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UPJ INSIGHT 18-Year Population Trends Determine Factors Associated with Future Access to Urologists

By: Stephen P. Pittman, MD; Shachi Patel, MS; Jeffrey A.Thompson, PhD; Ajay K. Nangia, MBBS | Posted on: 01 Sep 2022

Pittman SP, Patel S, Thompson JA, Nangia AK. 18-year population trends determine factors associated with future access to urologists. Urol Pract. 2022;9(5)441-450.

Study Need and Importance

Urologists remain in high demand across the United States, and concern regarding future access to care has been mounting due to the large increase in the aging U.S. general population. General population migration has not been accounted for in previous studies investigating access to care. Our study evaluated urologist density over time in light of U.S. population shifts to determine if urologists are following population patterns, and to identify factors associated with future access to care.

What We Found

Figure. Geographic depiction of the predictive effect of the independent factors associated with increasing urologist availability. Corresponding odds ratios are shown by color-matching with each individual legend. Darker regions indicate that an independent factor has a higher odds ratio in relation to predicting increasing urologist availability.

We analyzed county-level data from the U.S. Census, American Health Resources Files and American Community Surveys from 2000, 2010 and 2018. From 2000 to 2018, there was a 13% decline in local urologist availability (–0.03 urologists/10,000 individuals, 95% CI 0.02-0.04, p <0.0001). General population increased the most in the South (approximately +512,000) and decreased the most in the Northeast (approximately –352,000). Urologist availability fell in every region due to population increases, while a 4.5% decline in the Northeast is attributed to an actual loss of urologists, which outpaced a decline in general population. On multivariate analysis, metropolitan status was the greatest predictor of urologist availability (OR 1.86, 95% CI 1.47–2.34), followed by prior urologist presence (OR 1.49, 95% CI 1.16–1.89), defined as a higher number of urologists in 2000. The predictive weight of these factors varied by U.S. region, as indicated by color-mapped odd ratios in the Figure.

“From 2000 to 2018, there was a 13% decline in local urologist availability (–0.03 urologists/10,000 individuals, 95% CI 0.02-0.04, p <0.0001).”

Limitations

Our study is limited in that advanced practice providers or recent increases in utilization of telemedicine were not accounted for. Additionally, some urologists provide outreach clinics that cannot be captured by current data sets.

Interpretation for Patient Care

These results indicate that access to urologists is worsening across all regions, although for different reasons. Policymakers should address disparities in care based on regional socioeconomic factors that affect urologist practice patterns.