J. Stephen Jones, MD
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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 (see "Urologists bemoan 1-2 punch: Falling pay, rising overhead"). The most obvious finding is that
business, regulatory, and financial concerns remain widespread among urologists. Rising labor and malpractice costs in the
setting of reduced reimbursement create an undeniable squeeze inevitably diverting physician energy from where it should be
prioritized—patient care. As a result, only half of those surveyed state confidence that they would re-enter medicine if starting
over.
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.
The data suggest further consideration of the concept that urologists are voluntarily choosing a cleanly divided "two-track"
system. More time among respondents is still spent in the hospital operating room (mean, 9 hours) than performing office-based
procedures (mean, 8 hours). Clinic responsibilities remain substantial for all but subspecialty urologists at tertiary care
centers, but only one-fourth of respondents anticipate further decreasing time in the operating room. 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.
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