Trends in Inpatient Urological Surgery Practice Patterns.
BACKGROUND
As the nation's population ages and the number of practicing urologists per capita declines, characterization of practice patterns is essential to understand the current state of the urological workforce and anticipate future needs. Accordingly, we examined trends in adult inpatient urological surgery practice patterns over a five-year period.


METHODS
We used the Nationwide Inpatient Sample (NIS) data from 2005 through 2009 to identify both surgeons and urological surgeries. We classified the latter into 1 of 7 clinical domains (Endourology & Stone Disease, Incontinence, Urogenital Reconstruction, Urologic Oncology, Benign Prostate, Renal Transplant, and Other Urological Procedures). For each urological surgeon, three parameters were determined for each year: 1) Case-diversity (the number of distinct urological clinical domains in which they performed ≥2 procedures/year); 2) Subspecialty (the predominant clinical domain of cases that each surgeon performed); and 3) Subspecialty-focus (the proportion of a surgeon's total urological cases/year that belonged to their assigned clinical domain). We examined trends in these metrics over a five-year period, and compared results between urban and rural practice settings.


RESULTS
We analyzed data for 2,237 individual surgeons performing 144,138 inpatient surgeries. Over time, urologist's practice patterns evolved toward lower case-diversity (p<0.001) and greater subspecialty-focus (p<0.001). These trends were more pronounced for surgeons practicing in urban versus rural practice settings (p-values <0.05).


CONCLUSIONS
At a national level, urologists' inpatient surgical practice patterns are narrowing, with less case-diversity and higher subspecialty-focus. These trends are even more prominent among urologists in urban, compared with rural, practice settings.
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Scott R
SR
Hawken
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Lindsey A
LA
Herrel
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Chandy
C
Ellimoottil
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Zaojun
Z
Ye
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
J Quentin
JQ
Clemens
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
David C
DC
Miller
Physician Practice Patterns; Urological Surgical Procedures; Urology; Workforce