Trends in Inpatient Urological Surgery Practice Patterns

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Introduction As the nation's population ages and the number of practicing urologists per capita decreases, 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 during a 5-year period. Methods We used the Nationwide Inpatient Sample data from 2005 through 2009 to identify surgeons and urological surgeries. We classified the urological surgeries into 1 of 7 clinical domains (endourology and stone disease, incontinence, urogenital reconstruction, urologic oncology, benign prostate, renal transplant, and other urological procedures). For each urological surgeon 3 parameters were determined for each year, including 1) case diversity (the number of distinct urological clinical domains in which he/she performed 2 or more procedures per 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 per year that belonged to his/her assigned clinical domain). We examined trends in these metrics during a 5-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. Urologists’ practice patterns evolved with time toward less case diversity (p <0.001) and greater subspecialty focus (p <0.001). These trends were more pronounced for surgeons practicing in urban vs rural settings (p <0.05). Conclusions At a national level urologists’ inpatient surgical practice patterns are narrowing, with less case diversity and greater subspecialty focus. These trends are even more prominent among urologists in urban compared with rural practice settings.




Hawken, S. R., Herrel, L. A., Ellimoottil, C., Ye, Z., Clemens, J. Q., & Miller, D. C. (2016). Trends in Inpatient Urological Surgery Practice Patterns. Urology Practice, 3(6), 499–504.

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