The urological workforce is predominantly located in metropolitan areas, with only 0.5% of urologists in rural areas.¹ Interestingly, 62% of counties in the United States do not have a practicing urologist. Furthermore, the rural urological workforce is older, with 29.5% of those over 55 years of age practicing in a rural area compared to only 17% of those less than 54 years of age.¹ If the workforce does not replace those in rural areas as they retire, these patients will have decreased access to care.

The urological workforce also carries substantial debt: 21% carry debt and 11% carry over $150,000. This is logically skewed to younger urologists, with over 40% of those in practice 5 years or less having over $150,000 in debt.² Even more concerning, 54% of trainees carry more than $150,000 of debt, with 27% having over $250,000. Those with more debt were more likely to accept a practice opportunity when loan forgiveness was offered.³

The future decrease of the rural workforce and the high debt burden of our younger workforce form the 2 main elements of the Specialty Physicians Advancing Rural Care (SPARC) Act. This bill allows educational loans for specialty physicians to be paid, up to $250,000, over a 6-year period for service in rural areas. The amount is prorated at one-sixth of the total educational debt per year. The purpose of the panel discussion was to educate the advocacy participants on the importance of this bill as they went to Capitol Hill (Figures 1 and 2). This bill is currently endorsed by the American Medical Association, American College of Surgeons, and the American Gastroenterological Association.

Mr Jim Twaddell, senior policy advisor for Venable LLP, discussed cost and eligibility for the SPARC Act. Mr Twaddell stated that there is no specific funding amount or cost associated with the SPARC Act. However, the legislation authorizes appropriations of “such sums” that would be necessary to carry out the program. In addition, Mr Twaddell discussed that under the SPARC Act the specialty physicians eligible to participate in the programs are those identified in the report of the Health Resources and Services Administration titled “Projecting the Supply of Non-primary Care Specialty and Subspecialty Clinicians: 2010-2025.”

During the panel discussion, Kate Kraft, MD, and Jacob Thatcher, DO, gave candid responses concerning the need for the SPARC Act. Dr Kraft, professor and pediatric urologist at the University of Michigan, discussed several patients driving 7-8 hours to see her, given the level of specialty care needed for these patients. She discussed the hardships endured by the patients needing to make this commute and how this affected their everyday lives. Dr Thatcher, National Rural Health Association Health Policy fellow, hopes to return to rural Idaho to practice and discussed how this bill could help him do so in an economically feasible manner without being attached to a hospital agreement.

Drs Thatcher and Kraft were also asked about rural-urban divide in regard to practice opportunities. Dr Thatcher, who is training in a metropolitan center, is struggling to find mentors from rural areas to help him in his decision-making. Dr Kraft, residency program director at The University of Michigan, acknowledged current deficiencies across training programs in exposing and discussing rural opportunities to trainees. Both panelists agreed, the SPARC Act helps in providing awareness and opportunity for discussion of rural practice opportunities.

The SPARC Act meets a critical need for our workforce as well as timely, convenient access to care for our rural patients. This would also greatly benefit the financial well-being of the younger workforce and trainees exiting residency for choosing to take advantage of the SPARC Act.

Acknowledgment

We thank Jeremy Haines for reviewing the manuscript.