Introduction: Urology workforce projections predict an alarming shortage of urologists in upcoming decades. Survey data also suggest recently graduated urology residents do not feel ready for independent practice. In fact, over half (61%) perceived they were not proficient at performing robot-assisted laparoscopic prostatectomy. For these reasons, we conducted a study to determine whether perceived readiness for surgical practice among graduating urology residents was aligned with procedural demand and current workforce needs.
Methods: We assessed self-reported graduated urology resident proficiency for urologic procedures using survey data (Okhunov et al 2019). We selected 15 procedures with varying degrees of difficulty and reported proficiency. We then determined procedural demand for urologic care using 2017 national Medicare data. Lastly, we calculated correlation coefficients between perceived proficiency and case volume data to provide a framework for better alignment of training and demand.
Results: In 2017, there were a total of 6,784,696 urologic procedures performed through Medicare. Our 15 index cases accounted for 21.1% (n= 1,431,775) of these procedures, with a median number of 7,706 procedures. Endopyelotomy was the least common procedure (n= 98), while cystoscopy was the most common (n= 980,623). Medicare case volume was positively correlated with graduating residents’ procedural confidence (r = 0.86). We identified four categories with varied alignment of training and demand: 1) high volume and high confidence, 2) high volume and low confidence, 3) low volume and high confidence, and 4) low volume and low confidence (Figure).
Conclusions: Amidst an anticipated workforce shortage, aligning urologic training to achieve resident competency with current workforce demand is time-sensitive and important. Using national Medicare data coupled with recent graduated urology resident survey results, we provide a guiding framework for improving the alignment of training and workforce demand. Informed by these results, we recommend altering volume requirements, both increasing and decreasing, and fellowship training opportunities. Training requirements from the Accreditation Council for Graduate Medical Education (ACGME) should in part reflect these needs. Source of