Resilience. It was the theme of our recent and best-yet AUA Summit in Washington, DC. Our specialty faces so many challenges today. It feels like there’s “incoming” from all sides, all the time. Workforce concerns have surpassed our still-formidable administrative burden concerns, both in surveys and in our personal communications with colleagues.

Over the past 23 years, adjusting for inflation, our Medicare payments have gone down almost 30% while inflation continues to increase the cost of providing care. We physicians are the only group in health care paid by the federal government whose payments are not inflation adjusted. The Consolidated Appropriations Act of 2024 made this year’s Medicare cut less deep, but we’re still bleeding. One of the leading advocates for Medicare payment reform in the US House of Representatives is the AUA’s own Dr Greg Murphy (R, North Carolina). Our other colleague currently serving in Congress, Dr Neil Dunn (R, Florida), has also done tremendous work in this area. A group of senators have recently formed a work group to study and propose reforms to Medicare physician payment: Catherine Cortez Masto (D, Nevada), Marsha Blackburn (R, Tennessee), John Thune (R, South Dakota), John Barrasso (R, Wyoming; an orthopedic surgeon), Debbie Stabenow (D, Michigan), and Mark Warner (D, Virginia). I, like most of you, still get deep satisfaction from the practice of urology and feeling like I’m making a difference in my patients’ lives. External forces, however, continue to make it harder and harder to provide that care, and that’s why the third pillar of the AUA’s mission statement is “the formulation of health care policy.” That’s the work of the public policy council in our role as advisers to the AUA Board of Directors. Our work is about resilience in the face of persistent forces acting to reduce our ability to deliver the urologic care that Americans need.

Our state and federal legislative priorities are assessed by alternating biennial surveys of the membership on their state and federal pain points. Those data are evaluated by our State Advocacy Committee under the expert leadership of Dr Brian Duty, and our Legislative Affairs Committee under the sage guidance of Dr Robert Bass. Those committees formulate the suggested priorities and submit them to the AUA Public Policy Council, which approves and submits to the AUA board for approval. Our current state and federal priorities are shown in Figures 1 and 2. The lists do not imply a rank order of importance. The bulleted items serve as a signal to staff as to the issues on which we are willing to spend our limited time and resources.

Workforce. It has assumed a prominent place in our federal and state legislative agenda. I have tremendous admiration and gratitude for Dr Andy Harris and the members of the Urology Workforce Task Force, which has studied the problem from all angles and has published on several aspects of our workforce challenges. The task force has couched the problem as a supply-demand mismatch, which I think is a very effective way to attack the problem. There are not enough practicing urologists in the country. According to AUA Census data, 60% of US counties don’t have a urologist. And the problem is only getting worse. Those of us practicing in rural areas, in particular, are starting to see excess morbidity and even mortality from lack of availability of urological expertise. Possible solutions include making it less onerous for foreign-trained urologists to achieve American Board of Urology certification, increasing GME slots, and appropriate expansion of Advanced Practice Providers’ scope of practice to include select urologic procedures under the supervision of a physician as part of a physician-led team.

We can attack the demand side as well; for example, educating our primary care colleagues and other referral sources as to the basic initial management of certain urological conditions to avoid referrals too early in a disease process.

AUA Political Action Committee (AUAPAC). We don’t have a voice or brand recognition on Capitol Hill without a strong PAC. It’s the necessary facilitator of long-term congressional relationships. The PAC’s founding leadership has brought it very successfully from infancy to adolescence, and it’s now time that we make a strong adult out of this thing with some name recognition on Capitol Hill. PAC leadership will be working in the near term to reach out to different AUA constituencies with a targeted value proposition. With the diversity of our membership and practice types, the answer to the question “why should I give” is different for each. But a strong answer exists for each, and we are going to deliver that proposition to you in the near future. For residents, please start right now—today—to get in the habit of making an annual contribution to the AUAPAC. Use the QR code in Figure 3 to make a contribution.

I’m leading by example. I recently became the third Platinum member in AUAPAC’s history. The dollar amount is not important. Ten or twenty dollars helps. The act of making this a yearly habit is critical. We’ve got to create a culture in urology that the lawyers created years ago—which is why they are a $4M PAC.¹ We need to consider an annual PAC contribution a cost of doing business. It should be part of our annual professional checklist, like renewing our license and getting our CME done.

If you love this advocacy stuff like I do, please join us in Washington, DC, March 2-5, 2025, for the next AUA Advocacy Summit (Figures 4 through 9). If your heart is with us but you just can’t or don’t want to make the trip to DC, no problem. Please contribute to the PAC. (Scan the QR code right now!) It is the single best thing you can do to support AUA’s efforts toward improving the practice environment for every one of us.

We’ve got work to do! Let’s get to it!

AUAPAC is a “separate segregated” fund (SSF) established by the American Urological Association, Inc. Contributions to AUAPAC, which is a multicandidate committee, are not deductible as charitable contributions for Federal Income Tax purposes. Further, contributions by one person in the name of another person are prohibited. PAC contributions are also not reimbursable by an employer or any other entity. The FEC requires that certain information on each donor (who contributes $200 or more per year) such as the donor’s name, address, occupation, and employer’s name be collected and reported to the Commission. By contributing to AUAPAC you affirm that you: are a US citizen or an individual lawfully admitted with permanent resident status; that your contribution is made from your own personal funds and not from corporate, foreign national, or labor union funds; that you will not receive reimbursement by anyone for this contribution, and that your contributions to AUAPAC will not aggregate in excess of $5,000 per calendar year. Contributions are voluntary and you have a right to refuse to contribute without reprisal.