Shukla Devki, Hyman Max J, Agarwal Piyush K, Faris Sarah, Skolarus Ted A, Modi Parth K
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
The Center for Health and the Social Sciences, University of Chicago, Chicago, IL.
Urol Oncol. 2025 May;43(5):335.e9-335.e15. doi: 10.1016/j.urolonc.2024.09.034. Epub 2024 Oct 10.
The incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019.
We examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission.
We identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63-0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48-2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34-2.58, P < 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16-2.48, P = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78-3.74, P < 0.001), open radical nephrectomy (OR 2.06, CI 1.42-2.99, P < 0.001) and open radical prostatectomy (OR 2.12, CI 1.44-3.12, P < 0.001). Female urologists had significantly lower odds of performing each oncologic procedure.
In this analysis of early career urologist case logs, the proportion of urologists performing a radical cystectomy, radical nephrectomy, and open prostatectomy declined between 2003 and 2019. Oncology specialization or fellowship training, however, significantly increased the odds of performing the procedures. Specifically, oncology fellowship alone was associated with over 2 times the odds of performing major open oncologic procedures. These findings reflect ongoing specialization among early career urologists, such that an oncology fellowship or practice focus has likely become necessary for access to open urologic procedures and to become a high-volume urologic oncology surgeon.
随着美国人口老龄化，预计泌尿外科癌症的发病率将会上升，但泌尿外科医疗人员数量预计不会以相应的速度增长。为了解这种日益加剧的不平衡状况，我们探讨了2003年至2019年间早期职业泌尿外科医生进行肿瘤病例手术，尤其是开放性手术的程度。
我们检查了2003年至2019年间申请美国泌尿外科委员会口试认证考试（第二部分）的早期职业泌尿外科医生提交的病例记录。我们纳入了首次记录和末次记录之间跨度至少为120天的病例记录。我们使用CPT®编码来识别进行开放性根治性膀胱切除术、肾切除术或前列腺切除术的泌尿外科医生，以及进行微创根治性肾切除术或前列腺切除术的医生。我们计算了每年进行每种手术的泌尿外科医生的百分比。多变量逻辑回归分析分析了进行每种手术与肿瘤学专科或肿瘤学 fellowship培训之间的关联，并对性别、执业类型和病例记录提交年份进行了调整。
我们识别出2003年至2019年间提交病例记录的4166名不同的泌尿外科医生。他们的平均年龄为34.9岁，81.3%为男性，14.2%为肿瘤学专科医生，8.2%报告接受过肿瘤学 fellowship培训。从2003年到2019年，进行开放性肿瘤手术的泌尿外科医生比例下降，而进行微创肿瘤手术的比例增加。肿瘤学 fellowship培训显著增加了进行以下手术的几率：开放性根治性膀胱切除术（接受 fellowship培训的为72.5%，未接受 fellowship培训的为30.0%，OR 2.51，95% CI 0.63 - 0.92，P < 0.001）、开放性根治性肾切除术（接受 fellowship培训的为74.3%，未接受 fellowship培训的为42.4%，OR 2.02，95% CI 1.48 - 2.78，P < 0.001）、开放性根治性前列腺切除术（接受 fellowship培训的为42.1%，未接受 fellowship培训的为26.9%，OR 1.86，95% CI 1.34 - 2.58，P < 0.001）和微创根治性前列腺切除术（接受 fellowship培训的为80.4%，未接受 fellowship培训的为45.0%，OR 1.69，95% CI 1.16 - 2.48，P = 0.006）。当将仅具有肿瘤学专科的医生与同时具有肿瘤学专科和 fellowship培训的医生进行比较时，我们发现接受肿瘤学 fellowship培训的医生进行开放性根治性膀胱切除术的几率高出2倍多（OR 2.58，CI 1.78 - 3.74，P < 0.001）、开放性根治性肾切除术（OR 2.06，CI 1.42 - 2.99，P < 0.001）和开放性根治性前列腺切除术（OR 2.12，CI 1.44 - 3.12，P < 0.001）。女性泌尿外科医生进行每种肿瘤手术的几率显著较低。
在对早期职业泌尿外科医生病例记录的此次分析中，2003年至2019年间进行根治性膀胱切除术、根治性肾切除术和开放性前列腺切除术的泌尿外科医生比例下降。然而，肿瘤学专科或 fellowship培训显著增加了进行这些手术的几率。具体而言，仅肿瘤学 fellowship培训就与进行主要开放性肿瘤手术的几率高出2倍多相关。这些发现反映了早期职业泌尿外科医生中持续的专业化趋势，以至于肿瘤学 fellowship或专注于肿瘤学的实践可能已成为进行开放性泌尿外科手术以及成为大量进行泌尿外科肿瘤手术的外科医生的必要条件。
