At the 2024 AUA Advocacy Summit, the authors presented a panel discussion entitled “The Urologic Workforce Shortage: How Leveraging Data Can Drive The Conversation” (Figure 1). The panel consisted of the following topics: (1) Dr North presented, “How and what data can help us understand the problem?” (Figure 2); (2) Dr Van Horn presented, “What workforce trends are we seeing and what changes do we anticipate over time?”; (3) Dr Kieran presented, “How can we serve the rural population?” (Figure 3); (4) Ms Leff presented, “How do these issues affect patients?” (Figure 4); and (5) Dr Harris presented relevant legislative priorities.

Dr North, associate professor of urology and Chief of Pediatric Urology at Montefiore Health Systems, began by discussing the urologic workforce shortage, which is due to a mismatch between urologist supply and patient demand for our services. The supply shortage is due to at least 3 important factors: not training enough residents, the aging urologic workforce, and the changing demographic of the urologic workforce. Despite an increased need for doctors, with the passage of the Consolidated Appropriations Act in 2021, the number of Graduate Medical Education spots increased for the first time in 25 years. The number of medical school graduates has continued to increase without a concomitant increase in residency spots, leaving many qualified US medical school graduates without residency training. When looking at the 2024 Urology Match results, 23% of applicants went unmatched, meaning our specialty could train an additional 100+ interested residents each year if there were residency spots available. Another concern for future physician supply involves our aging urologic workforce. Almost 30% of practicing urologists are over the age of 65, and 50% are over the age of 55. The urologists in rural areas are shifted further towards higher age. Dr North presented the concern that as this group of urologists chooses to either cut back their work hours or retire altogether, it will increase our shortage of practicing urologists.

Dr North also discussed concerning changes in the well-being of the medical workforce. Physician burnout continues to drive doctors out of clinical medicine, and women urologists experience more burnout than men. Additionally, as women make up more of the urologic workforce, the differing practice patterns between men and women in urology may impact access to care. Women urologists are more likely to be in academic medicine, less likely to practice in rural areas, see fewer patients per week partly due to spending more time with each patient, and report planning to retire at an earlier age. It is unclear the impact this will have on our future workforce. When looking at the demand side, the aging US population will require more medical care and the Affordable Care Act has led to more Americans having access to health insurance. Since insured patients are more likely to seek preventive care, this increases demand for doctors. Dr North closed by stating the Health Resources and Services Administration has released projections showing that by 2036, urology will have enough physicians to meet 83% of overall demand for care. Even more worrisome is there will only be enough urologists to meet 38% of rural demand for care.

Next, Dr Van Horn, an Endourology Fellow at Loyola University Medical Center and a member of the AUAPAC Champions program, outlined the demographics of urologists and how they impact workforce projections in light of the urologic workforce shortage. She highlighted the shifting gender and race demographics, highlighting the increased representation of women and people of color within the trainee workforce as compared to current practicing urologists. The literature in multiple specialties shows that a diverse workforce leads to better patient care and increased care for underserved populations; these changes in urology will yield dividends for our patients as trainees enter the workforce. Notably, in this most recent Match cycle, 49% of matched applicants were not white and 45% were female, statistics more closely matching the US population. Unfortunately, there is attrition at various levels of training and practice in urology. Concerningly, the attrition rate of urology trainees is 3.7% overall and higher for women and under-represented minorities. Dr Van Horn highlighted these attrition points and how failure to address this issue will further exacerbate our workforce shortage.

Dr Kieran, professor of pediatric urology at Seattle Children’s Hospital and Vice Chair of Equity, Diversity, and Inclusion at the University of Washington Department of Urology, followed with discussing the magnification of the shortage in rural locations. About 1 in 5 Americans live in non-urban areas, and these rural citizens tend to be older and sicker than urban citizens. Similarly, about 1 in 5 urologists practice in nonmetropolitan areas of the US. Nearly two-thirds (63%) of counties nationally have no urologist. Urban urologists are younger on average compared to rural urologists, suggesting early-career urologists are gravitating toward practice in urban centers. Dr Kieran also mentioned the concerning numbers of physicians with burnout: a staggering 36% of urologists report burnout. Though this is stable from the 2016 AUA Census, burnout has risen in younger urologists (<45 years old, 38% to 45%) and in women (35% to 49%). Preserving the nonmetropolitan urology workforce requires engaging and retaining urologists working in nonmetropolitan areas. Understanding the quotidian differences in urban and rural urologic practice will inform how the AUA can best support all practicing urologists.

Dr Kieran then discussed her recent 2023-2024 AUA leadership program work as Team Burnett (Drs Paul Chung, Chris Deibert, Candace Granberg, and herself, mentored by Dr Bud Burnett), which surveyed rural urologists in the US. Most urologists (over 70%) opted for rural practice because they liked the area, while fewer than 10% selected a rural job based on a signing bonus or loan repayment. The biggest stressors for rural urologists were frequency and intensity of call, coordinating care with tertiary/quaternary institutions and personnel and clinical resources. Nearly half (46%) of rural urologists take call 10 or more days per month, and 49% experience burnout at least once monthly. Rural urologists also described logistic difficulties arranging collaborative or transfer care with tertiary and quaternary centers, with bed availability and interpersonal professionalism being major concerns.

Ms Leff then discussed her story and how the workforce shortage truly affects patients and the potential patient effects secondary to delays in care. Lastly, Dr Harris, chair of the AUA’s workforce taskforce, closed the panel by discussing legislative solutions proposed during this congressional session to ease the workforce shortage (Figure 5). These include the Resident Physician Shortage Reduction Act, Conrad State 30 and Physician Access Reauthorization Act, and the Specialty Physicians Advancing Rural Care Act.