American Urological Association Census Research Articles

An Analysis of American Urological Association Census Trends: Earlier Planned Retirement and Practice Pattern Changes May Exacerbate the Urology Workforce Shortage

ObjectiveTo explore how changes in planned retirement age, practice setting, and physician productivity may impact the workforce shortage in urology. MethodsWe compared data between the 2015 and 2022 American Urological Association census, a specialty-wide annual survey which collects data on demographics, practice patterns and procedures from a representative sample of US urologists. Workforce productivity was measured by the self-reported number of hours worked per week and patients seen per week. A novel formula was developed to demonstrate how planned retirement age and productivity impact the workforce’s production capacity. ResultsThe total number of practicing urologists increased during the period from 2015 to 2022 (11,990 to 13,976), while the mean age of practicing urologists decreased slightly (55.0 to 54.5 years; p <0.002). During this period, the mean planned age of retirement for all urologists decreased from 68.9 years to 67.7 (p <0.001). Urologists in solo practice had a significantly higher planned age of retirement at 71.9 years (p <0.001) as compared to all other practice models. The number of patients seen per week for all urologists decreased from 78.7 to 72.9 (p <0.001). The amount of hours worked per week remained relatively constant between the study periods. The maximum possible number of patients seen by the workforce prior to retirement increased by only 2.4% during the study interval. ConclusionThough the US urology workforce is growing and the mean age is decreasing, decreases in planned retirement age and productivity may offset these gains and intensify the physician shortage for US urologists.

Factors Influencing Medical Students' Pursuit of Urology: Results From the AUA Census (2019-2021).

Growing interest in urology among medical students highlights the need to understand factors influencing their specialty choice in today's context. We also investigate COVID-19's impact on these factors and any disparities among female and underrepresented in medicine (URiM) students. From 2019 to 2021, the AUA Annual Census survey included medical student-focused questions on demographics, career interests, and decision factors. Responses were analyzed. One hundred ninety-two medical students participated. Thirty-six (24%) identified as female and 19 (13%) as URiM. Common reasons students would choose urology included surgical procedures (93%) and "good lifestyle" among surgical careers (85%), with no differences across gender or URiM status. Compared to pre-COVID (2019), during COVID (2020-2021), a greater proportion of students cited cutting-edge technology (90.1% vs 73.1%, P = .008) and surgical procedures (98.6% vs 87.2%, P = .008) as reasons to choose urology. Reasons for not choosing urology included competitiveness (48%) and poor lifestyle (26%). Female and URiM students expressed concern related to the combined "male dominated/gender discrimination/lack of diversity" aspect (female 33% vs male 3%, P < .001; URiM 25% vs non-URiM 7%, P = .04). The AUA Census survey highlights factors influencing medical students' decisions regarding urology. Interest in procedural and technological aspects grew during COVID. Students expressed concern over the field's competitiveness and poor lifestyle, while also acknowledging that urology offers a favorable lifestyle compared to other surgical careers. Female and URiM students expressed ongoing concerns over the combined aspect of gender discrimination and/or the lack of existing diversity in the field.

Urologists’ Perceptions and Practices Related to Patient Smoking and Cessation: A National Assessment From the 2021 American Urological Association Census

To assess urologists' perceptions and practices related to smoking and smoking cessation. Six survey questions were designed to assess beliefs, practices, and determinants related to tobacco use assessment and treatment (TUAT) in outpatient urology clinics. These questions were included in an annual census survey (2021) offered to all practicing urologists. Responses were weighted to represent the practicing US population of nonpediatric urologists (N=12,852). The primary outcome was affirmative responses to the question, "Do you agree it is important for urologists to screen for and provide smoking cessation treatment to patients in the outpatient clinic?" Practice patterns, perceptions, and opinions of optimal care delivery were assessed. In total, 98% of urologists agreed (27%) or strongly agreed (71%) that cigarette smoking is a significant contributor to urologic disease. However, only 58% agreed that TUAT is important in urology clinics. Most urologists (61%) advise patients who smoke to quit but do not provide additional cessation counseling or medications or arrange follow-up. The most frequently identified barriers to TUAT were lack of time (70%), perceptions that patients are unwilling to quit (44%), and lack of comfort prescribing cessation medications (42%). Additionally, 72% of respondents stated that urologists should provide a recommendation to quit and refer patients for cessation support. TUAT does not routinely occur in an evidence-based fashion in outpatient urology clinics. Addressing established barriers and facilitating these practices with multilevel implementation strategies can promote tobacco treatment and improve outcomes for patients with urologic disease.

Patient Demand for Urologists in the United States: A Google Trends Analysis.

We sought to quantify patient demand for urologists on a state-by-state basis in the United States. Google Trends data were analyzed from 2004-2019 to determine average relative search volume for the term "urologist" in each state. The 2019 American Urological Association Census was used to determine the number of practicing urologists per state. A per capita concentration of urologists was calculated by dividing the number of providers by the estimated population in each state as reported by the 2019 Census Bureau. Relative search volume values were then divided by the concentration of urologists to estimate a physician demand index for each state scaled 0-100. The physician demand index was highest in Mississippi (100), Nevada (89), New Mexico (87), Texas (82), and Oklahoma (78). The concentration of urologists per 10,000 people was greatest in New Hampshire (0.537), New York (0.529), and Massachusetts (0.514), and lowest in Utah (0.268), New Mexico (0.248), and Nevada (0.234). Relative search volume was highest in New Jersey (100.00), Louisiana (91.67), and Alabama (87.67), and lowest in Wisconsin (31.17), Oregon (29.17), and North Dakota (28.50). The findings of this study suggest that demand is greatest in the Southern and Intermountain regions of the United States. Facing a shortage in the urology workforce, these data may aid physicians and policy makers in focusing interventions. These findings may further aid in future job allocation and practice distribution.

Electronic Health Record Use and Perceptions among Urologic Surgeons.

Electronic health records (EHRs) have become widely adopted with increasing emphasis on improving care delivery. Improvements in surgery may be limited by specialty-specific issues that impact EHR usability and engagement. Accordingly, we examined EHR use and perceptions in urology, a diverse surgical specialty. We conducted a national, sequential explanatory mixed methods study. Through the 2019 American Urological Association Census, we surveyed urologic surgeons on EHR use and perceptions and then identified associated characteristics through bivariable and multivariable analyses. Using purposeful sampling, we interviewed 25 urologists and applied coding-based thematic analysis, which was then integrated with survey findings. Among 2,159 practicing urologic surgeons, 2,081 (96.4%) reported using an EHR. In the weighted sample (n = 12,366), over 90% used the EHR for charting, viewing results, and order entry with most using information exchange functions (59.0-79.6%). In contrast, only 35.8% felt the EHR increases clinical efficiency, whereas 43.1% agreed it improves patient care, which related thematically to information management, administrative burden, patient safety, and patient-surgeon interaction. Quantitatively and qualitatively, use and perceptions differed by years in practice and practice type with more use and better perceptions among more recent entrants into the urologic workforce and those in academic/multispecialty practices, who may have earlier EHR exposure, better infrastructure, and more support. Despite wide and substantive usage, EHRs engender mixed feelings, especially among longer-practicing surgeons and those in lower-resourced settings (e.g., smaller and private practices). Beyond reducing administrative burden and simplifying information management, efforts to improve care delivery through the EHR should focus on surgeon engagement, particularly in the community, to boost implementation and user experience.

Editorial Commentary

No AccessUrology PracticeSpecialty1 Sep 2022Editorial CommentaryThis article comments on the following:Professional Burnout of Advanced Practice Providers Based on 2019 American Urological Association Census Data M. Louis Moy M. Louis MoyM. Louis Moy University of Florida, Gainesville, Florida More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000334.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 9(5), p. 497

Professional Burnout of Advanced Practice Providers Based on 2019 American Urological Association Census Data.

Burnout has been recognized as an occupational hazard among health care professionals. The objective of this study was to assess the extent and pattern of burnout in advanced practice providers (APPs) in urology by analyzing American Urological Association Census data. The American Urological Association conducts an annual census survey to all providers in the urological care community, including APPs. In the 2019 Census, the Maslach Burnout Inventory questionnaire was included to measure burnout among APPs. Demographic and practice variables were assessed to establish correlating factors to burnout. A total of 199 APPs (83 physician assistants and 116 nurse practitioners) completed the 2019 Census. Slightly more than 1 in 4 APPs experienced professional burnout (25.3% in physician assistants and 26.7% in nurse practitioners). Observed higher burnout rates were seen in APPs who were aged 45 to 54 (34.3%), women (29.6% vs 10.8% in men, p value <0.05), non-White (33.3% vs 24.9% in White), those who had 4-9 years of practice (32.4%) and those who practiced in academic medical centers (31.7%). Except for gender, none of the above observed differences were statistically significant. Using a multivariate logistic regression model, gender remained the only significant factor associated with burnout (women vs men with an odds ratio of 3.2 [95% confidence interval: 1.1-9.6]). Overall, APPs in urological care reported lower levels of burnout than urologists; however, there was a higher chance of female APPs experiencing higher professional burnout in comparison to their male counterparts. Future studies are needed to investigate possible reasons for this finding.

Demographic and Practice Trends of Rural Urologists in the U.S.: Implications for Workforce Policy.

There is a shortage in the number of urologists needed to satisfy the needs of an aging U.S. The urologist shortage may have a pronounced impact on aging rural communities. Our objective was to describe the demographic trends and scope of practice of rural urologists using data from the American Urological Association Census. We conducted a retrospective analysis of American Urological Association Census survey data over a 5-year period (2016-2020), including all U.S.-based practicing urologists. Metropolitan (urban) and nonmetropolitan (rural) practice classifications were based on rural-urban commuting area codes for the primary practice location zip code. We conducted descriptive statistics of demographics, practice characteristics and specific rural-focused survey items. In 2020, rural urologists were older (60.9 years, 95% CI 58.5-63.3 vs 54.6 years, 95% CI 54.0-55.1) and were in practice longer (25.4 years, 95% CI 23.2-27.5 vs 21.2 years, 95% CI 20.8-21.5) than urban counterparts. Since 2016, mean age and years in practice increased for rural urologists but remained stable for urban urologists, suggesting an influx of younger urologists to urban areas. Compared with urban urologists, rural urologists had significantly less fellowship training and more frequently worked in solo practice, multispecialty groups and private hospitals. The urological workforce shortage will particularly impact rural communities and their access to urological care. We hope our findings will inform and empower policymakers to develop targeted interventions to expand the rural urologist workforce.

The Current State of Educational Debt among Practicing Urologists

Previous studies have shown urology trainees to carry large amounts of educational debt. However, little is known about the educational debt metrics in the urology workforce. Therefore, we set out to characterize educational debt among practicing urologists. The American Urological Association (AUA) Workforce Workgroup examined the 2019 AUA Census data. Domains pertaining to demographics and educational debt were examined. Of respondents 31.6% never had educational debt, 47.6% have paid off all their debt, 9.9% had ≤$150,000 debt, and 11% had >$150,000. Of the respondents practicing urology for 11-15 years since completing residency 20.2% had ≤$150,000 debt and 6.5% reported >$150,000 compared to 29% and 17.4%, respectively, for those practicing urology 6-10 years since completing residency. Of female urologists 18.6% had ≤$150,000 and 18.4% carried over >$150,000 compared to 9.0% and 10.1%, respectively, among male urologists (p <0.001). Concerning race, 21% of Black respondents carried ≤$150,000 and 30.4% carried >$150,000 compared to 9.4% and 10.9% in whites and 12.5% and 4.2% in Asian respondents. Furthermore, those in academic settings were more likely to have educational debt compared to those in private groups, 13.5% vs 10.7% vs 10.1% ≤$150,000 and 12.5% vs 10.9% vs 10.3% >$150,000, respectively (p=0.01); 23.6% felt their educational debt contributed to burnoutConclusions:A large percentage of practicing urologists carry educational debt for several years after residency. A higher percentage of respondents with Black race and female gender have debt compared to white and Asian race, and male gender. A substantial proportion of those with debt feel the debt contributes to burnout.

Institutional Opioid Prescription Guidelines are Effective in Reducing Post-Operative Prescriptions Following Urologic Surgery: Results From the American Urologic Association 2018 Census

ObjectiveTo assess provider and practice characteristics that drive opioid prescription behavior using the American Urological Association census data. MethodsStratified weighted analysis using 1,157 census samples was performed to represent 12,660 urologists who practiced in the United States in 2018. We compared urologists according to their opioid prescription patterns to evaluate factors and motivations behind opioid use in the post-operative setting. ResultsOverall, 11,205 (88.5%) urologists prescribe opioids in the post-operative setting. The presence of procedure-specific institutional prescribing guidelines was associated with a greater tendency to prescribe ≤10 pills, and lesser tendency to prescribe 11 to 49 and ≥50 tablets following open abdominal (P = .003), laparoscopic (P < .001), scrotal (P < .001), and endoscopic surgeries (P < .001). The presence of institutional prescribing guidelines was associated with decreasing opioid prescriptions over a three-year period whereas not having guidelines was associated with an unchanged prescription practice over time. Basing current prescriptions on what was given to prior patients was reported by 85% and was more likely to result in an unchanged amount of prescriptions over time (29.2% vs 13.3%, P = .007). Motivations to avoid patient phone calls were reported by 23.8% and were more likely to increase the opioids provided within the next 3 years (3.2% vs 0.1%, P < .001). ConclusionPractitioners who endorsed using institutional guidelines prescribed fewer opioids following all types of surgery and were more likely to decrease their prescription behavior over time. This data supports continued efforts to provide urologists with more evidence-based guidance on best practice opioid prescribing in the future.

HF01-08 WOMEN ARE UNDERREPRESENTED IN PRESTIGIOUS RECOGNITION AWARDS IN THE AMERICAN UROLOGICAL ASSOCIATION

You have accessJournal of UrologyHistory of Urology Forum I (HF01)1 Sep 2021HF01-08 WOMEN ARE UNDERREPRESENTED IN PRESTIGIOUS RECOGNITION AWARDS IN THE AMERICAN UROLOGICAL ASSOCIATION Jessica Wenzel, Rebecca Agnor, Solange Bassale, Yiyi Chen, Anne Dudley, Courtney Rowe, and Casey Seideman Jessica WenzelJessica Wenzel More articles by this author , Rebecca AgnorRebecca Agnor More articles by this author , Solange BassaleSolange Bassale More articles by this author , Yiyi ChenYiyi Chen More articles by this author , Anne DudleyAnne Dudley More articles by this author , Courtney RoweCourtney Rowe More articles by this author , and Casey SeidemanCasey Seideman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001992.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the proportion of women who received awards from the American Urological Association (AUA) and evaluate whether this has changed over time as the proportion of practicing female urologists has increased. METHODS: A retrospective review of award recipients from the AUA website was performed. Gender of award recipient, type of award and year received were collected and the trend over time was compared with the AUA census. RESULTS: Of the 622 award recipients, 43 (6.9%) were women. There was a larger proportion of women who received early career awards (15/65; 23.1%) compared to women who received more prestigious mid (1/44; 2.3%) or senior (27/513; 5.3%) career awards. Additionally, 17/43 (39.5%) of female award recipients were not clinical urologists, compared to only 33/579 (5.7%) of male award recipients. CONCLUSIONS: Despite increased representation by women in the field of urology, women remain underrepresented in awards given by the AUA. Although the proportion of women receiving awards over time has increased, it remains less than expected given the increased proportion of practicing female urologists. Strategic initiatives should be employed to help advance women in academic urology. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e229-e230 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Wenzel More articles by this author Rebecca Agnor More articles by this author Solange Bassale More articles by this author Yiyi Chen More articles by this author Anne Dudley More articles by this author Courtney Rowe More articles by this author Casey Seideman More articles by this author Expand All Advertisement Loading ...

PD06-04 WORKFORCE DIVERSITY IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY: AN ANALYSIS OF THE AMERICAN UROLOGICAL ASSOCIATION CENSUS DATA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (PD06)1 Sep 2021PD06-04 WORKFORCE DIVERSITY IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY: AN ANALYSIS OF THE AMERICAN UROLOGICAL ASSOCIATION CENSUS DATA Humphrey Atiemo, Ekene Enemchukwu, and Elodi Dielubanza Humphrey AtiemoHumphrey Atiemo More articles by this author , Ekene EnemchukwuEkene Enemchukwu More articles by this author , and Elodi DielubanzaElodi Dielubanza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001974.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several studies have documented the lack of diversity in the physician workforce. Urology suffers from this same lack of diversity. The 2019 American Urological Association (AUA) census reported that underrepresented minorities in medicine (URM) groups, Black and Latino/Hispanic urologists comprised only 1.9% and 3.3% of the urologic workforce, respectively. Currently, racial disparities in the knowledge and treatment outcomes in minority women with pelvic floor disorders exist. Therefore the subspecialty of Female Pelvic Medicine and Pelvic Reconstructive Surgery (FPRMS) plays a pivotal role in providing care for these patients. The goals of this study are to examine trends in underrepresented minority (URM) representation in FPMRS and to determine the distribution of these providers amongst the AUA sections. METHODS: AUA Census data from 2014 to 2019 was queried to determine the racial/ethnic and gender distribution of the FPRMS specialist by AUA section. Racial groups were identified as White, Asian, Black, Multiracial, and other. This data was then compared to the other AUA subspecialties of Oncology, Pediatrics, and Endourology. RESULTS: Compared to Urologic Oncology, Pediatrics, and Endourology, FPRMS is the most racially diverse workforce. The largest rise in Black and multi-race providers was observed between 2014 (3.2%) and 2015 (11.1%). This growth has been sustained over the following 6 years. In contrast, the other urological subspecialties have remained relatively unchanged at approximately 3% (Figure 1). The largest percentage of URM practitioners were registered in North Central Section with the second highest URM presence in the Mid Atlantic section. FPRMS is also the most gender diverse urologic subspecialty with 46.5% of practitioners identifying as women. The second highest was in Pediatric Urology where women represented 25.1% in 2019. CONCLUSIONS: The FPRMS subspecialty appears to be the most diverse in Urology practice. Future studies are needed to determine the factors that contribute to this finding, such as gender and race concordant mentorship and sponsorship. Ultimately, one of the goals of achieving diversity in the FPRMS specialty is to achieve more equitable care for minority patients with pelvic floor disorders. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e100-e101 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Humphrey Atiemo More articles by this author Ekene Enemchukwu More articles by this author Elodi Dielubanza More articles by this author Expand All Advertisement Loading ...

Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census

To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. QIPS participants and non-participants significantly differed in distributions of age (P=.0299), gender (P=.0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P=.018) and higher clinical (45.2 vs 39.2, P=.022) and non-clinical (8.76 vs 5.28, P=.002) work hours per week. Non-participation was associated with male gender (OR=2.68, 95% CI 1.03-6.95) and Asian race (OR=2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs=8.72-27.8) for patient safety initiatives. QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.

Workforce Diversity in Female Pelvic Medicine and Reconstructive Surgery: An Analysis of the American Urological Association Census Data

To describe the current state of workforce diversity in Female Pelvic Medicine and ReconstructiveSurgery(FPMRS) using the 2014-2019 American Urological Association (AUA) census data. We evaluated FPMRS workforce diversity using the AUA census data from 2014 to 2019. Underrepresented in medicine (URiM) groups were categorized as individuals who self-identified as non-Hispanic Black/African American,Hispanic,Multiracial, and Other. The FPMRS workforce was then compared to the overall urologic workforce and the other urologic subspecialties (oncology, pediatric urology, and endourology) and assessed by AUA section. In 2019, 602 urologists self-identified as FPMRS providers. Of these 12.4% (n=74) were categorized as URiM urologists compared to 8% of the overall urologic workforce. Women who represent 9.9% of all urologists were overrepresented in FPMRS workforce (46.5%). FPMRS had the largest proportion of URiM and women urologists when compared to the other subspecialty areas. The FPMRS urologic subspecialty has the highest percentage of women and URiM urologists compared to all other urologic subspecialty areas. Engagement initiatives and targeted programs may offer insights into this trend. Further research is required to determine the impact of such programs in attracting URiM and women to FPMRS.

Professional Burnout, Career Choice Regret, and Unmet Needs for Well-Being Among Urology Residents

ObjectiveTo measure burnout and career choice regret from the American Urological Association Census, a national sample of urology residents, and to identify unmet needs for well-being. MethodsThis is a cross-sectional study describing U.S. urology residents’ responses to the 22-item Maslach Burnout Inventory and questions about career and specialty choice regret from the 2019 AUA Census. Respondents reported and prioritized unmet needs for resident well-being. ResultsAmong 415 respondents (31% response), the prevalence of professional burnout was 47%. Burnout symptoms were significantly higher among second-year residents (65%) compared to other training levels (P = .02). Seventeen and 9% of respondents reported regretting their overall career and specialty choices, respectively. Among the 53% of respondents who had ever reconsidered career and specialty choice, a majority (54%) experienced this most frequently during the second year of residency, significantly more than other training levels (P = .04). Regarding unmet needs, 62% of respondents prioritized the ability to attend personal health appointments; the majority experienced difficulty attending such appointments during work hours, more so among women than men (70% vs 53%, P < .01). ConclusionIn the largest study of urology resident burnout to date, 47% of residents, including 65% of second-year residents, met criteria for professional burnout. One in 6 residents reported career choice regret. Targeting interventions to early-career residents and enabling access to medical and mental health care should be priorities for reform.

Women Are Underrepresented in Prestigious Recognition Awards in the American Urological Association

ObjectiveTo determine the proportion of women who received awards from the American Urological Association (AUA) and evaluate whether this has changed over time as the proportion of practicing female urologists has increased. MethodsA retrospective review of award recipients from the AUA website was performed. Gender of award recipient, type of award and year received were collected and the trend over time was compared with the AUA census. ResultsOf the 622 award recipients, 43 (6.9%) were women. There was a larger proportion of women who received early career awards (15/65; 23.1%) compared to women who received more prestigious mid (1/44; 2.3%) or senior (27/513; 5.3%) career awards. Additionally, 17/43 (39.5%) of female award recipients were not clinical urologists, compared to only 33/579 (5.7%) of male award recipients. ConclusionDespite increased representation by women in the field of urology, women remain underrepresented in awards given by the AUA. Although the proportion of women receiving awards over time has increased, it remains less than expected given the increased proportion of practicing female urologists. Strategic initiatives should be employed to help advance women in academic urology.

Burnout in Canadian urology: Cohort analysis from the 2018 Canadian Urological Association census.

Physician burnout is associated with medical error, patient dissatisfaction, and poorer physician health. Urologists have reported high levels of burnout and poor work-life integration compared with other physicians. Burnout rates among Canadian urologists has not been previously investigated. We aimed to establish the prevalence of Canadian urologist burnout and associated factors. In the 2018 Canadian Urological Association census, the Maslach Burnout Inventory questions were assigned to all respondents. Responses from 105 practicing urologists were weighted by region and age group to represent 609 urologists in Canada. Burnout was defined as scoring high on the scales of emotional exhaustion or depersonalization. Demographic and practice variables were assessed to establish factors associated with burnout. Comparisons were made to the results of the 2016 American Urological Association census. Overall, 31.8% of respondents met the criteria for burnout. There was no effect of subspecialty practice or practice setting on burnout. On univariate analysis, rates of burnout were highest among urologists under financial strain (50.8%), female urologists (45.3%), and early-to-mid-career urologists (37.7-41.8%). Factors associated with demanding practices and poor work-life integration were predictive of burnout. A total of 12.2% of urologists reported seeking burnout resources and 54.0% wished there were better resources available. Urologist burnout in Canada is lower than reported in other countries, but contributing factors are similar. Urologists who report demanding clinical practices (particularly in early-to-mid career), poor work-life integration, financial strain, and female gender may benefit from directed intervention for prevention and management of burnout. Burnout resources for Canadian urologists require further development.

Characteristics of Participants in the American Urological Association Quality (AQUA) Registry and Early Impact of Participation on Quality of Care.

The American Urological Association Quality Registry (AQUA) is an approved Qualified Clinical Data Repository that was created in 2013 to serve as a platform of quality assessment and improvement. Little is known about how such specialty specific platforms are adopted and used. We describe AQUA participants and report early impact on quality metrics. We compared characteristics of practices and urologists participating in AQUA from 2014-2017 to those of the broader urologist workforce as reported in the 2017 American Urological Association Census, and examined pass rates of 4 measures reported to the Centers for Medicare and Medicaid Services after participation in AQUA. Participation increased during the first 4 years and included >125 practices and 1,148 urologists (9.2% of practicing U.S. urologists). Of AQUA participants 97.6% were in private practice, 1.9% were in academic practice and the rest (0.5%) were employed by private or public hospitals, compared to 59.1%, 25.5% and 11.2%, respectively, of urologists nationally. Among AQUA participants 95.9% lived in metropolitan areas, compared to 89.9% of urologists nationally. A total of 17 quality measures were reported to the Centers for Medicare and Medicaid Services through AQUA, of which 4 were urology specific and 13 were crosscutting. The average pass rate across the 4 select urological measures was 31.1% prior to AQUA dashboard access and 48.8% after access was gained, a 56.9% improvement (17.1% absolute difference). Early participants in AQUA were mostly community practitioners. Participation in AQUA seemed to facilitate quality score improvements, although whether this was due to improved measurement vs clinical care is unknown at this time.

Gender-based Differences in Career Plans, Salary Expectations, and Business Preparedness Among Urology Residents

To characterize gender-related differences between the values and salary expectations of US urology residents. We analyzed 2016-2018 American Urological Association Census data regarding residents' demographics, motivations, and concerns. To explore gendered differences, we queried Census items related to demographics, values, and preparedness for the business of practice. Descriptive statistics and test of hypotheses were used for analysis. A total of 705 residents responded of whom 196 (28%) were female. More than half of residents (54%) reported educational debt >$150,000. Factors influencing choice of practice setting included lifestyle (87%), compensation (82%), and location (78%) and was not significantly different between males and females. There were also no differences regarding planned practice setting. However, women had significantly lower first year salary expectations; 53% expected to make <$300,000, compared with only 32% of men (P <.001). Finally, significantly more women reported feeling unprepared to handle the business of urology practice, including salary negotiation, (74% vs 53%, P <.001). Among a nationally representative sample of urology residents, women had significantly lower salary expectations and expressed significantly more discomfort with the business aspects of medicine, including contract negotiation, than their male counterparts. These observational findings may contribute to and potentially perpetuate the urology wage gap.

#ILookLikeAUrologist: Using Twitter to Discuss Diversity and Inclusion in Urology

According to the 2018 American Urological Association census, only 9.2% of practicing urologists are female and 16% are non-Caucasian. Social media have been used in other medical disciplines to promote diversity and form networks for gender and racial minorities. We studied the hashtag #ILookLikeAUrologist, started to promote diversity and inclusion in urology, to determine if it had any signs of a community of practice. Over the 4 yr since its inception, there have been 3694 tweets using the hashtag #ILookLikeAUrologist. The discussion had 1348 unique contributors, hailing from 35 countries on six continents. There were 8,156,051 impressions, highlighting a wide potential reach for the discussion. In a random 25% sample of original tweets, the main themes were gender representation, followed by personal narratives and camaraderie. Most contributors were practicing urologists, followed by urology trainees, other physicians, and professional organizations. Although most posts were authored by women, men represented nearly a quarter of individual contributors. The #ILookLikeAUrologist hashtag has been widely used by a large global audience in urology. Future research is warranted to examine the impact of digital communities of practice on outcomes such as fostering collaboration, providing mentorship, and reducing burnout. Patient summaryThe #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology.