Urologists In Private Practice Research Articles

Exploring the Demands of Urology: On-Call Compensation, Frequency, and Variability.

We investigate and analyze the available information regarding on-call patterns among urologists in the US. The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze information from the 2022 AUA Census. Extracted data were analyzed to identify variability across gender, subspecialty, hours worked per week, AUA section, salary, and practice setting. We used χ2 tests to compare the groups with respect to each factor and defined statistical significance as a P value less than .05. There were significant differences by gender and several other on-call factors including being required to take call to maintain hospital privileges (reported by 76% of female urologists vs 67% of male urologists; P = .026), getting paid for weekend call (28% of females vs 38% of males; P = .030), and making over $500 per day when taking weekend call (18% of females vs 32% of males; P < .001). Other differences existed between AUA sections in percentage of physicians receiving over $500 for weekday or weekend calls (P < .001). Lastly, practice setting differed in likelihood of being paid over $500 for weekday call (44% reported by private practice urologists, 7% reported by academic urologists, 14% reported by institutional urologists; P < .001). These results underscore the substantial variability in on-call responsibilities and structure within the AUA workforce. Further research and regular participation in future censuses are recommended to continue to characterize these trends.

A Contemporary Review of Barriers and Methods to Fostering Academic Urologists.

Urology has shown a gradual decrease in the number of graduating residents who plan to pursue a career in academic medicine. Our objective was to identify barriers to academic urology, present options to mitigate those barriers, and explore strategic ways to encourage trainees to seek careers in academic urology. The authors performed a contemporary review of relevant articles through PubMed assessing prior survey studies, editorials, and expert opinion articles that evaluated academic urology, perceptions of academic medicine, physician burnout, and barriers that have been identified to pursuing careers in academic medicine. Selected articles were then independently reviewed by three authors for relevance and application of factors mitigating perceived barriers to pursuing a career in academic medicine, specifically academic urology.Barriers at the academic levels of medical school and residency were found to consist of the following: lack of exposure to research early in their medical careers, inadequate mentorship, all-specialty leading levels of burnout, current average levels of medical school indebtedness contrasted to perceptions of pay disparity when compared to private practice urologists' income, and perceptions of difficulty in maintaining the academic "triple threat." More acutely, the decision to make Step 1 a pass/fail exam, with the addition of historically low match rates in urology, have resulted in additional complications and concerns for aspiring academic urologists.There are clear barriers that graduating urology residents encounter when considering a career in academic medicine. In this review, we present possible mitigating factors that may be instituted at the individual, medical school, and postgraduate levels to increase the number of practicing academics.

MP57-03 A MORE GRANULAR EXAMINATION OF BURNOUT FROM THE AUA WORKFORCE WORKGROUP

You have accessJournal of UrologyCME1 Apr 2023MP57-03 A MORE GRANULAR EXAMINATION OF BURNOUT FROM THE AUA WORKFORCE WORKGROUP Seth Teplitsky, Amanda North, Raymond Fang, William Meeks, Kate Kraft, and Andrew Harris Seth TeplitskySeth Teplitsky More articles by this author , Amanda NorthAmanda North More articles by this author , Raymond FangRaymond Fang More articles by this author , William MeeksWilliam Meeks More articles by this author , Kate KraftKate Kraft More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Burnout continues to be a substantial issue among urologists. Burnout has been associated with depression, and poor patient outcomes. While this has been examined across our specialty, the AUA workforce workgroup sought to provide more granularity to enhance understanding. METHODS: The 2021 AUA census included the Maslach Burnout Inventory to further elucidate burnout among practicing urologists. The AUA data team provided statistical support. Data was collected regarding burnout, components of burnout including emotional exhaustion (EE) and depersonalization (D), and work-life balance questions. These results were then examined by race, gender, and AUA section. Statistical significance was set as p<0.05. RESULTS: Statistically significant differences are reported. Urologists in private practice reported higher burnout rates compared to those in academia, 39% vs 34%. Urologists subspecializing in urologic oncology reported higher burnout when compared to pediatrics and others (46% vs 25% vs 39%). Regarding EE, non-white members were more likely to experience low levels (67 vs 63%) while white members were more likely to experience moderate EE (25% vs 22%). Females were more likely to experience moderate to high-level EE than males. Non-white members were more likely to experience moderate D (26% vs 20%) than white members. The Mid-Atlantic section was more likely than others to report high-level D (51%), with the next closest being the Southeastern section (41%). Female members were more likely to experience high-level D (49% vs 34%). Regarding work-life balance, females were more likely to be dissatisfied (37% vs 23%). Females were more likely to feel their schedule had enough personal/family time (58% vs 34 % for males). No differences in race or geographic region were seen regarding enough personal/family time. CONCLUSIONS: Specific demographic differences are seen across burnout variables. Racial, gender, and regional variability should be further examined. Widespread variability, as seen in gender across multiple variables, is of considerable importance. An individualistic approach and local leadership engagement is prudent. The AUA workforce workgroup will continue to aid in understanding these issues among our members. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e785 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seth Teplitsky More articles by this author Amanda North More articles by this author Raymond Fang More articles by this author William Meeks More articles by this author Kate Kraft More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...

Feminization of urology and glass ceiling: Survey of women urologists in France

Urology has long remained the least feminized specialty. The objective of this study was to assess the demographic characteristics of female urologists and their feelings in terms of discrimination. The survey consisted of a questionnaire of 12 questions, sent by mailing to all female urologists, a first time in May 2016 (n=84), then a second time in January 2020 (n=98). The anonymized answers were analyzed and compared in order to assess the evolution over the last 4 years. The participation rate was 46.4% in 2016 (n=39 respondents) and 50% in 2020 (n=49 respondents). The majority of women worked full time (73.5%), with a hospital (38.8%), liberal (46.9%) or mixed (14.3%) activity. Their main theme was women's urology (57.1%). In 2020, 59.2% of respondents had encountered difficulties related to their status as women during their career and 28.1% difficulties related to motherhood. Female urologists in private practice were significantly less concerned than their counterparts with hospital or mixed activity (43.5% versus 73.1%, P=0.035). Women felt that they were underrepresented in association committees at 95.9% (vs. 82.1% in 2016) and in university positions at 79.6% (vs. 89.7% in 2016). Finally, 91.8% were in favor of the creation of an association of women urologists (vs. 53.8% in 2016). Women urologists may encounter difficulties related to their status as women during their professional career. Between 2016 and 2020, there is an increase in the feeling of under-representation within association committees and an increase in the need to federate. III, étude rétrospective cas-témoins.

Osteoprotection in patients with bone metastatic castration-resistant prostate cancer (mCRPC): real-world data from Germany, presented by d-uo

Patients with bone metastasis due to prostate cancer often present allover reduced bone mineral density. Additionally, patients with bone metastatic castration-resistant prostate cancer (mCRPC) have a relevant risk for skeletal-related events (SRE). We herein present real-world data (RWD) regarding osteoprotection in mCRPC patients with bone metastasis treated by German urologists in private practice. This is a questionnaire-based study including members of d-uo ("Deutsche Uro-Onkologen", German uro-oncologists). All patients with histologically confirmed prostate cancer seen at least once in the surveyed urology practice between July 2019 and June 2020 were included. Questions included start, type and duration of osteoprotection as well as supplementation with calcium and vitamin D. Between July 2019 and June 2020, a total of 3,692 patients with prostate cancer were seen at least once in 15 urology practices. There were 410 mCRPC patients (11.1%) with bone metastasis. Osteoprotection with denosumab or a bisphosphonate to prevent SRE was applied in 274/410 mCRPC patients (66.4%) with bone metastasis. In patients receiving osteoprotection, denosumab was chosen for 67.9% of patients and a bisphosphonate was chosen for 32.1%. Supplementation with calcium and vitamin D was performed in 93.4% of the patients. The median duration of treatment was 25.3 months for denosumab compared with 39.6 months for bisphosphonates. Patients with mCRPC with bone metastasis received osteoprotection in 2/3 of cases. Of these, 2/3 received denosumab and 1/3 received a bisphosphonate. The majority of patients were also treated with calcium and vitamin D. According to guideline recommendations regarding osteoprotection in mCRPC patients with bone metastasis, our RWD data showed some lack of guideline adherence.

Osteoprotection in patients with non-metastatic hormone-sensitive prostate cancer (mHSPC) receiving androgen-deprivation therapy (ADT): Real-world data from Germany, presented by d-uo

Patients with prostate cancer often present with reduced bone mineral density. We herein present real-world data (RWD) regarding osteoprotection in patients with non-metastatic hormone-sensitive prostate cancer (nmHSPC) receiving androgen deprivation therapy (ADT) treated by German urologists in private practice. This is a questionnaire-based study including members of d-uo ("Deutsche Uro-Onkologen", German uro-oncologists). Patients with nmHSPC between July 2019 and June 2020 were included. They were asked about start, type and duration of osteoprotection as well as supplementation with calcium and vitamin D. Between July 2019 and June 2020, a total of 3,692 patients with prostate cancer were seen at least once in one of the private practices of 15 urologists (all d-uo members). There were 844 patients (22.9%) with nmHSPC treated with ADT. Osteoprotection using denosumab or a bisphosphonate to prevent skeletal-related events (SRE) was applied in 183/844 patients (21.7%) with nmHSPC. In patients receiving osteoprotection, denosumab was chosen in 73.2% of patients and a bisphosphonate was chosen in 26.8% of patients. Supplementation with calcium and vitamin D was given in 84.7% of patients. Patients with nmHSPC received osteoprotection in 1/5 of patients. Of these, 3/4 received denosumab and 1/4 received a bisphosphonate. The majority of patients were additionally treated with calcium and vitamin D. In our study, osteoprotection in patients with nmHSPC was rather an exception.

Opioid-Free Ureteroscopy: Are Academic Urologists Lagging Behind Private Practice?

To examine overall trends in opioid prescribing after ureteroscopy and compared opioid use between private and academic practice settings. We also analyzed the potential for spillover effect from an unrelated opioid-reduction initiative for major oncologic surgery. We conducted a retrospective chart review of all ureteroscopies performed within our system at four distinct time points from 2016-2019. We recorded the type and number of opioid pills prescribed and calculated oral morphine equivalents. Analysis included comparison between community and academic hospitals as well as pre- and post-initiative. 555 patients undergoing ureteroscopy and 29 attending surgeons were included in the analysis. The median prescription size per ureteroscopy decreased throughout the study period in both the private and academic settings. From 2016-2017, median oral morphine equivalents (OMEs) decreased from 60 to 0 in the private setting and remained at 0 for the duration of the study period. Opioid reduction in the academic setting lagged behind private practitioners but median OMEs did steadily decrease to 0 in 2019. No significant spillover effect was observed. Since 2016, opioid prescribing following ureteroscopy has decreased in both the private and academic practice settings. Notably, private practice urologists achieved a median of 0 opioids 2 years prior to academic urologists. These data suggest that, in some circumstances, academic institutions may have been slower to respond to the opioid epidemic.

EDITORIAL COMMENT

The landscape of urologic employment has changed dramatically over the past 10 years. Older models of employment, such as independent practice and academic practice have given way to new models of employment, such as hospital-based employment, multispecialty group practice, and private equity (PE) acquired practices. Nie et al demonstrated that private equity acquisitions have become a dominant form of urology practice consolidation.1 They estimate that 7.2% of private practice urologists were employed by private equity backed firms and 25% of urologists in New Jersy and Maryland are employed by private equity firms.

Mapping Telemedicine in German Private Practice Urological Care: Implications for Transitioning beyond the COVID-19 Pandemic

Background: There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications. Methods: An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ² test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis. Results: 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations. Conclusion: Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.

Antibiotic stewardship (ABS)-strategies for urologists in private practice and hospitals

Antibiotika sind wirksame und sichere Arzneimittel und haben seit ihrer Einführung Millionen von Menschenleben gerettet. Die Weltgesundheitsorganisation (WHO) hat die weltweit zunehmenden Antibiotikaresistenzen als eines der größten Gesundheitsprobleme der Gegenwart identifiziert. Zu den häufigsten Indikationen für eine Antibiotikatherapie gehören Harnwegsinfektionen, bei denen nach aktuellen Erfassungen in einem sehr hohen Prozentsatz allerdings nicht leitliniengerecht behandelt wird. Um die fortlaufende Selektion von resistenten Bakterien, und unerwünschte oder sogar gefährliche Nebenwirkungen wie z. B. durch Schädigungen des Mikrobioms der Patienten zu vermeiden, sind dringend Strategien zur Verbesserung der Antibiotikatherapie durch „antibiotic stewardship“ (ABS) erforderlich. Insbesondere für Urologen in der ambulanten Patientenversorgung bedarf es hierfür neuer, innovativer und nachhaltiger Schulungskonzepte, die Wissen kontinuierlich aktuell halten und sachgerechte Antibiotikaverschreibungen nachhaltig unterstützen.

Characteristics, Burden, and Necessity of Inpatient Consults for Academic and Private Practice Urologists

ObjectiveTo compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists. Materials and MethodsWe performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of consult, reasons for consult, requesting physicians, and procedures performed were analyzed and compared. ResultsA total of 613 consults were identified. The most common consults were for a Foley catheter/suprapubic tube (16%), urinary retention (15%), kidney/bladder stones (11%), and hematuria (11%). Seventy-seven percent of the consults were seen in the day time and 79% were seen on the weekdays. One hundred and ten (18%) consults resulted in an operative intervention during the same admission. The others required a Foley catheter placement or suprapubic exchange (17%), bedside procedure (9%), or interventional radiology procedure (4%). The remaining 319 consults (52%) required no intervention and were considered potentially unnecessary. There were no differences in the timing of the consults and the need for intervention between academic and private practice urologists (P = .20). Only 37% of patients followed up as an outpatient. These potentially unnecessary consults resulted an annual loss of 265.8 hours for the urologists and $44,376.09 in excess health care costs. ConclusionOver half of inpatient urologic consultations required no urologic intervention and therefore represented potential overuse of urgent inpatient specialty care. This may contribute towards the growing epidemic of burnout in urology. Further work needs to be done to educate other hospital services and nurses to minimize these unnecessary consults.

Interdisciplinary education in urology: innovations for better training

The current version of the urology training program will concentrate on the mediation of competences and skills in various fields of action for outpatient urology instead of persisting on the minimum and reference numbers of surgical and diagnostic procedures. However, the following fields of action must be fulfilled: microbiology, andrology and systemic cancer therapy. There is justifiable concern that various institutions will lose their permission for acomplete 5‑year residency program based on the above-mentioned demands since not all institutions have all subspecialties in urology. Those institutions need to define new ways of residency training such as interdisciplinary programs within their own institution between disciplines like pediatric surgery, gynecology and medical oncology. Other options are combined training programs between regional urology departments with different main focuses or training programs between institutions and urologists in private practice. There is an unmet need to improve residency training as well as board examinations by new structures and areliable curriculum. Based on the changed main focuses of the new version of urology training, we need to discuss the future of residency programs. It might be helpful to discuss two different types of urology training with acommon trunk for the first three years followed by amore outpatient-based residency training for the general urologist and amore specialized training for the inpatient urologist to be educated in complex treatment modalities. An open mind to broadening our own horizon, respectful discussion with other departments and the development of common, reliable and interdisciplinary contents represent indispensable prerequisites to realize such an innovative future training program.

Adherence to the European Association of Urology Guidelines: A National Survey among Italian Urologists

Objective: The study aimed to explore adherence to the European Urological Association (EAU) Guidelines (GLs) grade A recommendation among Italian urologists. Materials and Methods: A 13-item multiple-choice questionnaire covering oncological and non-oncological urological diseases was e-mailed to all Italian Urologist Society (Società Italiana di Urologia or SIU) members. We asked members to provide an explanation for their answer choice where needed. The quantitative data were tested using the Pearson’s chi-square test. For all statistical comparisons, significance was considered as p < 0.05. Results: Of the 2011 invited SIU members, 210 (10.4%) completed the survey. The sample was composed of 22 (10.5%) Academic Urologists (AcUs), 110 (52.4%) Attending Urologists (AtUs), 32 (15.2%) Private Practice Urologists (PPUs), and 41 (19.5%) Residents in Urology (RUs). The mean adherence to the EAU Oncologic GLs ranged from 54.5 to 97.1%, while the adherence to the non-oncologic GLs ranged from 45 to 87.6%. We found that adherence differed across the working categories assessed. Conclusion: Our survey showed that professional role, updates, and local facilities seem to be the drivers that influence the non-adherence to the GLs. Urologists who work in university hospital would be more inclined to adopt the GLs compared to those who practice in non-academic centers.

MP40-20 DO SURGEONS WISH TO KNOW ABOUT THEIR LONG-TERM COMPLICATIONS?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2017MP40-20 DO SURGEONS WISH TO KNOW ABOUT THEIR LONG-TERM COMPLICATIONS? Jennifer Wimberly, Shawn Okpara, and Philippe Zimmern Jennifer WimberlyJennifer Wimberly More articles by this author , Shawn OkparaShawn Okpara More articles by this author , and Philippe ZimmernPhilippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1267AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inspired by our experience with handling long-term vaginal mesh complications, we aimed to assess practitioner′s interest in being made aware of their long-term surgical complications. METHODS Prior to a lecture on this topic, a 3 question survey (table 1) was administered to 16 faculty operative surgeons (FS) in the Department of Urology and to 59 future attendants who had enrolled to attend the lecture, including private practice urologists, nurse and midlevel providers. Long-term complications were defined as those involving re-admissions or reoperations beyond 30 days post-surgery as those are not captured by most quality improvement programs and not reported in Morbidity and Mortality conferences. RESULTS Of the 16 FS, 100% answered that doctors should be alerted of their post-surgical complications (question 1). And, of the lecture attendants, 95.6% also stated they wished to be alerted (10 skipped). Based on the second question on reasons for why we do not contact each other when we are made aware of a long-term complication, 60% of the FS and 53% of the attendants believed that a surgeon might not want to offend or lose a referral base. 13% of FS and 21% of attendants believed that surgeons not knowing his/her own outcomes data was a possible reason. 13% of surgeons and 21% of the attendants believe that the unwillingness to want to increase the operative surgeon′s legal risk could be a reason. 20% of surgeons and 17% of attendants believed that a surgeon might not think feedback decreases complication risks. Lastly 73% of FS and 72% of attendants believed that a surgeon being too busy to track down whom to contact is a primary reason. As far as the best method of providing this long-term tracking data (question 3), 94% of the FS and 84% of the attendants answered that a phone call was the best means for this feedback. The practicality of providing this feedback is hampered by unintended consequences of legal mandates related to patient protected health information. CONCLUSIONS Despite legal barriers in place prohibiting this process, this data suggest that operative surgeons and most urology care providers are interested in receiving information on their long-term post-surgical complications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e531 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jennifer Wimberly More articles by this author Shawn Okpara More articles by this author Philippe Zimmern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Residents training in private practice : Conflicts between circumstances, willingness, and reality

The increasing average age of urologists in private practice and outpatient treatment needs means that there is an increased demand for young urologists to cover outpatient care. Due to the increasing range of treatments, residents lack the mediation of those treatment methods and medical conditions which are necessary to become competent in the complete field of urology. To assess the willingness, the requirements, and the current implementation of residents training in private practice. A14-item online survey was sent to 1326 urologists in private practice to measure the willingness, the requirements, and the current implementation of residents training. Of the 219 (17 %) respondents, 25 % have already trained residents, 41 % were authorized to provide training to residents, and 87 % have taken the appointment of atrainee into consideration. The main reason for employing atrainee was the enjoyment of the teaching experience. The main reason against employing atrainee was the lack of financial compensation. Urologists in private practice are willing and able to participate in residents' training. An extended integration of urological training into private practice can contribute to ensure the teaching of awide variety of diseases/procedures and influence structural changes in the field of urology. Residents, private practitioners, and clinicians should search for solutions together with those responsible in the health care system for better integration of private practice into urology residents training.

"We talk it over"--mixed-method study of interdisciplinary collaborations in private practice among urologists and oncologists in Germany.

BackgroundUtilisation of multidisciplinary teams is considered the best approach to care and treatment for cancer patients. However, the multidisciplinary approach has mainly focused on inpatient care rather than routine outpatient care. The situation in private practice care and outpatient care is gradually changing. We aimed to 1), investigate interdisciplinary cooperations in the care of tumor patients among urologists and oncologists in the community setting, 2), establish an estimate of the prevalence of cooperation among oncologists and organ-specific providers in community settings in Germany and 3), characterise existing cooperations among oncologists and urologists.MethodsWe conducted simultaneously a cross-sectional survey with private practice urologists (n = 1,925) and a qualitative study consisting of semi-structured interviews with urologists and oncologists (n = 42), primarily with private practices, who had indicated cooperation the care of urological tumor patients.ResultsMost of the participants (66%) treated their own tumor patients. When physicians referred patients, they did so for co- and subsequent treatments (43%). Most cooperating urologists were satisfied with the partnership and appreciated the competency of their partners. Qualitative interviews revealed two types of collaboration in the community setting: formal and informal. Collaborations were usually ongoing with many physicians and depended equally on both patient preference and diagnosis.ConclusionJoint patient treatment requires clear delineation of roles and responsibilities and simple means of communication. Formal frameworks should allow for incorporation of patients’ critical role in collaboration decisions in treatment and care.

Urologists' Use of Intensity-Modulated Radiation Therapy for Prostate Cancer

BackgroundSome urology groups have integrated intensity-modulated radiation therapy (IMRT), a radiation treatment with a high reimbursement rate, into their practice. This is permitted by the exception for in-office ancillary services in the federal prohibition against self-referral. I examined the association between ownership of IMRT services and use of IMRT to treat prostate cancer.MethodsUsing Medicare claims from 2005 through 2010, I constructed two samples: one comprising 35 self-referring urology groups in private practice and a matched control group comprising 35 non–self-referring urology groups in private practice, and the other comprising non–self-referring urologists employed at 11 National Comprehensive Cancer Network centers matched with 11 self-referring urology groups in private practice. I compared the use of IMRT in the periods before and during ownership and used a difference-in-differences analysis to evaluate changes in IMRT use according to self-referral status.ResultsThe rate of IMRT use by self-referring urologists in private practice increased from 13.1 to 32.3%, an increase of 19.2 percentage points (P<0.001). Among non–self-referring urologists, the rate of IMRT use increased from 14.3 to 15.6%, an increase of 1.3 percentage points (P=0.05). The unadjusted difference-in-differences effect was 17.9 percentage points (P<0.001). The regression-adjusted increase in IMRT use associated with self-referral was 16.4 percentage points (P<0.001). The rate of IMRT use by urologists working at National Comprehensive Cancer Network centers remained stable at 8.0% but increased by 33.0 percentage points among the 11 matched self-referring urology groups. The regression-adjusted difference-in-differences effect was 29.3 percentage points (P<0.001).ConclusionsUrologists who acquired ownership of IMRT services increased their use of IMRT substantially more than urologists who did not own such services. Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy. (Funded by the American Society for Radiation Oncology.)

Localized Prostate Cancer Patients’ Information in Urology Outpatient Practice—Results of a Nationwide Prospective Study in Germany

Purpose: Many studies demonstrate the importance of an empathic communication with prostate cancer patients and show various information needs. Most of the studies are cross sectional. The present analysis aims to 1) provide detailed prospective data on the actual quality of patient information provided by urologists in private practice in Germany; and 2) explore sociodemographic, communicative, and health- and treatment related determinants of the quality of provider-patient-communication. Methods: HAROW is a prospective, observational study designed to collect clinical data and patient reported outcomes of different treatment options (hormonal therapy, active surveillance, radiation, operation, watchful waiting) for newly diagnosed patients with localized prostate cancer under real conditions. At 6-month intervals, general clinical data, patient reported outcomes and patients’ assessment of patient-physician-communication are documented. A total of 1893 questionnaires at t0 (initial diagnosis) and t1 (six months after diagnosis) were analyzed. A linear regression model was estimated. Results: The mean age of the men was 68.38 years, and most lived with their spouse or partner (94.1%). Most patients were informed about treatment options (t0 96%, t1 93.2%), but much fewer received information about self-help groups (t0 36.4%, t1 45.8%), rehabilitation (t0 59.9%, t1 68%), and second medical opinion (t0 57.2%, t1 59.3%). Older men (p = 0.02) and men living alone (p = 0.048) received less information than others. Physician empathy (p = 0.000) and prostatectomy treatment (p = 0.020) were positively associated with receiving more information. Conclusion: There is room for improvement in terms of informing prostate cancer patients about rehabilitation, second medical opinion and self-help groups. Urologists being empathetic share more information with their patients. Some patients receive less information than others, especially older patients living alone.

Benigne Prostatahyperplasie und Urolithiasis

The Academy Spring Forums held as part of the Southwest German Congress in Tübingen and the Congress of North Rhine-Westphalia in Aachen offer urologists in private practice and likewise hospital urologists a compact overview of new developments. This article summarizes the newest work on e.g. interventional therapy, uroliths, and extracorporeal shock wave lithotripsy for benign prostatic hyperplasia and urolithiasis.

A Survey of Ethically Challenging Issues in Urological Practice

We surveyed ethical attitudes among urological and nonurological practitioners, allowing for thought and discussion regarding ethical issues in a larger audience. With input from an academic urologist, a senior medical student and a hospital ethics committee member, a survey was created which asked for multiple choice responses to 3 demographic questions (practice type, age, location) and 10 ethically challenging clinical questions. Surveys were distributed online or via mail to 5 groups including academic urologists, urologists in private practice, medical students, hospital risk managers/attorneys and members of a bioethical society. Surveys were analyzed according to demographic variables. Surveys were sent out to 1,447 individuals and 340 responses were received (24%). There were statistically significant differences in the responses to several questions based on practice type, age and practice location. There was a lack of consistency in answer choices with greater than 50% agreeing on a single answer choice for only 4 of 10 questions (40%). This is the first study to our knowledge which attempts to objectively categorize ethical attitudes in a broad based survey of urologists and nonurologists, and challenges members of our profession to study their own responses to these ethical issues.