BALTIMORE, July 30, 2014—The American Urological Association (AUA) today issued a statement in response to the new Institute of Medicine (IOM) July 29 report, “Graduate Medical Education that Meets the Nation’s Health Needs.” The below statement is attributable to AUA Public Policy Council Vice Chair Dr. Christopher Gonzalez.
“The AUA applauds the Institute of Medicine (IOM) for studying the governance, finance and regulation of graduate medical education (GME) in the United States as outlined in its new report, “Graduate Medical Education That Meets the Nation’s Health Needs.” This is a much-anticipated report about an increasingly growing problem in the United States.
We stand in support of a need for stable, long-term funding for GME in the United States and also an increased focus on value and performance. However, we are concerned that the IOM’s report fails to provide recommendations that acknowledge that there is a physician workforce shortage across all of medicine. We have concerns over replacing indirect GME (which provides additional funding to teaching hospitals to help offset higher patient care costs) and direct GME funding with one single funding stream. Such consolidation may negatively impact teaching hospitals in their mission to take care of our sickest patients and to safely train medical residents. We are also concerned about the recommendation to create a new Department of Health and Human Services (HHS) GME policy council and a GME Center within the Centers for Medicare & Medicaid Services, which runs the risk of merely creating bureaucracies and delaying the training of new physicians needed to care for the growing patient population.
There is a physician workforce shortage across all of medicine. Reform must include plans to expand and increase funding for residency slots in needed and underserved areas of medicine. Primary and specialty care must form a united front to advance legislative reform of the GME system. Together with our colleagues across the healthcare space, we look forward to sharing perspectives on how to advance reform to ensure that our country has a sufficient physician workforce to meet patient demand.
About the Urology Workforce Shortage
The American Association of Medical Colleges (AAMC) has estimated a deficit of 130,000 physicians equally in primary care and non-primary care by the year 2025. By 2030, it is estimated that nearly 20 percent of the U.S. population will be age 65 or older. Elderly patients require three times the rate of surgical services the general population uses. (Williams 2010, US Census Bureau 2000 – 2050). To meet these population demands, the HHS projects a need for 14,000 urologists by 2015 and 16,000 urologists by 2020. Currently there are less than 10,000 urologists practicing in the United States, an unsustainable number required to care for an aging and growing population. There is also concern about the fact that Urology has the second-oldest surgical subspecialty workforce with an average age of 52.5 years. Currently 44 percent of the urology workforce is over the age of 55 with 18 percent age 65 or older and 7.4 percent over the age of 70.
Another concerning trend is the geographic distribution of urologists in the United States. In rural settings, urologists, on average, are 2.2 years older than those practicing in urban settings. As of 2009, the concentration of urologists practicing in an urban setting was seven times higher than the number practicing in a rural setting. Urologists in the rural setting tend to be older and nearing retirement. These data raise concerns that a disproportionate aging urology workforce significantly threatens access to urologic care, especially in rural areas, which comprise 18 percent of the U.S. population.
A recent AUA Workforce and Compensation Survey indicated that up to 20 percent of currently practicing urologists plan to retire in the next five to 10 years. Other independent analysis indicates that by 2030, urology will face a 32 percent (3,884 urologists) shortage in the number of providers necessary to care for a projected 364 million U.S. citizens. (Williams et al 2009)
These shortages, in combination with the 1997 freeze on GME funding at 170 funded urology residency slots, has led to a very precarious situation for our specialty and the ability of our teaching institutions to safely train high-quality urologists for the future. This past year, there were 285 PGY1 slots in the 2014 match, which means that 115 slots were funded with non-GME money. In a recent Society of University Urologists survey, clinical revenue and hospital funding appear to be the main financial support engines for faculty salary, resident education, dedicated resident research rotations and proficiency training (surgical training skills labs). This is not a sustainable model.”
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About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 20,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
Wendy Waldsachs Isett, AUA