Expanding access to urologic care in rural communities

In this video, Jennifer Miles-Thomas, MD, MBA, discusses the persistent shortage of urologists in rural communities and outlines practical, near-term strategies to improve access to care.

Miles-Thomas identifies lifestyle considerations as a primary barrier to rural practice, noting that most urologists train in large urban centers with extensive resources and may be hesitant to relocate to areas with fewer clinical supports, limited specialty back-up, and different educational or community infrastructures. Workforce shortages, family considerations, and mismatched expectations further compound the challenge.

Miles-Thomas emphasizes that teleurology and team-based care models offer significant promise. Many urologic conditions follow well-established guidelines that can be implemented by non-physician providers (NPPs) on the ground, with urologists providing virtual oversight and in-person care when procedures or surgeries are required. She notes, however, that urology has yet to standardize optimized clinical schedules or hybrid care models, limiting the full potential of telehealth and outreach clinics.

Regarding training, she calls for innovation in residency education. Although foundational competencies remain essential, trainees must also learn adaptive thinking, efficient learning strategies, and how to integrate emerging technologies. Financial and regulatory barriers—particularly liability concerns and the cost of technology adoption—continue to slow progress, underscoring the need for thoughtful policy and reimbursement reform.

To make rural urology sustainable, Miles-Thomas highlights the importance of partnerships between rural communities and larger health systems. Shared staffing, outreach clinics, and incentive-based reimbursement models can help balance financial risk and professional reward. Looking ahead, she envisions a hybrid model in which teams of urologists deliver a large portion of care virtually, supported by trained local staff, with carefully planned in-person visits for procedures and emergencies. Successful examples from academic medical centers expanding into community settings demonstrate that coordinated, cross-institutional collaboration can meaningfully improve rural access while maintaining quality.