An aging US population brings unique challenges to urologists and the urology workforce in general. As the average age of the population increases, this means that the frequency of urologic diseases and need for urology-related treatments also increases, and it is having an effect on the industry in general as demand increases. These demographic changes in the United States are in turn changing the demands on the urology workforce, creating a need by professionals to have the latest data, research, education, and advocacy for a changing industry.
With the findings published in the American Urology Association’s 2020 census, along with comparisons with their previous publications, we can form a clear picture of what the urology workforce and industry has been through in the past, what it is currently dealing with as of the 2020 publication, and we can also infer educated predictions about the future to anticipate what urologists and urology professionals will need to prepare for in order to meet the growing demand for urology care.
Here is a summary of some of the key findings of the AUA’s 2020 census:
- Increases in the number of practicing urologists in the USA
Since the AUA’s 2015 census, the number of practicing US urologists has increased along with the ratio of urologist-to-population, with the number of practicing urologists in 2015 being 11,990 which in 5 years has increased to 13,352 practicing professionals. It is important to note that in the AUA census, the term “practicing urologist” refers to any qualified and registered urologist, while a urologist who is referred to as “actively practicing” is one who has 25 hours or more each week of clinical duties.
Regarding population size, in December 2015 the USA population was 323,150,623, while December 2020 showed a population of 332,084,796, an increase of 8,934,173 or 2.76% versus the increase in practicing urologist numbers of 11.35% within that same timeframe.
- The amount of actively practicing urologists is increasing
If we are to compare actively practicing urologists between 2015 and 2020, we can see that in 2015, there was a total of 10,869 actively practicing urologists (approximately 90% of practicing urologists) while in 2020 that number rose to approximately 11,419 (or around 85.7%). While the total percentage of actively practicing urologists has fallen by 4.7 points, the growing number of urologists in general allows the number of actively practicing urologists to keep climbing, although the drop in percentage of actively practicing urologists may also be attributed to the aging US populations, as older urologists seek to reduce the amount of clinic hours they perform each week.
- The weekly workload of urologists has remained stable since 2015
Regarding the specific workload experienced by urologists through the changes from 2015 to 2020, there have not been any major changes in the weekly hours reported by the AUA census, with over 31% of actively practicing urologists in both 2015 and 2020 reporting more than 60 hours a week in 2015, the median number of work hours in a week was 55 hours, while in 2020, 76.6% of urologists reported working over 40 hours a week on average, which would bring the median number close to the 2015 levels although the exact median is not calculated in the 2020 census.
- The urology workforce is still concentrated in the same regions of the USA since 2015
Although the US state with the highest urologist-population ratio has changed from New York to Rhode Island from 2015 to 2020, This is still within a relatively small area within the Northeast. The state with the lowest urologist-to-population ratio has, however, remained the same, being Nevada. For additional perspective, in 2015 the average nationwide ratio was 3.72 urologists per 100,000 people, while the average for the more concentrated New York was 4.91 and Nevada’s was 2.35. By 2020, the national average had increased to 4.07, the state with the highest concentration of urologists changed to Rhode Island with 5.66, and Nevada with a ratio of 2.53.
This shows a national average increase of 0.35, an increase in the Northeast of 0.75, and an increase in the state of Nevada by 0.18 indicating that while urologist numbers are growing in the country, they have remained concentrated in the same region of the US, albeit in a different state.
- Age and gender demographics within the urology workforce
Comparing the 2020 census with that from 2015, even though the population continues to age and older individuals make up a larger segment of the US, the median age in the urology workforce has remained the same with a median of 55 years of age. Even though the number of urology professionals aged above 65 has increased from 27.8% to 30.1% of the workforce, this increase has been balanced out by an increase of one point among those younger than 34 years, increasing from 4.4% to 5.4%, and an increase from 22.8% to 24.6% in those aged between 35 and 44
This indicates that even as the older urologist demographic continues to grow, younger practicing urologists are also entering into the industry, maintaining the median age at 55.
Demographic areas that are currently experiencing some change in the urology workforce include gender and race. In 2015, women made up just 7.7% of the practicing urologist population with 922 individuals, an increase from the 897 in 2014. This trend of growth has continued, and by 2020, the percentage of female urologists sat at 10.3% with 1,375 individuals, making this the first time in history that women have exceeded the 10% mark as a gender demographic.
- Urologists practicing in non-metropolitan and rural areas
Out of the practicing urologists in the USA, 10.5% maintain their primary practices in non-metropolitan areas of the country, although approximately 20% of the US population lives in non-metropolitan areas, indicating a much lower ratio between urologists and local population. What is interesting to know is that the likelihood of urologists moving or maintaining their practices in non-metropolitan areas increases with the urologist’s age, perhaps as part of the preparations for retirement. Because the urologist population over the age of 65 is currently sitting at 30.1% in 2020, we may expect this sizeable segment to play a crucial role in leveling out the uneven ratio of urologists to population in non-metropolitan areas soon, although more data is indeed required.
In summary, although the US population continues to age and increases the demand for urodynamic testing and professionals in general, we can see that the number of actively practicing urologists is growing at a rate faster than the population, with more younger urologists entering the workforce as a sizeable portion continues to age towards retirement. Additionally, women are making up a larger portion of the workforce than ever before, and this trend may simply continue to increase.
It is interesting to see the concentration of urologists throughout the country, with the highest concentrations found in the Northeast and the lowest in Nevada which indicates that, in order to properly serve the people of Nevada State, it may be necessary to make Nevada a target point for more urodynamic work and to increase the presence of urologists there.
With the AUA releasing The State of the Urology Workforce and Practice in the United States, we will likely be seeing the 2021 issue shortly with the latest updates on the urology workforce.
