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UPJ INSIGHT Urologist Access for the Male Population: An 18-Year Study on Population Trends

By: Sarah K. Amalraj, MD, University of Kansas Medical Center, Kansas City; Stephen P. Pittman, MD, University of Kansas Medical Center, Kansas City; Shachi Patel, PhD, University of Kansas Medical Center, Kansas City; Jeffrey A. Thompson, PhD, University of Kansas Medical Center, Kansas City; Ajay K. Nangia, MBBS, University of Kansas Medical Center, Kansas City | Posted on: 18 Mar 2024

Amalraj SK, Pittman SP, Patel S, Thompson JA, Nangia AK. Urologist access for the male population: an 18-year study on population trends. Urol Pract. 2024;11(2):324-332.

Study Need and Importance

Multiple studies have shown that the number of urologists within the workforce is not sufficient for the growing elderly population. Analyzing shifts in the workforce and demographic trends spanning decades provides necessary information for health care policy makers to anticipate the need for specialists and allow for changes in funding trainees.

What We Found

Over an 18-year period, overall urologist availability decreased for men by 19.6%. Among the younger male cohort, urologist availability increased in metropolitan counties by 4%, but decreased by 16% in rural counties. There was a decrease in urologist availability of 28% and 43% in metropolitan and rural counties, respectively, in the older male population. Multiple logistic regression analyses demonstrated that metropolitan status was the most significant factor associated with urologist availability. As demonstrated in the Figure, the odds of each independent factor predicting urologist availability is dependent on geography.

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Figure. Geographical depiction of the predictive effect of the independent factors associated with increasing urologist availability for the younger male population. Corresponding odds ratios are shown by color-matching with each individual legend. Darker regions indicate that an independent factor has a higher odds ratio in relation to predicting increasing urologist availability. A, Metropolitan county status. B, Education. C, Poverty. D, Unemployment. E, Effect of the younger male population. F, Urologist availability.

Limitations

Our study is limited by omitting 2020 census data. This decision was made due to a change in the classification of urban and rural areas, which affected the classification of numerous counties. This study also does not incorporate the use of advanced care practitioners as those data were not readily available. Lastly, after the COVID-19 pandemic, the use of telehealth medicine has increased throughout the US—further studies are necessary to understand how telehealth may assist in providing urological care in underserved areas.

Interpretation for Patient Care

Urologist availability is a major concern in the US, especially in rural counties. As our study suggests, decreased access to urological care will continue to harm our patients until changes are made at the levels of graduate medical education, health policy, and workforce distribution.

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