If you feel like there’s a long wait to see a urologist, you aren’t alone. Urology is facing physician shortages, only anticipated to worsen with the aging population.
Michelle E. Van Kuiken, M.D.
Assistant Professor of Urology, University of California, San Francisco
Urology is a medical and surgical specialty that focuses on the care of the urinary bladder, kidneys, prostate, and genitalia. Some common reasons to seek care from a urologist include kidney stones; conditions related to the prostate, such as benign prostatic hyperplasia (BPH), elevated prostate-specific antigen (PSA), and prostate cancer; and quality-of-life issues, including urinary incontinence and erectile dysfunction. Notably, many of these conditions become more common as people age.
An aging population
The average age of a patient seeking care from a urologist in the United States is 52.3 years, and 34% of all patients seeking urologic care are aged 65 and older. Older patients utilize urological services at 3 times the rate of the general population, indicating a higher and more complex need for care.
As the U.S. population ages, there is a growing need for urological services. However, there are not enough urologists to meet this demand, and this gap is only expected to widen in the coming years. There are several factors underlying the predicted urologist shortage in the United States. Notably, the urology workforce itself is aging. According to the American Urological Association (AUA) Annual Census Data, the average age of a practicing urologist in the U.S. is 55 years, and nearly 30% of practicing urologists are over the age of 65. While the overall urology workforce has increased over the past several years, some of these gains may be offset by retirements. Additionally, while urologists continue to work a similar number of hours per week, the number of patients seen per week has declined, potentially due to increasing documentation requirements and increased patient complexity, both of which can contribute to burnout.
The problem of burnout and proposed solutions
Speaking of burnout, recent data have shown that urologists have been suffering from some of the highest rates of burnout and work stress compared to other medical and surgical specialties. This matters because burnout has been shown to contribute to increased medical errors, shortening of work hours, decreased productivity, and can lead to earlier retirement age. In short, if not addressed, burnout amongst urologists can further exacerbate the workforce shortage.
The AUA is aware of the workforce shortage concerns, and there are several proposed solutions in place. First, there is an effort to expand the entire physician workforce with the Resident Physician Shortage Reduction Act. This bill proposes to increase the number of residency spots by over 14,000 over the next seven years, with half of the available positions geared towards specialties with known shortage concerns, such as urology. Second, urology is actively employing a growing number of advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs), to help meet the growing patient demand. APPs can be particularly helpful in managing non-surgical patients and often have greater availability than their physician counterparts. Telemedicine, which saw a boom during the COVID-19 pandemic, also improves access to care by decreasing the cost and travel time associated with in-person visits.
In short, urologists are working hard and dealing with high levels of burnout to keep up with the increasing demand for their services. Several solutions are in place, but it will take time to see improvements in patient access.
