Newly elected AUA President Pramod C. Sogani, MD, discusses the AUA's new regional courses on advanced prostate cancer treatment and its expanded course offerings in urologic ultrasound, among other topics.
The AUA has developed new regional courses on advanced prostate cancer treatment and expanded its course offerings in urologic ultrasound. These are just two new educational efforts the AUA has rolled out to address member demand, according to newly elected AUA President Pramod C. Sogani, MD, who also discusses current initiatives in advocacy and research. Dr. Sogani is attending surgeon at Memorial Sloan-Kettering Cancer Center and professor of clinical urology at Weill Medical College of Cornell University, both in New York. He was interviewed by Urology Times Editorial Consultant J. Brantley Thrasher, MD, professor and chair of urology at the University of Kansas Medical Center, Kansas City.
PART 1: Challenges and opportunities facing AUA members
PART 2: New AUA educational initiatives
A primary concern for many practicing urologists relates to restrictions on the use of ancillary services, such as CT scans and pathology labs or pod labs. Where do we stand on this, and how does the AUA view the issue?
As you know, the AUA covers the interests of every member, whether the individual is an academician, practicing in a non-academic hospital, in a small group, or in a large group. We also know we as physicians strive to provide the best and most efficient care to our patients; therefore, if providing the best possible care to our patients includes offering acceptable ancillary services, the AUA supports these in-office services. What many may have read in the press is the negative aspect of ancillary services; there are many efficiencies and benefits to patients when these services are offered in the office or a practice.
The AUA has established guiding principles for providing ancillary services, and if we follow these guiding principles, I believe we are doing a service to our patients, not a disservice to the profession. AUA’s guiding ethical principles state if you own an ancillary service, it’s in the patient’s best interest to advise them of your ownership, reassuring them that their urologic care will not be disrupted if they seek an alternate physician supplier or provider of ancillary services. Urologists should provide patients with information explaining their treatment options and clearly explain that they are welcome to obtain a second opinion.
What are your highest priorities as AUA president?
My highest priority is to ensure the AUA continues to provide invaluable support to the urologic community through innovative research, education, and advocacy. One of the AUA’s hallmarks is the quality, evidence-based education it provides for urologists and urologic health care providers worldwide and throughout all stages of their careers. My passion is education, and being a mentor to our future generation of physicians; therefore, furthering what we have already achieved in instructional, online and hands-on courses, and even live surgery sessions is important to me.
tion, I am committed to supporting urologic research. I do believe today’s research is tomorrow’s practice and to advance the specialty of urology requires extending our science and specialty to new frontiers. The AUA and its Urology Care Foundation have provided research grants to more than 500 research scholars who have, in turn, made innovative contributions to the treatment of urological diseases and improved the lives of many of our patients. Research is very critical and it is important to invest in every opportunity to better serve the millions of patients living with urologic disease.
As I focus on these two areas, I also recognize funding for education and research remains a challenge, especially in this era of sequestration, which is why it is important to enhance our advocacy efforts and strengthen our relationships with such federal institutions as the NIDDK, NIH, and NCI. Educating them about the importance of funding for urologic research is something we will pursue very seriously with the support of our chair of research.
I also want to highlight the importance of the Urology Care Foundation and the work they do with researchers, health care providers, and caregivers to improve patients’ lives. We are in the process of looking for an individual to serve as chair or president of the Foundation and will make every effort to find the best fit and ensure they have the resources to further the Foundation’s mission.
Let’s talk a little further about the Urology Care Foundation. It’s not just a new name, but a new function. What will be the primary function of the Foundation under its new leader?
The Foundation has several functions, but its charge is to improve the prevention, detection, and treatment of urological diseases through research and education. Our new Foundation chair will be responsible for many aspects tied to improving patients’ lives, including raising funds for patient education, patient outreach, and advocacy, but his or her primary function will be to raise funds in order to advance research efforts. In 2012, the Urology Care Foundation provided AUA’s Office of Research with $666,600 in grants to fund 38 research projects.
It sounds as if there will be a lot more philanthropy involved in the Urology Care Foundation going forward.
That’s right. One of the objectives of changing the infrastructure was to make this board a philanthropic board rather than a physician-focused board. One of the biggest changes of note has been to the name of the Foundation. Previously known as the AUA Foundation, it is now known as the Urology Care Foundation. I think this new name more accurately reflects the commitment, care, and collaboration the Foundation is known for. Under the new structure, the Foundation is able to continue its fundraising for the Research Scholars Program, which provides opportunities for young scientists to begin strong careers in urologic research, and especially at a time when so many urology departments are faced with budget constraints that limit quality research efforts.
Let’s switch gears and talk about some of the educational initiatives that are starting to help our membership. First, with the release of several new oral agents for advanced prostate cancer, my understanding is the AUA is creating a number of regional advanced prostate cancer courses. Can you discuss those?
After many years, we finally have advances in the treatment of advanced prostate cancer, including drugs that can be given orally. This can help a patient when they come to you with early-stage cancer that happens to later develop into advanced-stage cancer. If the patient chooses not to see another physician, and if you can provide the same quality level of care during this stage of their disease, seeing and treating the patient yourself using these oral drugs offers the patient an environment and health care provider they trust and are comfortable with. It’s good for the care of the patient, good for the family, and good for you; you have developed a bond.
We expect many more urologists to treat advanced prostate cancer patients and with our educational efforts, AUA and its membership are dedicated to providing the best possible patient care. This will be a key area for the Office of Education to convey to our members. Thus, we are planning, in collaboration with Society of Urologic Oncology, to hold five regional educational courses for our members that will start very soon. These courses will be educational and clinical: case-based treatment, how to treat with the new drugs, what to expect with the new drugs, and side effects of the new drugs. Additionally, the courses will focus on the business aspect of treating advanced prostate cancer: the risks, coding needs, back-end office details, etc. These courses will be 1 day each consisting of three simultaneous breakout sessions, one each for urologists and oncologists; nurses and urology team; and practice managers, coders, billers, CEOs, and other administrators.
All groups will be discussing the same cases, based on the AUA CRPC Guideline index patients. These courses will be a great asset to our membership.
There are other initiatives the membership has been asking for, and I am proud to hear they have happened. For instance, I understand the Office of Education will offer a recertification course, so urologists who need to be recertified will have a training program allowing them to get ready for their test. Is that correct?
Yes. We realize the importance of recertification, and as such are planning a recertification review course in September of this year. It will be a 2-1/2-day course in which those needing recertification will be exposed to all the latest advances that have occurred over the years. It will also be an excellent review course for those planning to take the recertification exam.
I also hear AUA members say fairly often the demand for ultrasound courses has been great. Will the AUA be expanding the ultrasound courses this year?
You are correct that the ultrasound course has been extremely popular, and members want to preserve this imaging skill. An ultrasound to a urologist is like a stethoscope to a cardiologist; you cannot practice urology without it. As such, we are planning to have several additional courses this year to train urologists on the proper use of ultrasound imaging, which will cover not only the prostate, but also the kidneys, bladder, and testes. It will be a solid and beneficial educational tool for all urologists.
Tell us about the new workshop the AUA is planning for the residency program directors.
As with the ever-changing and evolving world we live in, we realize many things related to residency are changing just as quickly. Ensuring program directors are aware of and prepared for these changes is vital to supporting our next generation of urologists, and is why we are holding an additional course for the program directors early next year, possibly January or February.
Is there anything else new from the AUA Office of Education you would like to speak about?
Yes, I am very proud to say the AUA is developing an in-house online learning management system. This will enable the AUA to expand and deliver quality e-learning educational opportunities to supplement existing educational offerings and resources.
We are also considering the use of simulation for training. Some people in the field think simulation is going to be very helpful, while others are unsure whether it’s really necessary. We are going to explore it a bit more to see if the use of a simulation center would enhance the education of residents.
I see simulation, as many specialties do, as the wave of the future. I think it’s going to happen in urology. Would you agree?
I truly believe it will, and I think it is the way to go. It is a proven approach in other industries. A pilot cannot fly a plane unless they go through simulation training. Simulation takes an individual through various situations and enables them to fine-tune their training and abilities before really embarking on the actual effort. Having a tool that enables a physician to practice or replicate a surgical or invasive procedure is key to preparing them for the actual procedure on the patient. Technology is truly remarkable.
Is there key legislation the AUA is currently supporting?
Of interest to all the members is how to fix the sustainable growth rate (SGR) formula, which we’ve been hearing more about over the past several months. I think this is the one year we can get it fixed. SGR is on sale right now. If we can get it fixed for $138 billion, this is the best time to fix it, once and forever. We are working hard in that regard.
We are also trying to modify or repeal the Independent Payment Advisory Board, or IPAB. As you know, this board was created by President Obama, and it’s not accountable to Congress. The IPAB’s main job is to cut down the expenses of Medicare, and there is not a single physician on that board. We are working with members of Congress to see if we can repeal or modify that.
Are there any other current AUA initiatives you would like to discuss?
As I mentioned, we are working to preserve the in-office ancillary services exception. We will also be working extremely hard to obtain more funding for graduate medical education because we need more urologists to meet the future demand of patients who will need the specialty. The supply of urologists is going to be far less in the future unless we improve the GME funding and train more residents. We need to help lawmakers understand this is the time to increase the funding. Unfortunately, when the Balanced Budget Act was discussed in the late 1990s, they did not realize things would change so dramatically and the demand for our services would increase while the supply of urologists decreased. This is a very important gap to address.
Another priority is our AUA-led urotrauma bill. We have proposed a legislative amendment, spotlighting urotrauma, be added to the 2014 National Defense Authorization Act. This amendment calls for the Secretary of Defense and the Secretary of Veterans Affairs to jointly develop and implement a comprehensive policy on improvements to the care, management, and transition of recovering service members with urotrauma. We feel positive about the congressional support and feedback we have received thus far on this amendment and look forward to it being included and passed along with the 2014 National Defense Authorization Act.UT