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Letter to the editor: Consider foreign urologists as solution to shortage


In this letter to the editor, Faris Azzouni, MD, makes his case for foreign urologists as a solution to the urologist shortage.

The subject of this letter is to propose a solution to the urologist shortage problem in the U.S.

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As you are aware, the supply of U.S. residency graduates in urology is not sufficient to meet the great demand for this specialty in the country. In addition, many urologists are expected to retire in the next few years, which will only add to this problem. Many hospitals in the nation have been searching for a urologist for many years without success.

Many experts in the field believe that the solution to this shortage is to increase the number of residency slots and by training more PAs/NPs. While increasing the number of urology residency graduates is a step in the right direction, it remains insufficient by itself.

On the other hand, training more PAs/NPs to do the work of MDs will be a step in the wrong direction. Urology is a surgical specialty. Most patients prefer to see an MD, especially when serious health issues are present, such as cancer diagnoses, consultations on surgical treatments, pediatric issues, and infertility.

The solution I propose is to allow foreign urologists with sufficient training who have U.S. clinical experience and good references from U.S. board-certified urologists to be part of the urology family of the U.S. The way to do that is by revising the rules of the American Board of Urology (ABU) so that these foreign urologists would be able to sit for the ABU certification exam if they meet the required case log numbers and have endorsements from U.S. urologists. The current ABU requirements make it virtually impossible for any urologist with foreign residency training to become ABU certified.

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By the current ABU regulations, even world-known talented surgeons such as Urs Studer, MD, Peter Wiklund, MD, PhD, and others are unable to sit for ABU exam unless they work in a U.S. academic center for 7 years (why 7?), achieve the rank of a full professor (no academics exist in most U.S. community hospitals where the greatest demand is), and get endorsed from the chair and residency program director.

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In addition, extraordinary abilities in research, education, etc. need to be demonstrated. How is extraordinary research ability going to impact a surgeon’s ability to do a good prostatectomy operation?

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Take the United Kingdom, for example. In order to sit for the Royal College exam, which is the equivalent of the ABU exam, any candidate needs to have three reference letters from urologists who are actively practicing urology in the UK and registered in the General Medical Council of the UK. Such a requirement is fair! The current ABU regulations are unreasonable and unfair.

There are hospitals in the General Medical Council of the UK that are already overlooking ABU certification and hiring foreign-trained surgeons with adequate General Medical Council of the UK clinical experience and active state medical licenses. Many such urologists are already working in major academic centers in the U.S. and have demonstrated excellent levels of skills and knowledge.

Faris Azzouni, MD

Hays Medical Center

Hays, KS

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