Urologist Participation in Medicare Are Impacted by Subspecialty, Tenure, and Practice Type: A Retrospective Analysis...

To examine (1) trends in the incidence and duration of Medicare opt-outs among urologic surgeons, (2) the demographic and professional characteristics of urologists opting out, and (3) the surgeon-level predictors associated with the timing of Medicare opt-outs.

This retrospective study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Opt-Out Affidavits. Surgeon-level data were linked to public professional profiles using National Provider Identifiers to extract information on demographics, training, years in practice, practice type, subspecialty, and geographic location.

The incidence of Medicare opt-outs among urologic surgeons remained low between 2012 and 2025, averaging 3.9 opt-outs per year (n=51). Most opt-outs were male (92.2%) generalists (64.7%) in independent practice settings (54.9%) with more than 30 years of experience (56.9%). Opt-out lengths significantly declined over time, from an average of 5113.5 days in 2012 to 730.5 days in 2025. Predictors of later opt-out included female sex (+2.4years), fewer years in practice (+3.6years for <19years), and subspecialty in female urology (+4.8years) or sexual medicine (+2.3years). In contrast, earlier opt-out was associated with academic affiliation (-2.3years) and subspecialty in male infertility (-4.8years) or urologic oncology (-4.6years).

Although Medicare opt-outs remain rare among urologic surgeons, temporal trends reveal shortening durations of opt-out and distinct demographic and practice-related patterns in participation. These findings underscore the need for targeted efforts to support late-career and independently practicing urologists, while addressing evolving payment structures and retention strategies within Medicare to maintain workforce engagement.

Level III.