Understanding the long-term outlook of the urology workforce is critical to maintaining an adequate supply and distribution of urologists to meet patient needs, ensure access to care, and support strategic workforce policies. Since 2014, annual assessments of practicing urologists in the US have demonstrated an increasing physician supply and a similarly expanding residency training pipeline.¹

The reality, however, has raised concerns about the adequacy of the future workforce. According to the AUA, urology has long been one of the oldest specialties in medicine, with nearly one-third of practicing urologists above age 65 and a median age of 55.² Despite accelerating growth in the general population and in particular among seniors, who consume the majority of urological care, the number of urologists per capita has stagnated and remained relatively unchanged through 2019.¹ Increased attention to the composition of the urology workforce has also identified challenges in gender, racial/ethnic, and geographic diversity. For instance, while the proportion of women urologists in practice recently surpassed 10% for the first time, the trajectory of women entering the urology training pipeline has stalled.³ The COVID-19 pandemic has also added pressures on urology practices due to increased regulations, transition to telehealth, and administrative costs.

While recent workforce studies in urology have characterized the training pipeline,³ professional burnout,⁴ and gender and racial/ethnic diversity,^5-7 which urologists are leaving the workforce and when they are doing so remain a gap in our knowledge. Furthermore, a lack of evidence regarding the factors associated with both planned and unplanned workforce attrition has complicated efforts to reduce the rate of urologists leaving practice prior to their planned retirement age. Thus, a comprehensive assessment of how urologists’ planned retirement age changes over their careers, and which systemic factors mediate workforce attrition, can address a critical gap in knowledge with important research and policy implications.

Our AUA Data Research Program project aims to examine planned and actual retirement among a contemporary cohort of urologists and urology trainees to determine risk factors for workforce attrition. Using the AUA Annual Census data set, we are characterizing urologists’ reported planned and actual retirement age. We are also analyzing demographic-, economic-, and practice-related factors that are associated with retirement age to identify potential individual and systemic risk factors that accelerate unplanned workforce attrition. We plan to link individuals’ responses across Census administrations to assess how reported retirement age varies over time, including before and since the COVID-19 pandemic, and across the transition from training to practice.

The findings of our project can help the AUA advance workforce policy. For the past decade, attention to the urology workforce shortage has been a critical federal legislative priority of the AUA. Proposed action items have included bipartisan legislative support to increase the pipeline through expansion of urology residency slots as well as programs to financially incentivize residency graduates to pursue rural practice through educational loan repayment and deferment programs. For instance, the Residency Physician Shortage Reduction Act of 2023 (H.R. 2389/S. 1302) provides for a significant incremental increase in the number of Medicare-funded residency positions, above and beyond the expected increase in slots provided under current law, and inclusive of hospitals in rural areas as well as those in regions with defined workforce shortages. To reduce the economic burden of establishing a rural practice, the SPARC (Specialty Physicians Advancing Rural Care) Act (H.R. 2761/S. 705) establishes a student loan repayment program for specialty physicians in exchange for practicing in rural communities facing a shortage of physicians in their specialty. The SPARC Act has been endorsed by 21 provider organizations, including the AUA, and 30 patient advocacy organizations. Both bills were key legislative priorities championed by AUA members during the recent Annual Urology Advocacy Summit.

Our project can also help professional organizations like the AUA understand the needs of practicing urologists as they approach retirement by enhancing practice management resources. By identifying factors that are associated with unplanned workforce attrition and occupational variables that contribute to this end point, our project may guide recommendations to inform current graduate medical education “hidden curriculum” initiatives to prepare trainees for common challenges inherent to clinical practice. Cumulatively, this investigation has the potential to help make evidence-based recommendations to the AUA, state urological societies, and practice associations regarding the best approach to potentially extend the professional lifespan of contemporary urologists.

The team of principal investigator Kevin Koo, MD, MPH, MPhil, and co-investigators Candace Granberg, MD, and Gina Badalato, MD, was one of 6 research groups awarded a 2024 AUA Data Research Program Grant. Awardees use clinical data from the AUA Quality (AQUA) Registry or AUA Annual Census data to conduct clinical and workforce studies. Applications for the 2025 AUA Data Research Program will open in May.