The most recent Urology Times State of the Specialty survey is notable in confirming some widely accepted urologic practice trends, but challenging the significance of others.
However, encouraging signs emerge. Despite these very real non-medical concerns, most urologists continue to find the field professionally rewarding and realize unsurpassed autonomy. They are adopting new technologies such as laparoscopic/robotic surgery, hiring new associates and physician extenders, and attending an average of three professional meetings a year. Respondents devoted an average of 8 hours to CME and 11 hours to professional reading in the month leading up to the survey.
These are not signs of people focused solely on external pressures; they are signs of invigorated, dedicated professionals. Despite occasional predictions of a mass exodus from the field, the responses show that urologists practicing currently have no widespread plans for early retirement. Although only half are resolute that they made the right career choice, when considered from the optimist's viewpoint, only 21% state they definitely would not choose medicine again, and I question whether that minority really would walk away from this deeply satisfying profession.
Nevertheless, the trend away from large open surgery continues. The majority of operating time is endoscopic. Only 13% of the respondents' time is spent in laparoscopic or robotic surgery, but almost half of respondents seek more training in these areas. Thus, the trend toward minimally invasive surgery continues, and endourology remains the bread and butter of the American urologist.
Also notable is that one-third of urologists state they are now using an electronic medical record system. We have now surpassed a urologic tipping point, and the EMR has become an indispensable tool in the urologist's armamentarium. With its enhancement of documentation, assistance with quality assurance, ability to transmit information into and out of the practice, facilitation of accurate and adequate billing, and the inevitability of payer pressures to comply, the era of paper charting is drawing to a close. Always one of the most forward-thinking specialties, urologists are leading the way in this trend, as well.
I am tremendously encouraged by these findings. Doomsayers are gaining no ground in our specialty. Urologists continue to grow professionally and are prepared to take the lead in medicine in the foreseeable future.