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Urology Workforce Changes and Implications for Prostate Cancer Care Among Medicare Enrollees

Published:February 18, 2021DOI:https://doi.org/10.1016/j.urology.2020.12.051

      Highlights

      • The number of urologists increased from 9305 to 9570, while the number of urology practices decreased from 3588 to 2861 between 2010 and 2016.
      • The proportion of urologists in a multispecialty groups increased from 17.1% in 2010 to 28.2%% in 2016, while those within solo practices declined from 26.2% in 2010 to 15.8% in 2016.
      • A higher proportion of patients at hospital-owned practices were treated with observation and surgery, while those at large single specialty practices were treated with radiation therapy.

      Abstract

      Objective

      To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer.

      Methods

      Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Using a 20% sample of national Medicare claims, we identified all patients with incident prostate cancer and identified their primary treatment.

      Results

      The number of urologists increased from 9,305 in 2010 to 9,570 in 2016 (P = .03), while the number of practices decreased from 3,588 to 2,861 (P < .001). The proportion of urologists in multispecialty groups increased from 17.1% in 2010 to 28.2% in 2016, while those within solo practices declined from 26.2% to only 15.8% over the same time period. A higher proportion of patients at hospital-owned practices were treated with observation (P < .001) and surgery (P < .001), while a higher proportion of patients at large single specialty practices were treated with radiation therapy (P < .001).

      Conclusion

      We characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. This trend coincides with higher utilization of observation and surgical treatment for prostate cancer.
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