AUA census offers opportunity for urologists to have their voices heard

“Even though we set some priority areas, we also allow practicing urologists to make suggestions for things that they want to know about,” says Amanda North, MD.

The American Urological Association (AUA) recently released analyses on the data collected from the 2021 AUA annual census.1 In this interview, Amanda North, MD, chair of the AUA Data Committee, discusses the impact that the census has and how urologists can get involved with it. North is an associate professor of urology at Montefiore Medical Center in Bronx, New York.

What is the take-home message for practicing urologists based on the AUA census analysis?

There are a lot of take-home messages. My first take-home message is that the more people who respond to the census, the better our data are. In 2022, we had 4151 urologists, more or less, responding to the census. This is our greatest number ever. The more people who get involved in answering the census, the more useful our data are, because the more it represents what people are doing.

It also helps us understand areas where we need to improve. Where are there gaps? We know that there is a shortage of urologists practicing in rural areas. It was interesting, because when we looked at the APP census, there aren't a lot of APPs practicing in rural areas either. We could propose that nurse practitioners and PAs can take care of some of the basic urologic care in rural areas, until you look at their census and realize that that's not going to work because there's a shortage there too. That helps us understand that we need more creative solutions to staffing rural practices.

That's where that student loan bill comes in as one possible solution. If you didn't have all that census data from the APP census, from the resident census where we asked about practicing in rural areas, and then from the practicing urologists census, you might assume that there were solutions that aren't great solutions, because we have so much data. The take-home message is that the more we participate in the census, the more valuable the data are.

There's an opportunity for various stakeholders in urology to propose questions, and we take that seriously. We set priority areas to look at each year in the census. As we look toward the 2023 census, hematuria, and all of the conditions related to hematuria, like bladder cancer and kidney cancer in particular, are going to be on the 2023 census in some form, but we haven't written the questions yet.

We're also open to ideas that are timely, but we haven't thought of yet. I'll give you an example. I'm a pediatric urologist, and I practice in the Bronx. We've been finding over the last few years that we're getting more patients transferred to us with testicular torsion from outside hospitals. We know that that leads to a delay in care. We hadn't planned to put that question on the 2022 census, but somebody suggested it. We realized that we were hearing from our colleagues by word of mouth that they were experiencing the same problem of delayed care for torsion. So, we put it on the census because it was a timely question, and such an important question for patient care that we thought the results would be important. Those results aren't available yet. It's still being analyzed. I will find out next month what we found from that, but we're very open to new trends in urology.

Another example is private equity, which has been increasingly involved in medical practice. Understanding the relationship between urologists and private equity, in terms of practice ownership, is another question that's very modern and timely and something that we would like to learn more about. Even though we set some priority areas, we also allow practicing urologists to make suggestions for things that they want to know about. When those questions make sense for what we're doing that year, we like to put those questions on, even though we sort of have a concept of what the census should be.

There's a lot of opportunity for people to be involved in the process of creating the census every year. That's one of the fun things about it, to get the outside-the-box ideas from people. Even though I've been doing this for a while, I certainly don't know it all. I take care of children; if we're going to ask questions about bladder and kidney cancer, I'm hoping someone smarter than I will give me some good questions to ask about how we take care of those diseases. I know a little bit, but I don't know enough to write good questions. That would be my take-home.

Is there anything else that you would like to add?

I think people don't realize what an incredible resource the AUA census is. I'm a census nerd, and I will admit, I'm probably the only urologist in the world who has all 8 published census results downloaded on my computer and open in a PDF file for easy viewing. But the census data are available for anyone to look at. You go to the AUA website, go under research, and the census results—every single one—are published and free to AUA members.

The ideas that we've gotten for research or further investigation, just by scrolling through the census, you'd be surprised. There's a lot of opportunity for the census to generate interesting data about the urologic work force, about the practice of urology, and about the needs of urologists. I encourage people to take a look at the data. They are there. They are available to you whether you're interested in how APPs practice, or what's happening in the international urologic community, or what's happening with our trainees, or what's happening with us.

I encourage people to take a look, because there are so much data there. We looked at telemedicine trends over the past several years before COVID-19, and then during COVID-19, and now in the post-COVID-19 era. It's there for everyone to look at, so take a look at the census.


1. The American Urological Association releases key findings on residents & fellows from the 2021 AUA census. News release. American Urological Association. November 3, 2022. Accessed November 22, 2022.