Drexelius JA, Pomajzl AJ, Delto JC. A comparison of urological consultations in a private vs academic setting. Urol Pract. 2023;10(1):84-87.

Figure. Monthly comparison of private (P) vs academic (A) consult rates arranged from July to June, reflecting the academic year. Solid lines are observed consults. Dashed lines represent piecewise linear regression models with first-order autoregressive residual covariance structure. Error bars represent 95% CI.

Study Need and Importance

This study analyzes the differences between urological consulting service utilization in an academic compared to a private setting. Increased consultations can increase health care costs without necessarily affecting patient outcomes. A deeper understanding of urological consult patterns is necessary to identify areas of improvement in physician education to reduce excessive consultations.

What We Found

We demonstrated that significant differences exist between inpatient urological consult use in private and academic medical centers. Consults are ordered more frequently in an academic than a private setting (P < .00001). The consult rate in the private setting remained steady throughout the year, while the academic rate fluctuated in accordance with the academic calendar, until statistically equaling the private rate at the end of the academic year (see Figure). Urgent consults and urolithiasis consults were more common in the academic setting, while retention consults were more common in the private setting (P < .001).

Limitations

Limitations of this study include the data set being restricted to 5 years and a higher number of average patient-days in the latter half of the data set, which represents a potentially confounding factor for the increased rate of consultations. Additionally, we were unable to identify whether increased complexity of patients seen in an academic medical center could have influenced the rise in consultation rates in the academic setting.

Interpretation for Patient Care

Our data suggest there is likely a “learning curve” for the management of inpatient urological problems in an academic setting. Recognizing and understanding these practice patterns identifies a potential opportunity to improve medical education by incorporating more urological education in medical school and residency curriculums. Furthermore, improved utilization of inpatient urological consults in academic institutions could play a role in decreasing health care costs and reducing physician burnout.