SAN DIEGO, California — Parts of the United States are running out of urologists, warn investigators.
The number of urologists in the United States peaked in 2008 at 9852, and is now declining with serious consequences, especially in rural areas, said Raj Pruthi, MD, from the University of North Carolina at Chapel Hill. “We think this is a real problem.”
Dr. Pruthi presented the findings here at the American Urological Association (AUA) 2013 Annual Scientific Meeting.
The American population continues to grow, so the number of urologists per capita has been declining since at least 1991, he said.
And the problem is getting worse; almost half of all urologists are older than age 55, so there is not a lot of time to train all the urologists needed to replace them when they retire, he said.
The age of the American population is also increasing, and older people tend to need more urologic care.
Dr. Pruthi told Medscape Medical News that a higher proportion of urologists in the future will be women, and this could affect the productivity of the workforce because other researchers have found that women work fewer hours per week on average.
Research has suggested that members of the millennial generation prefer not to work as many hours as their parents and grandparents, he added, and that could affect urology care.
To estimate the number of urologists in coming decades, Dr. Pruthi and his team took the number of urologists in 2009, added new entrants, and then subtracted attrition, related to retirement or breaks in practice, from both training programs and the workforce.
They forecast a 29% reduction in the total number of urologists by 2025.
In 2020, there will be about 7500 urologists in the country. The US Health Resources and Services Administration estimates a need for 16,000 urologists that year, said Dr. Pruthi.
He noted that federal funding for urology residency programs was frozen in 1997.
A third of medical students who want to specialize in urology can’t get residencies in that specialty, he said. Most residency programs are partially funded by the income from clinical care.
Either implementing a recommendation from the Council of Graduate Medical Education or passing a bill now in the US Senate would increase the number of residency slots by 15%. But even then, there would be a 28% reduction in the supply of urologists by 2025, said Dr. Pruthi.
However, implementing the Deficit Reduction Commission’s proposal would reduce the workforce by 31%, the researchers project.
At the same time, the Affordable Care Act might expand the number of people seeking urologic care.
“There is a lot of discussion about the Affordable Care Act and expanding care,” said Dr. Pruthi. “We just want to enter this into the discussion — that there is an issue of supply. We really need to rethink all these issues.”
The shortage has serious consequences. Already many counties have no working urologists. Only 12% of urologists live in rural areas, whereas 18% of the total population does.
Other research has shown that mortality from bladder, prostate, and kidney cancer is significantly higher in counties with no urologists, said Dr. Pruthi.
Christopher Gonzales, MD, from Northwestern University in Chicago, Illinois, said he agrees with Dr. Pruthi’s findings.
He made a similar presentation to the Institute of Medicine on behalf of the AUA.
“We’re worried that the shortage we have is only going to get worse,” Dr. Gonzales told reporters attending a news conference. Nurse practitioners and physicians’ assistants can help manage some urologic problems, he said, but they are not qualified to do surgery.