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So Long, Solo Urologists: Trends from 2014 AUA Census Data
Michael Zavaski, MD1, Nawar Hanna, MD1, Manuel Ozambela, Jr., B.S.2, Philip Cheng, MD1, David Friedlander, MD, MPH1, Steven L. Chang, MD, MS1.
1Brigham & Women's Hospital, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA.

Title:
So Long, Solo Urologists: Trends from 2014 AUA Census Data
Background:
The rapidly changing landscape of health care in the United States has been associated with changes in practice structure among physicians nationwide. We analyzed the 2014 American Urological Association (AUA) Census data to assess the hypothesis that solo practitioners are a shrinking demographic in Urology.
Methods:
We obtained data from the de-identified 2014 AUA Census Public Use Microdata File after receiving institutional review board exemption. This Census included questions regarding practice type thus allowing for a dichotomization of the study cohort into Solo or non-Solo Practice among urologists. We evaluated the study cohort with descriptive analyses as well as multivariable logistic regression models to assess for characteristics predictive of being a solo practitioner; we assessed explanatory variables including year of training, gender, race, geographic location of practice site and completion of fellowship training. Our analyses incorporated survey weights, which allow for a nationally representative estimation.
Results:
We found that the year of completion of urologic residency training was highly predictive of solo practice (p<0.0001). There was a progressive decline in solo practice from 33% among urologists completing training prior to 1980 down to 9.5% among those completing training 2010 (see Figure). Additional independent predictors of solo practice included not pursuing post-graduate fellowship training (OR 2.7, p<0.0001) as well as practice in the South Atlantic (OR 2.36, p=0.01), South Central (OR 2.05, p=0.036), and Western (OR 2.22, p=0.02), versus practice in New England. We did not find that race or ethnicity was associated with practice type.
Conclusions:
The findings of the current study suggest that the urologic workforce is progressively shifting away from solo practice. Possible reasons include the increasing regulations and standards mandated by the government, rising numbers of integrated health care systems, and changes in reimbursement patterns. Future work is warranted to clarify the relationship between health care changes and the practice of urology.


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