Summary
Introduction
Over the past 25 years, Pediatric Urology fellowship programs accredited by the Accreditation
Council for Graduate Medical Education (ACGME) have more than doubled. This increase
may lead to a significant decrease in the number of operative cases per surgeon and
therefore impact the current practice of pediatric urology.
Objective
The objective in conducting this study is to try and predict the effect of the current
number of pediatric urology fellowship training positions on future case volume per
surgeon using a mathematical model and to discuss future management of the pediatric
urology workforce.
Design
The current study employed a mathematical model to predict the effect of the number
of fellowship graduates on future “case volume per surgeon”. We incorporated population
growth rates, to calculate incidence rates of key procedures/conditions and the anticipated
retirement rate of the current pool of pediatric urologists to help calculate this.
Results
There is a possibility to increase the number of practicing board-certified pediatric
urologists in the next 30 years from approximately 325 to 900 (figure). There will
be a twofold reduction in case volume per surgeon compared to the present in model
1. In model 2 the decrease in case volumes is less significant. The annual number
of fellows needed to obtain a future-to-current ratio equal to 1 is 16 for model 1,
and 26 for model 2.
Discussion
Our study demonstrates, by using two different models that the current number of pediatric
urology fellowship training positions in the United States will ultimately lead to
a significant decrease in the case volume per surgeons. Our model has limitations
as it relies on multiple assumptions. We are assuming that all fellowship positions
would be filled every year and that all fellows would graduate, establish their practices
in the United States, and devote 100% of their assumed 30-year professional career
to pediatric urology. We also made assumptions of disease occurrence and need for
surgical correction. The final assumption we made was that the birth rate would stay
static over the next 30 years even though it has been declining for many decades.
Conclusion
Graphical AbstractThe projected changes in pediatric urology manpower, eventually leading to a steady-state
of 900 pediatric urologists in 30 years, a point where the number of retiring pediatric
urologists will be replaced by an equivalent number of fellowship graduates on an
annual basis.
Keywords
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References
SPU. Fellowship Participating Programs. The society for pediatric urology. Retrieved 1 December, 2014, from.
- Does a surgeon's annual radical prostectomy volume predict the risk of positive surgical margins and urinary incontinence at one year follow-up? Findings from a prospective national study.Scand J Urol. 2012; 47: 92-100
- Radicalprostatectomy: does higher volume lead to better quality?.J Natl Cancer Inst. 1999; 91: 1906-1907
- Variations in morbidity after radical prostatectomy.N Engl J Med. 2002; 346: 1138-1144
- Radical cystectomy: defining the threshold for a surgeon to achieve optimum outcomes.Post Grad Med J. 2007; 83: 556-560
- Correlation between annual volume of cystectomy professional staffing, and outcomes: a state-wide, population-based study.Cancer. 2005; 104: 975-984
- Should cystectomy only be performed at high-volume hospitals by high-volume surgeons?.Curr Opin Urol. 2006; 16: 344-349
- Impact of surgical volume on mortality and length of stay after nephrectomy.Urology. 2004; 63: 862-867
- Hospital surgical volume, utilization, costs and outcomes of retroperitoneal lymph node dissection for testis cancer.Adv Urol. 2012; 2012
- A manpower calculus: the implications of SUO fellowship expansion on oncologic surgeon case volumes.Urol Oncol. 2014; 32: 42
ABU. National results of the pediatric Subspecialty Certification Examination. American Board of Urology. Retrieved December 1, 2014, from.
- Prevalence and natural history of cryptorchidism.Pediatrics. 1993; 92: 44-49
- Current understanding of hypospadias: relevance of animal models.Nat Rev Urol. 2015; 12: 271-280
- Contemporary epidemiological trends in complex congenital genitourinary anomalies.J Urol. 2013; 190: 1590-1595
- Trends in the rates of pediatric pyeloplasty for ureteropelvic junction obstruction over 19 years: a PHIS database study.Adv Urol. 2014; (2014:142625)
- Births: preliminary data for 2013.Natl Vital Stat Rep. 2014; 63: 1-19
- Augmentation cystoplasty rates at children's hospitals in the United States: a pediatric health information system database study.J Urol. 2006; 176: 1716-1720
- Pediatric urological manpower report; pediatric urological manpower committee of the american association of pediatric urology.. 1993; 150: 675-679
- Comparison of the learning curve and outcomes of robotic assisted pediatric pyeloplasty.J Urol. 2011; 185: 2517-2522
- Learning curve of robotic assisted pyeloplasty for pediatric urology fellows.J Urol. 2013; 190: 1622-1626
- Baby bust threatens growth.Wall Street Journal. December 4 2014;
Article info
Publication history
Published online: November 27, 2017
Accepted:
October 13,
2017
Received:
April 11,
2017
Identification
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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- Commentary to “The implications of fellowship expansion on future pediatric urologist surgical volumes”Journal of Pediatric UrologyVol. 14Issue 3
