Manpower needs in urology in the twenty-first century.

Physician supply factors are based on a number of variables. These include the base supply and retirements, which presently show that around 200 urologists are retiring per year. Death rates of both patients and physicians are significant. The rate of entry of graduating residents is important. Population changes (which certainly will continue to increase in the United States) are important. Needs-based projections, demand-needs based projections, and benchmarked projections are important issues. The immigration of physicians is important. So far, I think we have seen little emigration of physicians from the United States. A number of confounding variables can have impact and are almost impossible to predict at present. These include technology changes, disease patterns, and methods of care delivery. The Strategic Planning Committee thought we should aim for a band of 200 to 250 chief residents finishing one per year. We have already reached the 250 level. At 200 finishing per year, we would have 2300 fewer urologists in the year 2020 than we presently have. AT 225/year, we would have 1700 fewer urologists. At 250 (our present level), we will have 1100 fewer than now. These 8800 urologists would be caring for 60 million more patients, of whom 20 million would be Medicare patients. These patients would provide over 500 additional patient visits/year/urologist. I hope that I have convinced you that the system is correcting and responding to multiple market forces. I predict that urologists in practice in 2020 will be busy and that we will not have too many urologists if the graduating numbers are kept stable. If they drop much more, we could well have too few.