Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians.Asian Journal of AndrologyUrologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist... (Comparative Study)
Urologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist in practice patterns and outcomes between urologists and FMPs. Patients who underwent a vasectomy from 2010 to 2016 were identified. Postvasectomy semen analysis (PVSA) practices were compared between urologists and FMPs, before and after release of the 2012 AUA vasectomy guidelines. From 2010 to 2016, FMPs performed 1435 (35.1%) of all vasectomies. PVSA follow-up rates were similar between the two groups (63.4% vs 64.8%, P = 0.18). Of the patients with follow-up, the median number of PVSAs obtained was 1 (range 1-6) in both groups (P = 0.22). Following the release of guidelines, fewer urologists obtained multiple PVSAs (69.8% vs 28.9% pre- and post-2012, P < 0.01). FMPs had a significant but lesser change in the use of multiple PVSAs (47.5% vs 38.4%, P < 0.01). Both groups made appropriate changes in the timing of the first PVSA, but FMPs continued to obtain PVSAs before 8 weeks (15.0% vs 6.5%, P < 0.01). FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks, the earliest recommended by the AUA guidelines (4.1% vs 1.3%, P < 0.01). Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012. In summary, FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation, suggesting less penetration of AUA guidelines to nonurology specialties. Furthermore, FMPs had more positive results on PVSAs obtained within the recommended window.
Topics: Adult; Humans; Male; Physicians, Family; Practice Patterns, Physicians'; Retrospective Studies; Urologists; Vasectomy; Wisconsin
Promotional Payments Made to Urologists by the Pharmaceutical Industry and Prescribing Patterns for Targeted Therapies.Urology Feb 2021To measure the association between market-level promotional payments to urologists by the manufacturers of abiraterone and enzalutamide and national prescribing patterns.
To measure the association between market-level promotional payments to urologists by the manufacturers of abiraterone and enzalutamide and national prescribing patterns.
A 20% national sample of the 2015 Part D event file was used to identify patients filling their first prescription for abiraterone and enzalutamide and their prescribing physicians. The 2015 Open Payments data were used to characterize promotional payments made to physicians at the market level. Generalized linear models were then used to measure the relationship between market-level payments to urologists and the physician specialty prescribing abiraterone or enzalutamide for the first time RESULTS: In 2015, 2318 men filled a prescription for abiraterone or enzalutamide by a urologist or medical oncologist. Increasing market-level promotional payments to urologists for abiraterone or enzalutamide was strongly associated with a urologist prescribing either drug-24.3% versus 5.8% of those residing in the markets with highest and lowest level of promotional payments to urologists, respectively (P <.01). Neither the number of urologists residing in a market nor other promotional payment measures (ie, to medical oncologists for these drugs, or to all physicians for all other drugs) were associated with a urologist prescribing either drug.
Promotional payments to urologists at the market level are strongly associated with the specialty of the physician prescribing abiraterone or enzalutamide for the first time. Future work should elucidate the effects of the shift in prescribing patterns on quality of care and financial hardship for men with advanced prostate cancer.
Topics: Aged; Androstenes; Benzamides; Drug Industry; Drug Prescriptions; Humans; Male; Medicare Part D; Nitriles; Phenylthiohydantoin; Practice Patterns, Physicians'; United States; Urologists
Variation in Practice Patterns and Reimbursements Between Female and Male Urologists for Medicare Beneficiaries.JAMA Network Open Aug 2019Previous assessments of practice patterns and reimbursements for female urologists relied on surveys or board certification logs. A current evaluation of the geographic...
Previous assessments of practice patterns and reimbursements for female urologists relied on surveys or board certification logs. A current evaluation of the geographic distribution and practice patterns by female urologists would reveal contemporary patterns of access for Medicare beneficiaries.
To characterize the variation in practice patterns and reimbursements by urologist sex and the regional deficiencies in care provided by female urologists.
Design, Setting, and Participants
This population-based cohort study used the publicly available Centers for Medicare & Medicaid Services Provider Payment database to evaluate payments for US urologists. The cohort (n = 8665) included urologists who provided and were paid for 11 or more services to Medicare beneficiaries in 2016. Data collection and analysis were performed from October 3, 2018, through June 19, 2019.
Main Outcomes and Measures
Proportion of female-specific services, payments per beneficiary, and payments per work relative value unit (wRVU) by urologist sex were assessed. Density of female urologists across hospital markets was also identified.
Among the 8665 urologists who received payments in 2016, 7944 (91.7%) were men and 721 (8.3%) were women. Female urologists, compared with male urologists, saw a lower proportion of patients with cancer (mean [SD], 16.3% [9.2%] vs 22.7% [8.8%]; P < .001) and a greater proportion of female Medicare beneficiaries (mean [SD], 52.8% [23.2%] vs 24.4% [10.3%]; P < .001). Female urologists generated a greater proportion of wRVU from urodynamics (median [IQR], 2.88% [1.26%-4.84%] vs 1.07% [0.31%-2.26%]; P < .001) and gynecological operations (median [IQR], 0.68% [0.45%-1.07%] vs 0.41% [0.20%-0.81%]; P < .001) than male urologists. In addition, female urologists, compared with their male counterparts, received lower median payments per beneficiary seen ($70.12 [interquartile range (IQR), $60.00-$84.81] vs $72.37 [IQR, $59.63-$89.29]; P = .03) and lower payments per wRVU ($58.25 [IQR, $48.39-65.26] vs $60.04 [IQR, $51.93-$67.88]; P < .001). One-third (103 [33.7%]) of 306 hospital referral regions had 0 female urologists, and 80 (26.1%) had only 1 female urologist.
Conclusions and Relevance
Female urologists were more likely to provide care for female Medicare beneficiaries, to receive lower payments per wRVU generated and beneficiaries seen, and to be difficult to access in certain geographic areas; these findings have policy-related implications and highlight the regional deficiencies in urological care and reimbursement discrepancies according to urologist sex.
Topics: Cohort Studies; Fee-for-Service Plans; Female; Humans; Male; Medicare; Practice Patterns, Physicians'; Sex Factors; United States; Urologists; Urology
Comparison of Urologist Satisfaction for Different Types of Prostate MRI Reports: A Large Sample Investigation.Korean Journal of Radiology Dec 2020To evaluate urologist satisfaction on structured prostate MRI reports, including report with tumor-node-metastasis (TNM) staging (report B) and with Prostate Imaging...
To evaluate urologist satisfaction on structured prostate MRI reports, including report with tumor-node-metastasis (TNM) staging (report B) and with Prostate Imaging Reporting and Data System (PI-RADS) score with/without TNM staging (report C, report with PI-RADS score only [report C-a] and report with PI-RADS score and TNM staging [C-b]) compared with conventional free-text report (report A).
MATERIALS AND METHODS
This was a prospective comparative study. Altogether, 3015 prostate MRI reports including reports A, B, C-a, and C-b were rated by 13 urologists using a 5-point Likert Scale. A questionnaire was used to assess urologist satisfaction based on the following parameters: correctness, practicality, and urologist subjectivity. Kruskal-Wallis H-test followed by Nemenyi test was used to compare urologists' satisfaction parameters for each report type. The rate of urologist-radiologist recalls for each report type was calculated.
Reports B and C including its subtypes had higher ratings of satisfaction than report A for overall satisfaction degree, and parameters of correctness, practicality, and subjectivity ( < 0.05). There was a significant difference between report B and C ( < 0.05) in practicality score, but no statistical difference was found in overall satisfaction degree, and correctness and subjectivity scores ( > 0.05). Compared with report C-b ( > 0.05), report B and C-a ( < 0.05) showed a significant difference in overall satisfaction degree and parameters of practicality and subjectivity. In terms of correctness score, neither report C-a nor C-b had a significant difference with report B ( > 0.05). No statistical difference was found between report C-a and C-b in overall satisfaction degree and all three parameters ( > 0.05). The rate of urologist-radiologist recalls for reports A, B, C-a and C-b were 29.1%, 10.8%, 18.1% and 11.2%, respectively.
Structured reports, either using TNM or PI-RADS are highly preferred over conventional free-text reports and lead to fewer report-related post-hoc inquiries from urologists.
Topics: Humans; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Staging; Personal Satisfaction; Prospective Studies; Prostatic Neoplasms; Surveys and Questionnaires; Urologists
Urology Journal Mar 2017To investigate patients' preferences for the gender of their urologist.
To investigate patients' preferences for the gender of their urologist.
MATERIALS AND METHODS
Patients who visited a urologic center were asked to complete a self-administered questionnaire on the preferences for the gender of their urologist as well as on their age, education level and employment status.
Of 270 respondents, 144 subjects (53%) had a preference for the gender of their urologist, whereas 126 subjects (47%) had no preference. Among 154 female respondents, 56 (36.4%) patients had no preference;96 (62.3%) patients had preferences for female urologists; and only 2 (1.3%) patient preferred male urologists. Among 116 male respondents, 70 (60.3%) patients had no preference; 30 (25.9%) patients had preferences for male urologists; and 16 (13.8%) preferred female urologists. Of patients that did express a preference, 87.5% (126/144) preferred the same gender urologist, with 65.2% (30/46) of male patients preferring male urologists and 97.9% (96/98) of female patients preferring female urologists (p < .001). However, age and education level werenot correlated with gender preference.
More than half the female participants had a preference for the same gender of urologist, whereas the majority of male participants expressed no preference for the gender of their urologist. Furthermore, gender preference was not correlated with age and education level.
Topics: Adult; Age Factors; Aged; Educational Status; Female; Humans; Male; Middle Aged; Occupations; Patient Preference; Physicians, Women; Republic of Korea; Sex Factors; Surveys and Questionnaires; Urologists; Young Adult
Emergency upper urinary tract decompression: double-J stent or nephrostomy? A European YAU/ESUT/EULIS/BSIR survey among urologists and radiologists.World Journal of Urology Jul 2022To evaluate the decompression of the pelvicalyceal system between urologists and radiologists. (Review)
To evaluate the decompression of the pelvicalyceal system between urologists and radiologists.
A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL).
Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively.
The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.
Topics: Decompression; Humans; Hydronephrosis; Nephrostomy, Percutaneous; Quality of Life; Radiologists; Stents; Ureter; Urologists
Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists.International Braz J Urol : Official...To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020.
To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020.
MATERIALS AND METHODS
A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states.
Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012).
COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
Topics: Betacoronavirus; Brazil; COVID-19; Coronavirus Infections; Humans; Life Style; Pandemics; Pneumonia, Viral; Practice Patterns, Physicians'; Quality of Life; SARS-CoV-2; Surveys and Questionnaires; Telemedicine; Urologic Diseases; Urologic Surgical Procedures; Urologists; Urology; Workload
American Journal of Men's Health Sep 2018There are several studies on patients' preference for same-gender physicians, especially female preference for same-gender gynecologists. Data regarding the preferences...
There are several studies on patients' preference for same-gender physicians, especially female preference for same-gender gynecologists. Data regarding the preferences of urology patients, of whom the majority are males, are scarce. The objective of this study is to assess provider gender preference among urology patients. One hundred and nineteen consecutive men (mean age 57.6 years) who attended a urology clinic in one university-affiliated medical center were prospectively enrolled. A self-accomplished 26-item anonymous questionnaire was used to assess patients' preferences in selecting their urologist. Of the 119 patients, 51 (42.8%) preferred a male urologist. Patients exhibited more same-gender preference for physical examination (38.3%), or urological surgery (35.3%), than for consultation (24.4%). Most patients (97%) preferred a same-gender urologist because they felt less embarrassed. Four patient characteristics were identified to be significantly associated with preference for a male urologist: religious status, country of origin, marital status, and a prior management by a male urologist. Of these, religious status was the most predictive parameter for choosing a male urologist. The three most important factors that affected actual selection, however, were professional skills (84.6%), clinical experience (72.4%), and medical knowledge (61%), rather than physician gender per se. Many male patients express gender bias regarding their preference for urologist. However, professional skills of the clinician are considered to be more important factors when it comes to actually making a choice.
Topics: Adult; Choice Behavior; Communication; Humans; Male; Middle Aged; Patient Participation; Patient Preference; Patient Satisfaction; Physician-Patient Relations; Prospective Studies; Surveys and Questionnaires; Urologists
"I Don't Know What I'm Doing… I Hope I'm Not Just an Idiot": The Need to Train Pediatric Urologists to Discuss Sexual and Reproductive Health Care With Young Women...The Journal of Sexual Medicine Oct 2018Although pediatric urologists have taken responsibility for initiating discussions on sexual and reproductive health with spina bifida patients, research shows that very...
"I Don't Know What I'm Doing… I Hope I'm Not Just an Idiot": The Need to Train Pediatric Urologists to Discuss Sexual and Reproductive Health Care With Young Women With Spina Bifida.
Although pediatric urologists have taken responsibility for initiating discussions on sexual and reproductive health with spina bifida patients, research shows that very few girls and women with spina bifida have ever discussed this topic with any physician.
We sought to better understand pediatric urologists' gaps in knowledge and training needs in the sexual and reproductive health education of women with spina bifida with the goal of creating a tool kit to equip providers to have these discussions.
In this qualitative study, pediatric urologists were interviewed separately about their current practices, perceived barriers, knowledge gaps, and recommendations for the tool kit until thematic saturation was reached. The interviews were recorded and transcribed verbatim, then analyzed using grounded theory by 3 independent reviewers.
MAIN OUTCOME MEASURES
To evaluate the perspectives and practices of pediatric urologists, we identified the overlapping themes of the interviews. Consensus on themes was reached.
10 Pediatric urologists participated in the study, including 5 men and 5 women, of whom 4 were fellows and 6 were attending physicians (mean years of practice 18, range 6-31 years). The mean number of patients followed up in the respective spina bifida clinics or by the provider was 434 (range 24-1,500). The following themes regarding pediatric urologists' experience providing sexual and reproductive health education to women with spina bifida emerged. Pediatric urologists': (i) lack of formal training; (ii) knowledge gaps such as spina bifida sexuality, fertility, and pregnancy experience; (iii) barriers to having sexual and reproductive health conversations such as lack of comfort and lack of time; (iv) facilitators of these conversations such as a long-term relationship with the patient and the patient's own initiative; (v) desire to learn and provide competent care; and (vi) recommendations for a web-based tool kit that would include content to address the knowledge gaps and training about how to start sexual and reproductive health conversations.
These findings can provide the beginning concepts for the development of training on providing sexual and reproductive health education for pediatric urologists' care for women with spina bifida.
STRENGTHS & LIMITATIONS
This study gives the perspectives of 10 pediatric urologists with a diversity of backgrounds, but all of whom care for a large number of spina bifida patients. This does not give the perspectives of the spina bifida women themselves, which will be evaluated in the next phase of the study.
Pediatric urologists are not trained and do not feel prepared to provide sexual and reproductive health education for girls and women with spina bifida. However, they do see it as their scope of practice and wish to acquire competence in this area. Streur CS, Schafer CL, Garcia VP, et al. "I Don't Know What I'm Doing… I Hope I'm Not Just an Idiot": The Need to Train Pediatric Urologists to Discuss Sexual and Reproductive Health Care With Young Women With Spina Bifida. J Sex Med 2018;15:1403-1413.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Pediatrics; Qualitative Research; Reproductive Health; Sexual Behavior; Sexual Health; Spinal Dysraphism; Urologists
Journal of Endourology Apr 2020To define current trends in the utilization of renal thermal ablation by urologists in the United States. A six-month case log data for renal procedures submitted by...
To define current trends in the utilization of renal thermal ablation by urologists in the United States. A six-month case log data for renal procedures submitted by certifying and recertifying American urologists from 2003 to 2018 were obtained from the American Board of Urology and stratified by current procedural terminology code. The utilization of thermal ablative techniques was examined with respect to overall trends, surgeon, and practice characteristics associated with its use. Six thousand two hundred eleven unique urologists performed 54,075 renal procedures, including 1916 (3.5%) thermal ablations, 630 (1.2%) renal biopsies, 17,361 (32.1%) partial nephrectomies, 20,403 (37.8%) radical nephrectomies, and 7957 (14.7%) nephroureterectomies. Eight hundred twenty-five (13.3%) unique urologists performed renal ablations, including 1344 (70.2%), 418 (21.8%), and 154 (8.0%) laparoscopic, percutaneous, and open ablation procedures, respectively. The annual volume of ablation was highest in 2008, followed by 2010 and 2009. On multivariate modeling of those performing renal interventions, the first decade of practice, self-declared endourologist, urologist who completed an endourology fellowship, urologist who practices in the Mid Atlantic, North Central, South Central, and South Eastern United States (compared with New England) were more likely to perform thermal ablation for renal masses. Urologists who perform renal biopsies and partial nephrectomies are also more likely to perform ablation of renal masses. Thermal ablation accounted for a small percentage of renal interventions performed by urologists in the last 1.5 decades with definable associations to practice characteristics. Renal ablation was most commonly performed laparoscopically, with declining use in recent years.
Topics: Humans; Nephrectomy; Practice Patterns, Physicians'; Surgeons; United States; Urologists; Urology