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GLOBAL STATE OF UROLOGY Urology in Canada: Navigating Challenges, Embracing Opportunities

By: D. Robert Siemens, MD, FRCSC, Editor, The Journal of Urology®, Queen’s University, Kingston General Hospital, Ontario, Canada | Posted on: 15 Mar 2024

It’s an honor to have been asked by AUANews to reflect on our specialty as practiced in Canada now and into the near future. Sitting down to write this was a bit daunting, speaking for our community, but having had the privilege of volunteering with the Canadian Urological Association (CUA) over the last 20 years or so, and acting as President this year, has allowed some insights that this audience may find interesting.

Canada boasts a decentralized health care system that is publicly funded and universally accessible, which significantly influences urology practice. One of the most distinctive features of our system is the emphasis on equitable access to medical services, irrespective of financial status. Health care is funded and administered mainly by each province and territory, guided by its insurance plans. Benefits and delivery can vary by region, but all citizens and permanent residents have access to medically necessary hospital and physician services free at the point of need. For most Canadians, this has become ingrained as a core value of our health care system since its conception in the mid-1960s. Although there are excluded services, including dental care and outpatient prescription drugs requiring other coverage or insurance, the vast majority of urological care is an insured service.

I think that a natural sequela of our ingrained universal health care model might be the ease of creating collaborative and multidisciplinary approaches to care, which are now inherent in our contemporary urology practice. Team-based care, involving different specialists, primary care, and allied health professionals, is of course pivotal for comprehensive patient management. In my experience, the lack of any real market competition in our specialty in Canada may have facilitated the potential for deep and seamless coordination among health care providers, fostering a holistic approach to urological conditions, especially cancer care.

Despite the many benefits of our system, it is essential to acknowledge the major challenges currently facing urology in Canada. One significant concern, shared in many countries, is the growing demand for urological services amid limited resources. Increasing patient volumes, coupled with a shortage of urologists in certain regions and surgical resources that are limited mostly by hospital constraints, pose challenges in maintaining timely access to care. The backlog of elective surgeries, exacerbated by the pandemic, has created a strain on the health care system, which is particularly evident in urology. Finally, a major issue now is a shortage of primary care, challenging the system as our population ages. Addressing these issues requires ongoing strategic planning, hard decisions on resource allocation, and quickly implementing innovative approaches, such as strengthening virtual care/artificial intelligence tools, to enhance the efficiency of urological services.

A specific example of resource constraints is inconsistent access to new technology. Since the start of my practice, technological advancements have played a transformative role in our specialty. Access to this new technology (ie, robotic platforms, latest lasers, enucleation morcellators, etc) remains sporadic and uncoordinated given our spread out population densities. Many larger hospitals have stressed budgets that often then struggle with these expenses, and increasingly require philanthropy from our communities even for moderately costly equipment. Being late adopters of technological advances is not always a bad thing, rationalizing use for the most cost-effective applications. Nonetheless, our close relationship with our American cousins can make this gap seem discouraging at times. As a result, the emergence of private clinics, focused on providing more expedient care with access to newer technologies, will challenge (or perhaps help transform) our health care system. We will be watching these developments closely in the coming years.

To the next generation of urologists in Canada, I offer the following advice:

  • Foster collaboration. Urology is inherently multidisciplinary. Collaborate with colleagues from various specialties locally to enhance patient outcomes and contribute to the broader health care ecosystem in your backyard.
  • Advocate for resources. Advocate for adequate resources to address the growing demand for urological services. Across Canada, advocacy can be a challenge, but get involved in engaging with local/regional policymakers to ensure your hospital can effectively meet the needs of patients.
  • Embrace technology. Emerging technologies and innovative approaches will enhance the efficiency and effectiveness of the care you can deliver. Artificial intelligence tools (with humans in the loop) are poised to really enhance our practice (the “machines” have not yet collapsed humanity).
  • Prioritize lifelong learning. Stay updated on the latest advancements through continuous education. The field is dynamic and ever changing, so a concrete strategy and commitment to lifelong learning are essential to the care of your patients and your well-being.

Finally, and perhaps most importantly, get involved in regional/national urological associations. As an example, the CUA provides incredible products, specifically in the education, research support, and advocacy realms. In the last year, the CUA has delivered over 200,000 patient information brochures, as well as provided 124 Section 1 group learning credits and 212 Section 3 self-assessment credits. Multiple clinical tools are all freely available and found online at UROPedia Canada. The CUA this past year has created 5 new guidelines and 2 best practice reports aimed at supporting Canadian clinical practice. Further, it awarded $755,000 to our Canadian members in grants to support Canadian urological research. These impressive stats, for an association serving just over 1,600 members, speak to what one can do with a group of dedicated and like-minded volunteers, expertly guided by a small but professional association staff.