Number of urologists to decline 29% by 2025, according to AUA paper

San Diego-Researchers are predicting that the number of urologists in the United States will fall sharply over the next 12 years, dropping by almost 30% by 2025 compared to 2009.

The decline could boost mortality rates from several types of cancer and leave rural areas especially vulnerable to a shortage of urologic surgeons, added the authors, who presented their findings at the AUA annual meeting in San Diego.

"The demand is going to go up, and there aren't going to be enough of us," co-author Raj S. Pruthi, MD, chief of urology and professor of surgery/urology at the University of North Carolina, Chapel Hill, told Urology Times.

This will be good for existing urologists as they face greater demand for their services, Dr. Pruthi said. But in the big picture, he said, the urologist shortage threatens effective health care in the United States.

Dr. Pruthi and colleagues project a 29% decrease in the number of urologists from 2009 to 2025 and a 25% dip in full-time equivalent positions.

This trend will add to the existing shortage of urologists: The results say the per-capita level of urologists in 2009 reached its lowest level in 30 years. At the same time, the United States is aging: an estimated 20% of Americans will be 65 years of age or older in 2030, compared to 13% now.

Will it help if the medical community acts to prevent a greater urologist shortage? The study authors recalculated their projections to take into account possible increases in physicians due to proposals, such as federal legislation, to increase the number of doctors in the pipeline. But the projections barely changed: The number of urologists expected to be on the job by 2030 stayed around 7,000 (give or take a few hundred) regardless of the scenario.

As of 2009, there were 10,221 urologists in the country. The U.S. Department of Health and Human Services estimates that 14,000 urologists will be needed by 2015 and 16,000 by 2020.

"It's a double-edged sword," said Mark Stovsky, MD, MBA, a urologist at Cleveland Clinic who moderated the poster session where the study was presented. "We're faced with a problem that we've really benefited from over the past 20 years."

GME cuts, aging work force to blame

The authors attribute the urologist shortage to cuts in graduate medical education positions as far back as the 1980s and an aging urologist work force.

What to do? Co-author Jed Ferguson, MD, a University of North Carolina urology resident who presented the study, said a variety of strategies are needed, including more funding for urologist training, increased use of non-physician providers, and more urology-related care by primary care providers.

"Any realistic solution will likely combine all of the above and will be critical to providing urologic care to those in need," Dr. Ferguson said.

Dr. Pruthi told Urology Times that the authors will next try to adjust their projections to take into account the work habits of female urologists (whose numbers are on the rise) and young urologists from the millennial generation. Members of these groups tend to have different views about the work-life balance than other urologists, he said, and that can affect the amount of patient care that they're willing to take on.UT