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PD17-07 PROJECTING THE UROLOGY WORKFORCE OVER THE NEXT 20 YEARS
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Patients were mailed follow-up questionnaires. Outcomes included perception of quality of care, knowledge of prostate cancer screening, and the decision to pursue screening. Statistical analyses included ANOVA models for continuous outcomes and logistic regression models for binary outcomes. RESULTS: A total of 329 patients were enrolled. Patients in the DA arm were significantly less likely to report that their provider encouraged them to talk about their health questions compared to those in the SOC arm (72%, 71/97, vs. 87%, 78/88, respectively, p¼0.014). However, the addition of SDM to DA did not significantly impact their perception of this interaction (78%, 70/88, vs. 87%, 78/88, respectively, p¼0.400). Interestingly, DA alone did not improve prostate knowledge compared to SOC (4.5/- 1.7 vs. 4.5+/- 1.7, respectively, p¼0.929). However, when SDM was added to the DA, the mean knowledge score increased significantly compared to SOC (5.11.7 vs. 4.51.7, respectively, p¼0.030). In addition, patients in the DA+SDM arm were significantly more likely to report talking about having a procedure with their provider compared to the DA alone arm (33%, 30/88, vs. 16%, 16/ 96, respectively, p¼0.011). As it relates to prostate cancer screening, 4% in the SOC arm underwent PSA screening within 1 day compared to 29% in DA alone arm (p¼0.017) and 19% in the DA+SDM arm (p¼0.128). CONCLUSIONS: Providing patients a DA without a personal interaction diminishes the patient’s perception of the quality of care. In addition, providing a DA results in patients undergoing PSA-based screening without understanding the consequences of such screening. Particularly with complex issues such as the decision to pursue PSAbased prostate cancer screening, tools cannot substitute for direct interaction with a trusted provider. Instead, a DA should be used to facilitate the shared decision making process, which is critical for improving patient knowledge and understanding. Source of Funding: VM Prostate Cancer Research Fund
PD17-07 PROJECTING THE UROLOGY WORKFORCE OVER THE NEXT 20 YEARS Maxim McKibben*, E Will Kirby, Chapel Hill, NC; Joshua Langston, Norfolk, VA; Matthew Nielsen, Mathew Raynor, Eric Wallen, Angela Smith, Michael Woods, Raj Pruthi, Chapel Hill, NC INTRODUCTION AND OBJECTIVES: Given the growing population of older Americans, projections of medical workforce supply and demand are the focus of increasing attention. In a geriatric-heavy specialty such as urology, anticipating need and the ability to meet future demand is crucial, and robust estimates regarding future urology workforce size and composition are lacking. Based on current workforce data and trends regarding urologist retirement, certification rate, and use of advanced care practitioners (ACPs - nurse practitioners, physicians assistants, and certified nurse specialists), the objective was to forecast the size and composition of the urology workforce over the next 20 years. METHODS: Current urology physician workforce was estimated from the American Board of Urology (ABU) certification data, the 2014 American Urological Association (AUA) Census, and the American Association of Medical Colleges 2014 Physician Specialty Databook. Incoming workforce was estimated from ABU and AUA residency match data. Estimates of the ACP workforce were extracted from the 2012 AUA Physician Survey. Full-time equivalent (FTE) calculations were based on metrics from a 2013 urology workforce survey. Overall workforce projections were created using a stock and flow population model. RESULTS: Slight growth in overall urology (urologist + ACP) workforce FTEs is expected over the next 20 years, from 14,343 in 2015 to 14,806 in 2035. A significant decline in urologist FTEs is anticipated, from 10,772 in 2015 to 8,505 in 2035. The ACP workforce should increase markedly, from 8,710 in 2015, to 15,369 in 2035. Women as a proportion of the workforce should increase as well, from the current
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7.1% to about 20% of the workforce by 2035. Multiple alternate scenarios were evaluated, with a range of forecasted FTEs in 2035 from 13,729 to 17,249. CONCLUSIONS: The aging US population will increase demand for urologic care in the near future, but estimates of the urology workforce suggest a decrease in urologists, and minimal overall growth when accounting for ACPs as well. Assuming current practice patterns, urologists and urology ACPs may not meet future demand. This forecast highlights the need for discussion and planning among leaders in the field to find creative solutions for this impending workforce shortage.
Source of Funding: None
PD17-08 THE ASSOCIATION OF TRAVEL DISTANCE TO CYSTECTOMY ON READMISSION AND SURVIVAL Troy Sukhu*, Jason Lomboy, Matthew Macey, Anne Marie Meyer, Ke Meng, Matthew Nielsen, Raj Pruthi, Eric Wallen, Michael Woods, Angela Smith, Chapel Hill, NC INTRODUCTION AND OBJECTIVES: The relationship between distance traveled for surgery and risk of readmission and subsequent survival remains unclear. We hypothesized that larger distances would increase the risk of readmission and mortality following cystectomy. METHODS: Using a linked data resource combining the Central Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients undergoing radical cystectomy for bladder cancer from 2003-2008. Complications were grouped based on previously published standards: genitourinary, gastrointestinal, wound, infection, venous thromboembolism, and others. Travel distances were calculated by using straightline distances between zip codes of patient and cystectomy provider. Bivariable analyses were performed, and multivariable logistic regression was used to evaluate the association of travel distance to cystectomy with likelihood of readmission. Kaplan-Meier curves were used to investigate the effect of travel distance and readmission to the index or non-index hospital on survival. RESULTS: Of 735 patients who underwent cystectomy, 171 (23%) were readmitted within 30 days, and n¼156 (21%) were readmitted between 31-90 days. Mean age was higher among those readmitted, but was statistically non-significant. No significant differences were noted based on race, stage, comorbidity status, or complication type. However, on bivariable analysis, distance to the cystectomy provider > 30 miles was associated with a higher likelihood of readmission (p¼0.0009). On multivariable analysis, the only predictor of 30-day readmission was a longer travel distance to the cystectomy provider (table 1). Results were also analyzed for 31-90 day readmissions, but no significant predictors were identified. Travel distance did not impact overall survival (p¼0.7608) but readmission to a non-index hospital was associated with worse survival than those readmitted to the hospital which performed the surgery (p¼0.01).
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Patients were mailed follow-up questionnaires. Outcomes included perception of quality of care, knowledge of prostate cancer screening, and the decision to pursue screening. Statistical analyses included ANOVA models for continuous outcomes and logistic regression models for binary outcomes. RESULTS: A total of 329 patients were enrolled. Patients in the DA arm were significantly less likely to report that their provider encouraged them to talk about their health questions compared to those in the SOC arm (72%, 71/97, vs. 87%, 78/88, respectively, p¼0.014). However, the addition of SDM to DA did not significantly impact their perception of this interaction (78%, 70/88, vs. 87%, 78/88, respectively, p¼0.400). Interestingly, DA alone did not improve prostate knowledge compared to SOC (4.5/- 1.7 vs. 4.5+/- 1.7, respectively, p¼0.929). However, when SDM was added to the DA, the mean knowledge score increased significantly compared to SOC (5.11.7 vs. 4.51.7, respectively, p¼0.030). In addition, patients in the DA+SDM arm were significantly more likely to report talking about having a procedure with their provider compared to the DA alone arm (33%, 30/88, vs. 16%, 16/ 96, respectively, p¼0.011). As it relates to prostate cancer screening, 4% in the SOC arm underwent PSA screening within 1 day compared to 29% in DA alone arm (p¼0.017) and 19% in the DA+SDM arm (p¼0.128). CONCLUSIONS: Providing patients a DA without a personal interaction diminishes the patient’s perception of the quality of care. In addition, providing a DA results in patients undergoing PSA-based screening without understanding the consequences of such screening. Particularly with complex issues such as the decision to pursue PSAbased prostate cancer screening, tools cannot substitute for direct interaction with a trusted provider. Instead, a DA should be used to facilitate the shared decision making process, which is critical for improving patient knowledge and understanding. Source of Funding: VM Prostate Cancer Research Fund
PD17-07 PROJECTING THE UROLOGY WORKFORCE OVER THE NEXT 20 YEARS Maxim McKibben*, E Will Kirby, Chapel Hill, NC; Joshua Langston, Norfolk, VA; Matthew Nielsen, Mathew Raynor, Eric Wallen, Angela Smith, Michael Woods, Raj Pruthi, Chapel Hill, NC INTRODUCTION AND OBJECTIVES: Given the growing population of older Americans, projections of medical workforce supply and demand are the focus of increasing attention. In a geriatric-heavy specialty such as urology, anticipating need and the ability to meet future demand is crucial, and robust estimates regarding future urology workforce size and composition are lacking. Based on current workforce data and trends regarding urologist retirement, certification rate, and use of advanced care practitioners (ACPs - nurse practitioners, physicians assistants, and certified nurse specialists), the objective was to forecast the size and composition of the urology workforce over the next 20 years. METHODS: Current urology physician workforce was estimated from the American Board of Urology (ABU) certification data, the 2014 American Urological Association (AUA) Census, and the American Association of Medical Colleges 2014 Physician Specialty Databook. Incoming workforce was estimated from ABU and AUA residency match data. Estimates of the ACP workforce were extracted from the 2012 AUA Physician Survey. Full-time equivalent (FTE) calculations were based on metrics from a 2013 urology workforce survey. Overall workforce projections were created using a stock and flow population model. RESULTS: Slight growth in overall urology (urologist + ACP) workforce FTEs is expected over the next 20 years, from 14,343 in 2015 to 14,806 in 2035. A significant decline in urologist FTEs is anticipated, from 10,772 in 2015 to 8,505 in 2035. The ACP workforce should increase markedly, from 8,710 in 2015, to 15,369 in 2035. Women as a proportion of the workforce should increase as well, from the current
e401
7.1% to about 20% of the workforce by 2035. Multiple alternate scenarios were evaluated, with a range of forecasted FTEs in 2035 from 13,729 to 17,249. CONCLUSIONS: The aging US population will increase demand for urologic care in the near future, but estimates of the urology workforce suggest a decrease in urologists, and minimal overall growth when accounting for ACPs as well. Assuming current practice patterns, urologists and urology ACPs may not meet future demand. This forecast highlights the need for discussion and planning among leaders in the field to find creative solutions for this impending workforce shortage.
Source of Funding: None
PD17-08 THE ASSOCIATION OF TRAVEL DISTANCE TO CYSTECTOMY ON READMISSION AND SURVIVAL Troy Sukhu*, Jason Lomboy, Matthew Macey, Anne Marie Meyer, Ke Meng, Matthew Nielsen, Raj Pruthi, Eric Wallen, Michael Woods, Angela Smith, Chapel Hill, NC INTRODUCTION AND OBJECTIVES: The relationship between distance traveled for surgery and risk of readmission and subsequent survival remains unclear. We hypothesized that larger distances would increase the risk of readmission and mortality following cystectomy. METHODS: Using a linked data resource combining the Central Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients undergoing radical cystectomy for bladder cancer from 2003-2008. Complications were grouped based on previously published standards: genitourinary, gastrointestinal, wound, infection, venous thromboembolism, and others. Travel distances were calculated by using straightline distances between zip codes of patient and cystectomy provider. Bivariable analyses were performed, and multivariable logistic regression was used to evaluate the association of travel distance to cystectomy with likelihood of readmission. Kaplan-Meier curves were used to investigate the effect of travel distance and readmission to the index or non-index hospital on survival. RESULTS: Of 735 patients who underwent cystectomy, 171 (23%) were readmitted within 30 days, and n¼156 (21%) were readmitted between 31-90 days. Mean age was higher among those readmitted, but was statistically non-significant. No significant differences were noted based on race, stage, comorbidity status, or complication type. However, on bivariable analysis, distance to the cystectomy provider > 30 miles was associated with a higher likelihood of readmission (p¼0.0009). On multivariable analysis, the only predictor of 30-day readmission was a longer travel distance to the cystectomy provider (table 1). Results were also analyzed for 31-90 day readmissions, but no significant predictors were identified. Travel distance did not impact overall survival (p¼0.7608) but readmission to a non-index hospital was associated with worse survival than those readmitted to the hospital which performed the surgery (p¼0.01).