Re: Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement
2013-01-01

Recent trends suggest that the overall number of urologists in the United States is at the lowest per capita since 1981. Urology workforce trends indicate that in this group, the second oldest surgical subspecialty workforce, the average age is 52.5 yr, with 18% aged 65 yr. Furthermore, growing numbers in the independent practice sector have raised the salary discrepancy between independent and academic practice, resulting in a shortage of academic urologists. Reduced research funds, less support for teaching, and the increasing pressure to provide clinical revenues have all contributed to the alarming current shortage of academic urologists in the United States. Gonzalez and McKenna suggest that the ‘‘relative dearth of analysis focused on the urology workforce shortage, academic workforce challenges, and the shortfall of Graduate Medical Education funding for urology residents make these data relevant for future endeavors.’’ Their conclusion is that the current urology training system is in a critical state and not sustainable. Experts’ comments: The most important and valuable asset of an academic medical unit lies in its teaching faculty and residents. The costs associated with recruiting and training new faculty are estimated to be >1.5 times that of a faculty member’s first-year salary [1], with greater costs of replacement associated with the physician-scientist. This trend is also increasing in Europe and the rest of the world. Clinical activity and funding provide the critical revenue and value-added services to support the recruitment and retention of new residents and high-quality medical faculty. This financial strain has led to reduced resources for training and increased pressure, not only on hospitals but on academic physician-scientists. High expectations are placed on developing world-class training programs. Unless we support our young urologists and nurture research and academic advances, the lack of training funds will pose a serious threat to the future generation. We must, therefore, identify other sources to support existing programs. Clearly, with reduced funding available from governmental sources in recent years, there has been an increased emphasis on partnerships and alliances with industry. Our future success in urology depends on nurturing enthusiasm amongst the next generation for a career with an academic interest, adequate reimbursement, and access to cutting-edge therapies in today’s fast-paced technical world. We also need to provide greater opportunities for networking between the current and next academic generation to stimulate collaborative working practices, thereby providing an optimal environment for the critical evaluation and development of the next generation of therapeutic advances, which will inevitably need to balance scientific advances with economic and moral issues. It is vital to increase the visibility of urology, especially starting at an early stage, by raising the profile of urology in medical school. For the future generation, it is important to demonstrate a wide treatment spectrum [2]. We must emphasize the diverse career opportunities available, from conservative and medical therapies to both minimally invasive and open surgical options. Exciting new developments are just around the corner within oncology, functional urology, and tissue engineering as well as the technological advances in minimally invasive surgery.