Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

Abstract

Objective: To assess an aging subspecialty workforce and growing population that portends challenges in meeting patient care needs. We hypothesized that rural physicians are retiring at higher rates than their urban counterparts in the United States and that this represents a bellwether for workforce challenges at large. Methods: We analyzed data from the 2014-2016 American Urological Association Census, a sample-weighted representative survey of urologists, as a case study for subspecialists. We compared urologists who work in rural regions to nonrural regions on available characteristics. Results: In 2016, rural urologists accounted for 2.4% of 12,186 practicing urologists in the United States. General urology remained the focus of 90% of rural urologists, compared to 59% of nonrural urologists (P = .03). Alarmingly, 48% of rural physicians were >65 years old in 2016 compared to 29% in 2014, and 33% of rural urologists were solo practitioners compared to 9% of nonrural urologists (P < .01). The planned retirement age for rural physicians increased from 68 in 2014 to 73 in 2016 (P trend = .02). The percentage of rural practice urologists has remained stable since 2014. Conclusions: Rural urologists are older and provide more general urological care than their nonrural counterparts. Rural urologists are postponing retirement. Although this might be due to personal desires and financial goals, it may also be due to a relative absence of potential junior partners. Given that almost 50% of rural urologists were older than 65 in 2016, this is not a sustainable solution to an impending shortage of physicians. Greater innovation in telemedicine or alternative care models will soon be needed.

Video Visits as a Substitute for Urological Clinic Visits

“…Furthermore, with the expansion of telehealth services to new patients during COVID-19, researchers must evaluate the impact on access to urologic care especially given existing concerns about workforce shortage issues and impact of rurality on access to specialty care. 26 , 27…”

The impact of COVID-19 on urology office visits and adoption of telemedicine services

“…Although telemedicine has tremendous potential to really make a dent in the ’access to care’ issue that has plagued the American healthcare system, there will need to be a coordinated effort from the government, payers, and healthcare systems, to make a conscious effort to improve health literacy and awareness as well as long term policy changes. Approximately 90% of practicing urologists had a primary practice location in a metropolitan area which furthers the rural-urban divide [17 ▪▪ ,35]. In order for patients living in a rural area to have access to specialist care, regulations regarding originating site requirement, new patient telemedicine services, and reimbursement need to be made permanent.…”

Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

“…Likewise, the National Academy of Medicine has identified rural location as a potential risk factor for health care disparity [ 10 ]. Rural PCa survivors face unique challenges in accessing care such as a lack of subspecialized urologists in rural areas [ 11 ], lower access to advanced imaging modalities (including a pre-biopsy MRI) [ 12 ], hospital closures due to consolidation [ 13 ], and a lower inclination of newly trained physicians to practice in rural areas [ 14 ]. Access to healthcare promptly and the quality of care are likely to affect cancer care outcomes such as mortality, although the evidence regarding the association of rural/urban residence with mortality is mixed [ 15 , 16 , 17 ] depending on the study setting and adjustment of other demographic and clinical characteristics.…”