Department of Pediatric Urology, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA.
J Pediatr Urol. 2018 Jun;14(3):246-250. doi: 10.1016/j.jpurol.2017.10.013. Epub 2017 Nov 27.
Over the past 25 years, Pediatric Urology fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) have more than doubled. This increase may lead to a significant decrease in the number of operative cases per surgeon and therefore impact the current practice of pediatric urology.
The objective in conducting this study is to try and predict the effect of the current number of pediatric urology fellowship training positions on future case volume per surgeon using a mathematical model and to discuss future management of the pediatric urology workforce.
The current study employed a mathematical model to predict the effect of the number of fellowship graduates on future "case volume per surgeon". We incorporated population growth rates, to calculate incidence rates of key procedures/conditions and the anticipated retirement rate of the current pool of pediatric urologists to help calculate this.
There is a possibility to increase the number of practicing board-certified pediatric urologists in the next 30 years from approximately 325 to 900 (figure). There will be a twofold reduction in case volume per surgeon compared to the present in model 1. In model 2 the decrease in case volumes is less significant. The annual number of fellows needed to obtain a future-to-current ratio equal to 1 is 16 for model 1, and 26 for model 2.
Our study demonstrates, by using two different models that the current number of pediatric urology fellowship training positions in the United States will ultimately lead to a significant decrease in the case volume per surgeons. Our model has limitations as it relies on multiple assumptions. We are assuming that all fellowship positions would be filled every year and that all fellows would graduate, establish their practices in the United States, and devote 100% of their assumed 30-year professional career to pediatric urology. We also made assumptions of disease occurrence and need for surgical correction. The final assumption we made was that the birth rate would stay static over the next 30 years even though it has been declining for many decades.
This exercise, even with its inherent limitations, is still sufficient to demonstrate that fellowship expansion warrants thoughtful discussion.
在过去的 25 年中，由研究生医学教育认证委员会（ACGME）认证的小儿泌尿科住院医师培训计划增加了一倍多。这种增长可能导致每位外科医生的手术病例数量显著减少，从而影响小儿泌尿科的当前实践。
进行这项研究的目的是尝试使用数学模型预测当前小儿泌尿科住院医师培训职位数量对未来每位外科医生手术量的影响，并讨论小儿泌尿科劳动力的未来管理。
本研究采用数学模型预测 fellowship毕业生数量对未来“每位外科医生手术量”的影响。我们纳入了人口增长率，以计算关键手术/病症的发病率和当前小儿泌尿科医生队伍的预期退休率，以帮助计算。
在未来 30 年内，有可能将执业的 board-certified 小儿泌尿科医生的数量从大约 325 人增加到 900 人（图）。与当前模型相比，每位外科医生的手术量将减少两倍。在模型 2 中，手术量的减少不那么显著。要使未来与当前的比率等于 1，模型 1 需要每年增加 16 名学员，模型 2 需要增加 26 名学员。
我们的研究表明，通过使用两种不同的模型，美国目前的小儿泌尿科住院医师培训职位数量最终将导致每位外科医生手术量的显著减少。我们的模型存在局限性，因为它依赖于多个假设。我们假设所有的住院医师职位每年都会被填补，所有的住院医师都会毕业，在美国建立自己的实践，并将他们假设的 30 年职业生涯的 100%投入到小儿泌尿科。我们还对疾病的发生和手术矫正的需求做出了假设。我们做出的最后一个假设是，即使在过去几十年里出生率一直在下降，但在未来 30 年内出生率仍将保持稳定。
即使存在固有局限性，这项研究仍然足以表明住院医师培训计划的扩张需要进行深思熟虑的讨论。
