Navigating the urology workforce crisis: A call to action

“Don’t judge each day by the harvest you reap but by the seeds you plant.” — Robert Louis Stevenson

As a practicing urologist and department chair who has trained several hundreds of students, residents, and fellows, I see daily evidence of a mounting crisis in our specialty. Our clinics are overflowing, surgical block times are often limited, and patients in rural areas of our states often drive several hours for even routine care. More concerning is the access to high-quality, patient-centered, research-driven, multidisciplinary care for those with disparities that place them at the highest risk for poor outcomes due to delay in diagnosis or limited access to care. These stories are not outliers—they reflect a systemic imbalance between supply and demand that is well documented in recent analyses from RAND,¹ the Association of American Medical Colleges (AAMC),² the Health Resources and Services Administration (HRSA),^3,4 and the American Urological Association (AUA).⁵ Together, these data leave us with both a sobering diagnosis and a mandate for action.

A More Sophisticated Look at Physician Manpower

The 2025 RAND-AAMC system-dynamics model represents a major step forward in how we understand physician manpower. Unlike static ratio-based models, RAND’s approach accounts for workforce inflows and outflows—medical school expansion, graduate medical education bottlenecks, retirements, advanced practice providers (APPs), integration, and system inefficiencies.

The implications for surgical specialties are alarming. By 2036, AAMC projects a shortfall of 10,100–19,900 surgeons.² HRSA’s 2024 workforce report estimates urology will fall to just 82% adequacy by 2037—an 18% gap.^3,4 And, although thoracic and vascular surgery face similar or worse shortages, the burden in urology is uniquely concerning given the age-driven rise in incidence of diseases such as prostate cancer, stone disease, benign prostatic hyperplasia, and incontinence. Without intervention, our specialty risks being unable to meet even baseline patient needs.

The AUA Census: Ground-Level Clarity

The AUA Census adds vital granularity, confirming what many of us already feel in clinic:

• Geographic maldistribution: 62% of U.S. counties have no practicing urologist.

• Aging workforce: Nearly 20% of urologists are over age 65, with many nearing retirement.

• Reliance on APPs: 84% of practices employ nurse practitioners or physician assistants, who increasingly shoulder outpatient and perioperative responsibilities.

• Heavy workload: Urologists average approximately 45 hours and 70 patient encounters per week, with the majority performing major inpatient operations.⁵

These data align with the lived reality of our clinics and operating rooms: too few providers, too many patients, and growing dependence on collaborative care models.

What This Means for Urologists and APPs

For practicing urologists, the message is clear: Unless we expand the pipeline, improve efficiency, and retain talent, our already stretched workforce will be overwhelmed. For our APP colleagues, the Census confirms what many of us already know: Your role is not supplementary, but central to the care delivery now and going forward. The future of urology depends on APPs managing much of the perioperative, urgent, and routine care that keeps practices viable and surgeons focused where they are most needed.

Strategies That Move the Dial

So how do we respond? The RAND model points to leverage points; the AUA Census shows us where gaps already exist. The following strategies are both pragmatic and necessary:

1. Expand and target training. Increase GME positions in urology, with deliberate placement in rural and underserved areas where retention is most likely. Fellowship growth should reflect projected need in oncology, endourology, pediatrics, and reconstruction. The implementation and economics of this are complex, with multiple competing specialties and the need for approval at the national and local level, followed by complexity of securing the necessary funding that will inevitably come from private and local/state funding.

2. Protect the pipeline. Federal and philanthropic support should ease medical school debt and expand opportunities for expansion with diverse groups. Diversity in urology is improving but fragile; it will require mentoring and institutional commitment to sustain.

3. Elevate APPs. Establish structured clinical and perioperative fellowships along with career ladders for APPs. With 84% of practices already employing APPs, formalized training and role definition will expand access while ensuring quality. Early exposure to urology in their core curriculums will also be needed to attract more candidates to the field. This is also a great opportunity for us a field to more formally impact the quality of their training in our subspecialty field.

4. Optimize throughput. The shortage is not simply one of headcount. Operative bottlenecks, imaging delays, and inefficient scheduling all reduce effective capacity. Expanding ambulatory surgery centers, leveraging telehealth triage, and rethinking block allocation can extend the reach of existing providers. Undoubtedly, use of artificial intelligence particularly to improve office efficiencies, and documentation will be welcomed and could aid in preventing provider burnout.

5. Retain the workforce. Retirement and burnout are imminent threats. Creating flexible call schedules, phased retirement pathways, and administrative support can help us keep experienced urologists engaged and productive longer. We need to continue to keep up with the changing landscape of our field, and continuing medical education and continuous urologic certification will be key to ensuring safe and quality care to our patients. On that note, urologists contemplating a transition toward retirement, they may want to rethink their retirement runway and extend their American Board of Urology certification in the event that they delay retirement or reenter the workforce after only a short exit from the workforce as they reenter in a different practice arrangement.

A Call to Colleagues

As urologists, we pride ourselves on being problem solvers. Yet the workforce crisis is one we cannot solve in the clinic alone. It requires coordinated advocacy at both the local and national level, institutional vision, and leadership from those of us who have benefitted most from this specialty. Creativity and partnerships with public and private health care institutions may provide new pipelines for providers and new opportunities in underserved and rural areas.

I urge my colleagues to act with urgency: Advocate for GME expansion, redesign team-based models, mentor the next generation, and empower APPs to work at the top of their license. As urologists, we should be proactive and creative as we find new ways to attract, retain and train the next generation. As department chairs and leaders, we must balance tradition with innovation, preserving the core of urologic surgical training while adapting to new realities.

The alternative—longer waits, fewer urologists, and diminished access for our patients (and someday for ourselves)—is unacceptable. The patient waiting months for a prostatectomy or cystectomy, or traveling hundreds of miles for stone surgery, the family delayed in starting cancer care with the potential negative impact on outcome—they are why we must lead this change.

Urology has always been a field defined by adaptability and ingenuity. Meeting this challenge will require both, and it will require us to act now.

REFERENCES

1. Tomoaia-Cotisel A, Allen SD, Cave S, et al. Modeling physician workforce supply, demand, and need using system dynamics: model structure and assumptions. RAND Corporation. March 5, 2025. Accessed September 3, 2025. https://www.rand.org/pubs/research_reports/RRA2616-1.html

2. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. 2024 update. Accessed September 3, 2025. https://www.aamc.org/media/75236/download

3. Health Resources & Services Administration. Physician Workforce: Projections, 2022–2037. Accessed September 3, 2025. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/physicians-projections-factsheet.pdf

4. Adashi EY, O'Mahony DP, Gruppuso PA. The National Physician Shortage: Disconcerting HRSA and AAMC Reports. J Gen Intern Med. 2025 May 6. doi: 10.1007/s11606-025-09575-7. PMID: 40329027

5. American Urological Association. 2024 AUA Census Results. Accessed September 3, 2025. https://www.auanet.org/research-and-data/aua-census/census-results