Simon Neuwahl

Recent Trends in the Urology Workforce in the United States

The present study examines the current status of urology physician manpower in the United States, in the context of trends in the demographics, geographic distribution, and practice make-up of urologists. Physicians were identified as surgeons and classified into surgical groups using a combination of American Medical Association primary and secondary self-reported specialties and American Board of Medical Specialties certifications. From these groups, urologic surgeons were isolated for analysis. The supply of urologists per capita has declined since 1981 - most dramatically since 1991. With an average age of 52.5 years, urology is one of the oldest surgical specialties. Over 7% of urologists are older than 70 years and 44% are older than 55 years, suggesting an aging urology workforce. The number of female urologists has grown almost a 1000-fold and represents a growing and younger cohort of the workforce. The number of rural urologists and the number of international medical graduates have continued to decline since 1981. Over the past 10 years, an increasing number of urologists are now in group practices (over 60%), and these tended to be younger and in urban settings. In contrast to most other surgical specialties, there has been a decrease in the supply of urologists relative to population growth, which is expected to be exacerbated by an aging and relatively older urology physician workforce, particularly in rural areas, a slight increase in female urologists, and the gravitation of younger urologists toward group practice in urban areas.

The Employed Surgeon: A Changing Professional Paradigm

OBJECTIVE To identify trends and characteristics of surgeon employment in the United States. Surgeons are increasingly choosing hospital or large group employment as their practice environment. DESIGN American Medical Association Physician Masterfile data were analyzed for the years 2001 to 2009. SETTING Surgeons identified within the American Medical Association Masterfile. PARTICIPANTS Surgeons were defined using definitions from the American Medical Association specialty data and the American Board of Medical Specialties certification data and included active, nonfederal, and nonresident physicians younger than 80 years of age. MAIN OUTCOME MEASURES Employment status and trends. RESULTS The number of surgeons who reported having their own self-employed practice decreased from 48% to 33% between 2001 and 2009, and this decrease corresponded with an increase in the number of employed surgeons. Sixty-eight percent of surgeons in the United States now self-identify their practice environment as employed. Between 2006 and 2011, there was a 32% increase in the number of surgeon in a full-time hospital employment arrangement. Younger surgeons and female surgeons increasingly favor employment in large group practices. Employment trends were similar for both urban and rural practices. CONCLUSIONS General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance.

The impact of general surgeon supply on the risk of appendiceal rupture in North Carolina.

Objective:To determine whether individuals from surgery-specific service areas with a low supply of general surgeons (GSs) are at increased risk for ruptured appendicitis (ruptured appendicitis is an indicator of surgical access). Background:The increased health care costs and morbidity linked to appendiceal rupture are considered preventable in most cases with timely access to surgery. Among the factors thought to affect an individuals access to surgery for appendicitis is the relative supply of GSs. The maldistribution of GSs is targeted by a Medicare bonus payment although the impact of GS supply on surgical access has yet to be fully described. Methods:Patients discharged from acute care and ambulatory surgery facilities in North Carolina from 2007 to 2009 were pooled for observational analysis. Using ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes, cases were identified as ruptured or unruptured. GS shortage levels based on supply were calculated at the surgical service area level and tested for an association with an individuals risk of rupture using logistic regression. Results:Living in a service area with less than 3 GSs per 100,000 people significantly increases the probability of rupture in individuals with appendicitis, compared with living in a service area with at least 5 GSs per 100,000. Conclusions:The supply of GSs does affect access to surgical services for appendicitis. Expanding on this finding, the recently instituted HPSA (health professional shortage area) surgical incentive payment from the Affordable Care Act should be evaluated closely for its effectiveness. Enhancing supply in critical shortage areas could reduce appendiceal rupture and improve surgical access more generally.