What Is Needed to Support Nonurban Urology in the United States? Perspectives From Urologists in Rural and...

Twenty percent of Americans live in nonurban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of nonmetropolitan urologists (NMUs) in the United States.

Based on the results of the 2022 AUA Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in nonmetropolitan areas. Multiple choice answers were summarized as proportions, and free-text answers were collected and grouped by theme.

One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), older than 55 years (76.1%), in practice > 25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next 5 years. Call burden is the most likely reason to leave practice (40%).

Most urologists practicing in nonmetropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within 5 years. Understanding contemporary stressors can inform policies to support current and future NMUs.