National Trends in Urology Fellowship Training and Subspecialization: A 10-Year Analysis of the American Urological...

To describe trends in urologic fellowship training and subspecialization nationwide and to identify areas of need in the national distribution of subspecialists.

Data from the American Urological Association Annual Census of United States Practicing Urologists from 2014 to 2024 was analyzed using weighted responses to account for non-response bias. Trends regarding fellowship training, subspecialization, and practice patterns were examined. The analysis was descriptive to identify shifts over time.

From 2014-2024, an average of 2088 urologists practicing in the United States completed the census yearly with an average response of 16.3%. The proportion of fellowship-trained urologists has increased over time (4 0% in 2014 to 46% in 2024) while the proportion of general urologists has decreased (63% in 2014 to 54% in 2024). Urologic oncology is the most common specialty (13% in 2024) and there have been increasing trends in several other specialties such as urogynecology, urologic reconstructive surgery, and robotics. There has been a decrease in urologists in private practice (64% in 2014 to 42% in 2024) and an increase in academic and hospital employment. Subspecialized urologists are more likely to practice in academic settings (66% in 2024). Fellowship-trained and subspecialized urologists are more likely to practice in metropolitan areas.

Subspecialization and fellowship-training has increased among urologists practicing in the United States with a corresponding decrease in general urology practice. Subspecialized urologists more often practice in urban and academic settings. This trend may affect nationwide access to urologic care.