Temporal Trends and Practice Patterns in the Urology Work Force between Low and High Density Population Areas

Introduction To evaluate access to urological care and potential work force shortages it is essential to understand geographic variation in physician supply and practice patterns among urologists. We sought to quantify differences between urban and nonurban urologists in the United States and evaluate these trends with time. Methods We obtained procedural case logs from the ABU (American Board of Urology) for 9,390 urologists undergoing ABU initial certification or recertification during 2003 through 2015. We performed summary statistics to characterize the practice patterns and case mix of nonurban urologists (practice setting less than 100,000 population) and urban urologists (practice setting greater than 100,000 population). Results Of 8,180 urologists (87.1%) with practice setting information 6,907 (84.4%) practiced in an urban setting vs 1,273 (15.6%) in a nonurban setting. The proportion of nonurban urologists decreased from 2003 to 2015 (19.4% to 14.2%, p = 0.06). A higher proportion of urban urologists were female (9.5% vs 6.8%, p = 0.007). Nonurban urologists were more likely to be general urologists (88.0% vs 71.8%, p <0.001) and be in practice longer (mean ± SD 11.0 ± 8.4 vs 9.2 ± 8.3 years, p <0.001). Nonurban urologists were more likely to be solo practitioners (21.8% vs 9.5%, p <0.001) and less likely to perform major urological cases with a median of 5 (IQR 1–12) vs 9 cases (IQR 3–19) annually (p <0.001). Conclusions Imbalance in the geographic distribution of urologists appears to be growing. With an aging nonurban urological work force that is performing fewer major operations Americans residing in nonurban areas may face barriers in access to care.