Background

Urological care is important to millions of patients in the United States affected by urological diseases and conditions, as well as their families. Understanding the current urology workforce is critical to prepare for the future delivery of urological care, especially as the U.S. population ages and the demand for such care and services grows. This study aims to examine the size of the urology workforce in the United States as well as its demographic and geographic distribution through exploration of workforce data from the American Urological Association Annual Census. ¹

Study Data

The yearly master files of practicing urologists in the United States (population files) and the AUA Annual Census sample files (sample files) from 2014 to 2020 were used to build the urologist cohort for analysis. The master files, derived from the National Provider Identifier (NPI) files and the American Board of Urology certification records, contain medical specialty, gender and location data on all U.S. practicing urologists. The Census sample files collected yearly through the AUA Annual Census contain detailed information on demographics, training and practice characteristics.

Statistical Analysis

The number of practicing urologists in the United States was calculated directly from the population files. Estimates of age, ethnicity and race were calculated using statistical samples from the Census and are reported with the appropriate standard errors due to sampling bias. To further account for survey sampling bias, Census data were weighted to represent the urologist population regarding post-stratification factors, including gender, geography, current certification status and years since initial certification. ² Data were analyzed using IBM SPSS ^® 26.0.

Trends in Workforce Size

The number of practicing urologists in the United States grew from 11,703 in 2014 to 13,352 in 2020, an increase of 1,649 urologists (14.1%), implying an average growth rate of 275 urologists (2.4%) per year. This incremental rate outpaces the growth of the U.S. population (0.62%) but lags the growth of the U.S. population age 65 or older (3.42%), the demographic with the highest demand for urological care. ³

Trends in Geographic Distribution

From 2014 to 2020 the number of practicing urologists increased faster geographically in nonmetropolitan areas than in metropolitan areas (25.9% vs 12.8%). The fastest growth rate was seen in the AUA South Central (19.3%) and Western (17.5%) Sections, while the slowest growth rate was noted in the New York (4.1%) and Northeastern (7.9%) Sections.

Trends in Age

While the number of practicing urologists in the United States increased among all age groups, the number of urologists age 65 or older grew the fastest, from 2,679 (22.9%) in 2014 to 4,020 (30.1%) in 2020 (p <0.05). The average age of U.S. practicing urologists increased from 53.1 years in 2014 to 55.2 years in 2020 (p <0.05).

Trends in Gender

There was a significant increase in the number of women in the urology workforce, from 897 in 2014 to 1,375 in 2020. The average annual growth rate was 8.9% for women compared to 1.8% for men. For the first time in history women urologists exceeded 10% of the workforce in 2020.

Trends in Racial and Ethnic Diversity

Little change was observed in the number of urologists self-identifying as having Hispanic ethnicity or nonWhite race between 2014 and 2020. However, the fraction of White urologists actually increased from 9,241 urologists (83.4%) in 2014 to 10,784 urologists (84.7%) in 2020 (p <0.05).

Conclusion

The AUA Census is an invaluable tool that illustrates how the urology workforce has changed during the last 6 years in the United States. While the urology workforce has grown, the rate of increase is not keeping pace with the rapidly growing number of older Americans. The Census also demonstrates an increasing number of women urologists, although these numbers do not yet come close to achieving representation consistent with the gender mix of graduating U.S. medical students. ⁴ However, this study also indicated no growth in the number of urologists with Hispanic ethnicity or nonWhite race, suggesting the need for continued efforts to improve recruitment of underrepresented minorities in medicine to the field.

Future workforce policy efforts may use these data as a benchmark to follow the effectiveness of policies to train and retain a more racially, ethnically and gender diversified urologist workforce.

We thank Raymond Fang and Roxann Nottingham for significant contributions to the manuscript.