On February 27, 2023, 240 members of the urological community arrived in Washington, DC, for the Annual AUA Advocacy Summit. Among them were community urologists, patient advocacy groups, providers of all levels, and university specialists from every area of the country. As trainees, we represented one quarter of the group, stepping out of our scrubs and into a new role as advocates for our patients and profession.

Our first day consisted of extended issue briefings. We learned the potential of harnessing federal law to augment our patients’ access to prostate cancer screening. Since 2012, there have been ongoing conversations about the utility of prostate cancer screening with the U.S. Preventative Services Task Force (USPSTF). The AUA’s efforts have upgraded the USPSTF grade to C for men aged 55-69. However, we know that age is not the only consideration; there are discrete risk factors, such as family history and race. The “PSA Screening for HIM [High-risk Insured Men] Act” leverages the Affordable Care Act’s requirement of insurance coverage for “A” and “B” ratings and asks Congress to cover the cost of PSA screening for our most at-risk patients, including African American men and men with a family history of prostate cancer.

We then turned our attention to issues related to access to urological care. Our small field of urology has marked inequities in the distribution and availability of providers. According to the most recent AUA Census, 62% of U.S. counties do not have a urologist, and 90% of urologists practice in metropolitan areas. We need the tools to expand our reach, and multiple of our legislative priorities addressed that issue. The first key development has been the widespread use of telehealth. The inception of the federally designated Public Health Emergency in 2020 created new flexibility in telehealth logistics, waived the geographic restrictions, and allowed for audio-only visits. This revolutionized urological practice with most urologists incorporating telehealth into their practice. As the Public Health Emergency comes to an end, these allowances are only guaranteed through December 31, 2024. We requested that Congress support permanent expansion of telehealth benefits. We asked them to consider payment parity, which will allow us to maintain the infrastructure needed to support telehealth long term.

As telehealth allows easier ways to bring patients to urologists, we also are seeking to increase access to urological care in underserved communities. All types of specialist care are scarce in rural areas, but as noted above, this disparity is particularly notable in our field. The Specialty Physicians Advancing Rural Care (SPARC) Act asks Congress to provide specialty medicine physicians, including urologists, who practice within rural communities with loan forgiveness opportunities.

Finally, our last “ask” was for Congress to support reform to the Medicare Physician Fee Schedule. Medicare funding and, specifically, multiple urological procedures are facing cuts in reimbursement, and reimbursement for labor has not increased as expenses to practice increase. After we spent our first day taking deep dives into the issues we would discuss with our representatives and senators, we were prepared to take our knowledge to Capitol Hill.

On day 2, our group had 186 meetings with various members of Congress and their staff. After multiple years of Zoom meetings, it felt incredibly meaningful to meet with our legislators in person. As we explained the landscape of prostate cancer screening, one staffer responded that they may not have been talking about PSA tests yesterday but certainly would be now. And although change is incremental, it was exciting to see our impact. In fact, shortly after our visit on March 10, U.S. Senators Roger Wicker (R, Mississippi) and Jacky Rosen (D, Nevada) reintroduced the bipartisan SPARC Act.

As urology residents, we are the first call for every dose of acetaminophen and simethicone. Our days are focused on triaging emergency consults and scoping difficult catheters. Every day, we shape our professional identity as urologists through our interactions with patients. The AUA Advocacy Summit allowed us a unique opportunity to broaden our perspective beyond daily clinical care and to assume roles as physician leaders and advocates. Caring for our patients starts at the level of answering every page on the hospital floor but extends to the level of national advocacy that will change the way we are able to treat and care for our patients in the future.