 5 years in the USA and Canada, to 7 years in Australia and New Zealand and 9 years in the UK. Ease of entering urology training for international medical graduates also varies, with the UK relatively easier compared to other countries. All countries encourage participation in research during training as well as completion of non-urology and urology specific surgical examinations. Conclusion Following the Royal College of Surgeons Improving Surgical Training report, it is vital that the UK incorporates optimal elements of international programs in order to provide the best standards for trainees and world-class care in urology.
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Affiliation(s)
- Rishi Naik
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | - Indrajeet Mandal
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | | | - Rowan Casey
- Department of Urology, Colchester General Hospital, Colchester, UK
| | - Nikhil Vasdev
- UCL Medical School, Faculty of Medical Sciences, University College London, London
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Leiser CL, Anderson RE, Martin C, Hanson HA, O'Neil B. Combining Drive Time and Urologist Density to Understand Access to Urologic Care. Urology 2020; 139:78-83. [PMID: 32081672 PMCID: PMC7237283 DOI: 10.1016/j.urology.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/08/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To improve our understanding of timely access to urologic care, we leveraged driving time combined with a measure of urologist density. MATERIALS AND METHODS We identified all urologists who billed Medicare using National Provider Identifier in 2015 and geocoded their practice location. We developed drive-time based service areas for each provider using Esri's street network dataset stratified into 30, 60, 90, and 120-minute areas. Population characteristics were aggregated and block groups were assigned to a Hospital Referral Region. RESULTS We identified 10,170 urologists that billed Medicare in 2015 in the United States. Compared to the northeast, vast expanses of land across the western United States have drive times to urology care >60 minutes. However, less than 13% of the US population is unable to obtain urologic care within 30 minutes. Likely reflecting rural populations, White and American Indian populations are represented in greater proportion among those requiring a longer drive time to urologic care. Disparities were noted between areas with timely access to a high versus low density of urologists; low density areas have a greater proportion of Black and Asian populations and greater income inequality. CONCLUSIONS Drive time to urologists combined with urologist density is a novel approach to investigating urologic care access and a tool for health disparities research. While almost all of the US population lives within 1-hour drive time to a urologist there remains important differences in the population severed by high compared to low provider density.
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Affiliation(s)
- Claire L Leiser
- University of Utah, Huntsman Cancer Institute, Salt Lake City, UT
| | - Ross E Anderson
- University of Utah, Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Heidi A Hanson
- University of Utah, Huntsman Cancer Institute, Salt Lake City, UT
| | - Brock O'Neil
- University of Utah, Huntsman Cancer Institute, Salt Lake City, UT.
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Feng H, Berk-Krauss J, Feng PW, Stein JA. Comparison of Dermatologist Density Between Urban and Rural Counties in the United States. JAMA Dermatol 2019; 154:1265-1271. [PMID: 30193349 DOI: 10.1001/jamadermatol.2018.3022] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce. Objective To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme. Design, Setting, and Participants This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists. Main Outcomes and Measures Active US dermatologist and physician density. Results In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to younger than 55 years increased 75% in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170% in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities. Conclusions and Relevance Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time. Correcting the workforce disparity is important for patient care.
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Affiliation(s)
- Hao Feng
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Juliana Berk-Krauss
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.,Yale University School of Medicine, New Haven, Connecticut
| | - Paula W Feng
- Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
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Murphy A, Teplitsky S, Das AK, Leong JY, Margules A, Lallas CD. Medical evaluation and management of male and female voiding dysfunction: a review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2019; 57:220-232. [PMID: 30990789 DOI: 10.2478/rjim-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 06/09/2023]
Abstract
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
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MESH Headings
- Cystitis, Interstitial/diagnosis
- Cystitis, Interstitial/etiology
- Cystitis, Interstitial/therapy
- Female
- Humans
- Male
- Prostatism/diagnosis
- Prostatism/etiology
- Prostatism/therapy
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Bladder, Underactive/diagnosis
- Urinary Bladder, Underactive/etiology
- Urinary Bladder, Underactive/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/therapy
- Urination Disorders/diagnosis
- Urination Disorders/etiology
- Urination Disorders/therapy
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Affiliation(s)
- Alana Murphy
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Akhil K Das
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Andrew Margules
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Assessing the role of urologists and general surgeons in the open repair of bladder injuries: Analysis of a large, statewide trauma database. J Trauma Acute Care Surg 2019; 87:1308-1314. [DOI: 10.1097/ta.0000000000002462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nam CS, Mehta A, Hammett J, Kim FY, Filson CP. Variation in Practice Patterns and Reimbursements Between Female and Male Urologists for Medicare Beneficiaries. JAMA Netw Open 2019; 2:e198956. [PMID: 31397864 PMCID: PMC6692839 DOI: 10.1001/jamanetworkopen.2019.8956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Abstract
Importance Previous assessments of practice patterns and reimbursements for female urologists relied on surveys or board certification logs. A current evaluation of the geographic distribution and practice patterns by female urologists would reveal contemporary patterns of access for Medicare beneficiaries. Objective To characterize the variation in practice patterns and reimbursements by urologist sex and the regional deficiencies in care provided by female urologists. Design, Setting, and Participants This population-based cohort study used the publicly available Centers for Medicare & Medicaid Services Provider Payment database to evaluate payments for US urologists. The cohort (n = 8665) included urologists who provided and were paid for 11 or more services to Medicare beneficiaries in 2016. Data collection and analysis were performed from October 3, 2018, through June 19, 2019. Main Outcomes and Measures Proportion of female-specific services, payments per beneficiary, and payments per work relative value unit (wRVU) by urologist sex were assessed. Density of female urologists across hospital markets was also identified. Results Among the 8665 urologists who received payments in 2016, 7944 (91.7%) were men and 721 (8.3%) were women. Female urologists, compared with male urologists, saw a lower proportion of patients with cancer (mean [SD], 16.3% [9.2%] vs 22.7% [8.8%]; P < .001) and a greater proportion of female Medicare beneficiaries (mean [SD], 52.8% [23.2%] vs 24.4% [10.3%]; P < .001). Female urologists generated a greater proportion of wRVU from urodynamics (median [IQR], 2.88% [1.26%-4.84%] vs 1.07% [0.31%-2.26%]; P < .001) and gynecological operations (median [IQR], 0.68% [0.45%-1.07%] vs 0.41% [0.20%-0.81%]; P < .001) than male urologists. In addition, female urologists, compared with their male counterparts, received lower median payments per beneficiary seen ($70.12 [interquartile range (IQR), $60.00-$84.81] vs $72.37 [IQR, $59.63-$89.29]; P = .03) and lower payments per wRVU ($58.25 [IQR, $48.39-65.26] vs $60.04 [IQR, $51.93-$67.88]; P < .001). One-third (103 [33.7%]) of 306 hospital referral regions had 0 female urologists, and 80 (26.1%) had only 1 female urologist. Conclusions and Relevance Female urologists were more likely to provide care for female Medicare beneficiaries, to receive lower payments per wRVU generated and beneficiaries seen, and to be difficult to access in certain geographic areas; these findings have policy-related implications and highlight the regional deficiencies in urological care and reimbursement discrepancies according to urologist sex.
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Affiliation(s)
- Catherine S. Nam
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Hammett
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Frances Y. Kim
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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Beller H, Lobo JM, Horton BJ, Sims T, Corey T, Tyson T, Schenkman NS, Krupski TL, Jones RA. Adapting nurse-led cystoscopy experience to the United States: Tele-cystoscopy a possible compromise? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haerin Beller
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Jennifer M. Lobo
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Bethany J. Horton
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Terran Sims
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Thomas Corey
- Center for Telehealth; University of Virginia; Charlottesville Virginia
| | | | - Noah S. Schenkman
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Tracey L. Krupski
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Randy A. Jones
- School of Nursing; University of Virginia; Charlottesville Virginia
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Cohen AJ, Ndoye M, Fergus KB, Lindsey J, Butler C, Patino G, Anger JT, Breyer BN. Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census. J Rural Health 2019; 36:300-306. [DOI: 10.1111/jrh.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew J. Cohen
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Medina Ndoye
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Kirkpatrick B. Fergus
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - John Lindsey
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Christi Butler
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - German Patino
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Jennifer T. Anger
- Cedars‐Sinai Department of SurgeryDivision of Urology Los Angeles California
| | - Benjamin N. Breyer
- Department of UrologyUniversity of California‐San Francisco San Francisco California
- Department of Biostatistics and EpidemiologyUniversity of California‐San Francisco San Francisco California
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Gaither TW, Awad MA, Breyer BN, Greene KL. Gender and Racial Disparities in Early Urology Exposures during Medical School. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Han J, Rabley A, Vlasak A, Bozorgmehri S, Bird V, Moy L. Career Expectations and Preferences of Urology Residency Applicants. Urology 2019; 123:44-52. [DOI: 10.1016/j.urology.2018.07.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/23/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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Talton W, Lindner H, Rovito MJ. Increasing Urologic Care Ratios: Implications of Male Patient Care in Florida. Am J Mens Health 2018; 12:2029-2036. [DOI: 10.1177/1557988316664904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ongoing trends have revealed an inverse relationship between population growth and the number of practicing urologists in the U.S. per capita, which threatens urologic care accessibility. Furthermore, different regions in the United States may be more negatively impacted due to higher population growth rates. The state of Florida witnessed over a 10% higher growth rate compared with national figures between 2000 and 2015. Coupled with data suggesting that since the 1980s, the number of U.S. urologists per capita has been decreasing, the foreseeable future presents many challenges regarding health equity and accessibility. This secondary analysis aimed to investigate the implications of forecasted urologic care decline within a growing population and how it can contribute to adverse male health outcomes. National- and state-level data were collected to calculate a series of urologic care ratios as defined by the number of urologists compared with population sizes. Analyses revealed that national-level urologic care ratios and prostate cancer incidence rates have a significant positive relationship, lending to the conclusion that with fewer urologists, the number of cases identified will decrease. State-level forecasted models indicated that the urologic care ratio will decrease approximately 30% in Florida from 6.23 per 100,000 in 2010 to 4.39 per 100,000 by the year 2030. As growth in demand for urologic care will increase in the next decade, a dire public health scenario is potentially unfolding. Future implications of undiagnosed prostate cancer due to the lack of access will drive an increase in mortality rates as well as health equity concerns for men.
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Trends in Urological Referral Patterns: A Study of Community and University Urologists in the United States. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Johns Putra L, Cheng J, Dowling C, Clarke A. Practice patterns of female urologists in Australia and New Zealand. BJU Int 2018; 122 Suppl 5:9-14. [DOI: 10.1111/bju.14407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lydia Johns Putra
- Ballarat Urology; Ballarat Vic. Australia
- Ballarat Health Services; Ballarat Vic. Australia
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Lee W, Chen A, Kalil R, Cohen T, Berg WT, Waltzer WC, Kim J, Adler HL. Medicaid Patients Experience Longer Wait Times at Academic Urology Clinics Compared to Patients with Medicare. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Wai Lee
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Andrew Chen
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Ramsey Kalil
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Tal Cohen
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - William T. Berg
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Wayne C. Waltzer
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Jason Kim
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Howard L. Adler
- Department of Urology, Stony Brook Medicine, Stony Brook, New York
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Differences in early career operative experiences among pediatric urologists. J Pediatr Urol 2018; 14:333.e1-333.e7. [PMID: 30006256 DOI: 10.1016/j.jpurol.2018.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Previous research suggests that pediatric urologists feel well trained by their fellowship for cases encountered early in their career. We questioned the complexity and diversity of cases new pediatric urologists were actually performing. OBJECTIVE The aim was to identify the frequency with which newly trained pediatric urologists are performing various procedures, investigate which factors are associated with case complexity and diversity, and evaluate for differences between male and female surgeons. STUDY DESIGN Case logs of urologists from July 30, 2007, to June 30, 2013, initially applying for the certifying examination who self-identified as pediatric urologists were reviewed. Data points included cases/dates, and surgeon demographics. An in-depth analysis was performed on 51 index cases from the 71 included pediatric urologists, for which a level of complexity was assigned. RESULTS Compared with the bottom volume quartile, surgeons in the top quartile performed more cases of minimal (115.9 ± 8.7 vs. 51.7 ± 8.7, p < 0.001), moderate (31.1 ± 2.7 vs. 10.1 ± 1.0, p < 0.001) and significant (10.8 ± 1.9 vs. 2.0 ± 0.4, p < 0.001) complexity. More than 90% logged circumcisions, orchiopexies, and inguinal hernia repairs, while less than 1.5% logged open nephroureterectomies or complete male epispadias repair. Surgeons submitted at least one of 17.2 ± 0.5 (range 5-28) unique codes. The figure presents the percentage of current procedural terminology (CPT) codes performed by each urologist. Surgeons with the least case diversity performed a higher percentage of low-complexity cases, and lower percentages of moderate and complex cases (p < 0.001). Males, comprising 60.6% of urologists, performed more cases than females (342.9 ± 30.9 vs. 229.1 ± 18.1, p = 0.007), averaging more cases of minimal (95.0 ± 6.6 vs. 73.3 ± 4.6, p = 0.018) and significant (6.7 ± 1.0 vs. 2.8 ± 0.5, p = 0.005) complexity. There was no difference in cases of moderate complexity (22.0 ± 1.9 vs. 18.1 ± 2.1, p = 0.201). DISCUSSION In general, pediatric urologists should expect to perform many minor cases when they enter practice. Women are entering urology in increasing numbers. In our study, female urologists performed fewer cases. This could have implications for the workforce, which in urology in general is expected to decrease. CONCLUSIONS Case diversity and degree of complexity vary among newly trained pediatric urologists. The urologist with the greatest case diversity never performed 45% of the 51 analyzed CPT codes, while the one with the least case diversity never performed 90% of the codes. Male surgeons performed more operations, particularly those of minimal and significant complexity. The variability in operative experience reinforces the importance of continuing education and mentorship after completion of fellowship.
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Rotker K, Iosifescu S, Baird G, Thavaseelan S, Hwang K. What's Gender Got to Do With It: Difference in the Proportion of Traditionally Female Cases Performed by General Urologists of Each Gender. Urology 2018; 116:35-40. [DOI: 10.1016/j.urology.2017.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
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Do Women Work Less Than Men in Urology: Data From the American Urological Association Census. Urology 2018; 118:71-75. [PMID: 29723591 DOI: 10.1016/j.urology.2018.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To further explore the issue of work parity between male and female urologists in the context of demographics, practice characteristics, subspecialty affiliation, and planned retirement. MATERIALS AND METHODS We analyzed data from the 2014 American Urological Association census, which is a specialty wide survey distributed to the entire urology community in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared clinical and nonclinical hours worked by gender after adjusting for age, practice setting, fellowship type, and whether or not the urologist performed inpatient operations. RESULTS Of the 11,703 practicing urologists in the United States, female urologists make up approximately 7.7% of the workforce (n ~ 897). Female practicing urologists were younger (66.4%, <45 years old), had shorter training intervals, and a younger planned retirement age than their male counterparts (63 years vs 68.5 years, P <.001). More women were fellowship-trained in a urologic subspecialty (54.9% vs 34.9%, P <.001) and more were in academic practices (33.2% vs 21.9%, P = .03). After adjusting for age, practice type, subspecialty, and inpatient operations performed, there was no difference in hours worked between women and men (beta-coefficient -2.8, 95% confidence interval -6.4 to 0.7, P = .12). CONCLUSION Gender does not appear to drive the number of hours urologists work per week. There is work hour parity between women and men practicing urologists in both clinical and nonclinical hours. Women are proportionately more likely to pursue fellowship training and hold academic positions.
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Ellison JS. Editorial Comment. J Urol 2018:S0022-5347(18)42745-0. [PMID: 29596807 DOI: 10.1016/j.juro.2018.02.3096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jonathan S Ellison
- Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, Washington
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45
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Sukhu T, Pruthi NR, Deal A, Langston J, Kirby EW, Raynor M, Gonzalez C, McKenna P, Smith AB, Pruthi RS. Workforce Characteristics in Urology. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Troy Sukhu
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas R. Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison Deal
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joshua Langston
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E. Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew Raynor
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Patrick McKenna
- Department of Urology, University of Wisconsin, Madison, Wisconsin
| | - Angela B. Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S. Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Thomas K, Saltzman A, Hebert K, Montgomery M. Work-Life Integration of Female Urologists. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katharine Thomas
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Amanda Saltzman
- Department of Surgery, Division of Urology, University of Colorado, Aurora, Colorado
| | - Kristi Hebert
- Department of Urology, University of California Irvine, Orange, California
| | - Melissa Montgomery
- Department of Urology, Ochsner Clinic Foundation, New Orleans, Louisiana
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Nemoto K, Suzuki Y, Kondo Y. Current work environments: What problems are being faced by Japanese urologists? Int J Urol 2018; 25:327-336. [PMID: 29332306 DOI: 10.1111/iju.13517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/24/2017] [Indexed: 01/20/2023]
Abstract
Computer technology has contributed to innovative progress in industrial infrastructures and has had a major influence on various work environments. Evaluations of work environments are routinely carried out in Western countries, but historically there has been resistance to such evaluations in Japan. In this mini-review, we discuss the current work environments of urologists in Japan. The number of urologists has increased each year, and the population density of urologists was 5.4 (per 100 000 people) in 2014. The average age of urologists in Japan was 48.9 years, and the percentage of female urologists was just 5.3%. Additionally, the geographic distribution of urologists was uneven in Japan. From projections based on population dynamics, the need for more urologists in the near future will probably increase. Because medical environments vary depending on the country, it is necessary to understand current work environments in greater detail initially. Furthermore, we should determine original measures for the establishment of satisfactory urological work environments in Japan.
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Affiliation(s)
- Kaoru Nemoto
- Department of Urology, Nippon Medical School, Chiba-Hokusoh Hospital, Chiba, Japan
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School, Chiba-Hokusoh Hospital, Chiba, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
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Schoenthaler M, Hein S, Seitz C, Türk C, Danuser H, Vach W, Miernik A. The stone surgeon in the mirror: how are German-speaking urologists treating large renal stones today? World J Urol 2017; 36:467-473. [PMID: 29218404 DOI: 10.1007/s00345-017-2148-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/01/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To elucidate the current treatment strategies of LRS in German-speaking Europe. Little is known about the treatment of large renal stones (LRS > 3 cm) in daily urological practice. LRS therapy can be, however, challenging and hazardous. MATERIALS AND METHODS A 39 item web-based survey was performed among urologists listed by the German, Austrian and Swiss Associations of Urology, addressing professionals treating LRS "on their own" and working in a German-speaking country. Uniparametric descriptions indicated as absolute numbers and percentages without p values, simple linear associations and bubble plots without arithmetic means or bar charts with standard deviation between targeted parameters and percentages were used. RESULTS 266 of the 6586 responding urologists claimed to treat urinary stones on a regular basis. The majority of them were male (90.2%) and over 50 years old (42.9%). Most stones are treated in non-university hospitals (69.5%). 81.9% of all the institutions treat more than 150 cases/y. Open surgery is still performed in 45.5% of the centres, laparoscopy in 32%. Percutaneous nephrolithotomy (PNL) is the primary treatment option. Antimicrobial strategies vary considerably. Serious complications seem to be rare. However, quite a few responders reported treatment-related deaths. The main limitation is the absolute number of urologists performing LRS treatment, which is unknown. CONCLUSIONS The German-speaking urologist treating LRS is a male and over 50. Although he performs PNL primarily, he is not averse to open surgery and SWL. He applies guidelines and employs modern equipment. Only antimicrobial strategies are out of line with the international standards.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christian Seitz
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Türk
- Department of Urology/Stone Centre, Hospital Rudolfstiftung, Ziehrerplatz 7/7, 1030, Vienna, Austria
| | - Hansjörg Danuser
- Department of Urology, Kantonsspital, 6000, Lucerne 16, Switzerland
| | - Werner Vach
- Centre for Medical Biometry and Medical Informatics, University of Freiburg, Stefan-Meier Str. 26, 79104, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Romanelli M, Issa T, Zahnd W, Dynda D, Alanee S. Impact of County Rurality and Urologist Density on the Practice of Inguinal Lymph Node Dissection and Mortality in Patients Diagnosed with Squamous Cell Carcinoma of the Penis. Ann Surg Oncol 2017; 25:334-341. [PMID: 29110272 DOI: 10.1245/s10434-017-6211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inguinal lymphadenectomy (LND) is influential in reducing the mortality of squamous cell carcinoma of the penis (SCCP). We investigated the impact of urologic workforce density (UD) and rural residence (RR) on the practice of LND and mortality of SCCP (SCCP-RM). MATERIALS AND METHODS UD was determined from the 2014 to 2015 Area Health Resource File data, while RR was determined using the 2003 rural-urban continuum codes. All cases of SCCP within the surveillance, epidemiology, and end results 18 registry with known county codes were used for analysis (n = 2863). RESULTS Overall, 48.69% of cases lived in a county with less than the mean UD, 8.38% lived in counties with no urologists, 14.60% lived in a rural county, and 19.2% (n = 550) had LND performed. UD and RR had no impact on the prevalence of LND, number of lymph nodes examined, or the mean number of lymph nodes positive for SCCP (all p > 0.05). Adjusted analysis indicated that older patients and patients with regional stage of cancer were at a greater risk for post-LND SCCP-RM (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.28-2.21, and HR 4.32, 95% CI 3.09-6.06, respectively). There was no difference in the HR of SCCP-RM dependent on race, marital status, education, RR, UD, or LND. CONCLUSION While demand on the urologist workforce has increased in rural demographics, no impact of limited access to urologists on the practice of LND in SCCP could be identified in this study. In addition, there was no significant difference in the risk of SCCP-specific mortality related to lower UD or RR.
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Affiliation(s)
- Michael Romanelli
- Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Tariq Issa
- Vanderbilt University, Nashville, TN, USA
| | - Whitney Zahnd
- Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Danuta Dynda
- Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Shaheen Alanee
- Urologic Oncology, Department of Urology, Henry Ford Health System, Detroit, MI, USA.
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Stimson C, Karrass J, Dmochowski RR, Pichert JW. Academic Urological Surgeons have Greater Exposure to Risk Management Activity than Community Urological Surgeons: An Empirical Analysis of Patient Complaint Data. UROLOGY PRACTICE 2017. [DOI: 10.1016/j.urpr.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C.J. Stimson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jan Karrass
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W. Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
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