Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census
Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census
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DOI：
10.1111/jrh.12376
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发表时间：
2020-06-01
影响因子：
4.9
通讯作者：
Breyer, Benjamin N.
中科院分区：
文献类型：
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作者：
Cohen, Andrew J.;Ndoye, Medina;Breyer, Benjamin N.
目的评估老龄化的专科劳动力和不断增长的人口预示着满足患者护理需求的挑战。我们假设，乡村医生的退休比率高于美国的城市医生，这代表着整个劳动力挑战的风向标。方法我们分析了2014-2016年美国泌尿外科协会人口普查的数据，这是一项对泌尿科医生进行的样本加权代表性调查，作为亚专家的案例研究。我们比较了在农村工作的泌尿科医生和在非农村地区工作的泌尿科医生的可用特征。结果2016年，美国12,186名执业泌尿科医生中，乡村泌尿科医生占2.4%。普通泌尿科仍然是90%的农村泌尿外科医生关注的重点，相比之下，非农村泌尿外科医生的这一比例为59%(P=.03)。令人担忧的是，2016年48%的乡村医生年龄为65岁，而2014年这一比例为29%；33%的乡村泌尿外科医生单独执业，而非乡村泌尿外科医生的这一比例为9%(P<；.01)。乡村医生的计划退休年龄从2014年的68岁提高到2016年的73岁(P趋势=0.02)。自2014年以来，乡村执业泌尿科医生的比例一直保持稳定。结论农村泌尿外科医生年龄较大，提供的一般泌尿外科护理比非农村医生多。农村泌尿科医生正在推迟退休。虽然这可能是由于个人欲望和财务目标，但也可能是因为相对缺乏潜在的初级伴侣。鉴于2016年近50%的农村泌尿科医生年龄超过65岁，对于即将到来的医生短缺来说，这不是一个可持续的解决方案。不久将需要在远程医疗或替代医疗模式方面进行更大的创新。
Objective To assess an aging subspecialty workforce and growing population that portends challenges in meeting patient care needs. We hypothesized that rural physicians are retiring at higher rates than their urban counterparts in the United States and that this represents a bellwether for workforce challenges at large. Methods We analyzed data from the 2014-2016 American Urological Association Census, a sample-weighted representative survey of urologists, as a case study for subspecialists. We compared urologists who work in rural regions to nonrural regions on available characteristics. Results In 2016, rural urologists accounted for 2.4% of 12,186 practicing urologists in the United States. General urology remained the focus of 90% of rural urologists, compared to 59% of nonrural urologists (P= .03). Alarmingly, 48% of rural physicians were >65 years old in 2016 compared to 29% in 2014, and 33% of rural urologists were solo practitioners compared to 9% of nonrural urologists (P< .01). The planned retirement age for rural physicians increased from 68 in 2014 to 73 in 2016 (Ptrend = .02). The percentage of rural practice urologists has remained stable since 2014. Conclusions Rural urologists are older and provide more general urological care than their nonrural counterparts. Rural urologists are postponing retirement. Although this might be due to personal desires and financial goals, it may also be due to a relative absence of potential junior partners. Given that almost 50% of rural urologists were older than 65 in 2016, this is not a sustainable solution to an impending shortage of physicians. Greater innovation in telemedicine or alternative care models will soon be needed.