Urology workforce stable but facing access and pipeline challenges, AUA Census finds

The 2025 American Urological Association (AUA) Census reveals a specialty on stable ground but facing structural challenges—particularly around geographic access and workforce demographics—that will require coordinated responses from health systems, training programs, and policymakers, according to Hung-Jui (Ray) Tan, MD, MSHPM, an associate professor of urology at the University of North Carolina in Chapel Hill. Tan spoke with Urology Times regarding the survey during the 2026 AUA Annual Meeting in Washington, DC.

The access picture is stark. Approximately 62% of US counties have no practicing urologist, and 90% of urologists practice in metropolitan or urban areas.

"How can we ensure that we provide care to the whole entire country with the access challenges that we are starting to see?" Tan said. The data do, however, capture some organic responses to the problem already underway within the specialty. Roughly one-third of urologists travel to satellite clinics—often at significant distance from their primary practice location—to bring care to underserved areas. Telehealth adoption is another lever that is narrowing the gap, although Tan noted it was not specifically captured in this census cycle.

Beyond direct clinical reach, the census data are serving a policy function."This data about where our workforce is and where the potential gaps are has been used by our advocates on Capitol Hill to advocate for the use of telehealth and continued reimbursement," Tan said. The findings have also informed the AUA's position on legislation such as the SPARK Act, which would provide loan repayment for urologists who practice in rural areas—a policy tool directly responsive to the geographic maldistribution the census documents.

The workforce's age profile adds urgency to the access question. The median age of practicing urologists is 54 years, and approximately one-third of the workforce is at or approaching retirement age. Tan identified an important nuance in how this demographic shift should be interpreted: generational differences in career expectations are changing the calculus.

"People who are younger, who are entering into the workforce, have just different views about when they're going to retire, how long they're going to work, and what intensity of work they want to do," he said. Those expectations—which may differ significantly from those of the generation currently leading practices and health systems—represent an evolving dynamic that training programs and administrators will need to account for in workforce planning.

Taken together, Tan characterized the 2025 census as a document that both affirms the specialty's current strength and provides an evidence base for the work ahead.

"We are on solid footing, but there are emerging challenges for us," he said.