A manpower calculus: the implications of SUO fellowship expansion on oncologic surgeon case volumes. Urol Oncol 2014 Jan;32(1):42.e7-12
Date
08/06/2013Pubmed ID
23911685DOI
10.1016/j.urolonc.2013.05.003Scopus ID
2-s2.0-84890795894 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
INTRODUCTION: Society of Urologic Oncology (SUO)-accredited fellowship programs have undergone substantial expansion. This study developed a mathematical model to estimate future changes in urologic oncologic surgeon (UOS) manpower and analyzed the effect of those changes on per-UOS case volumes.
MATERIALS AND METHODS: SUO fellowship program directors were queried as to the number of positions available on an annual basis. Current US UOS manpower was estimated from the SUO membership list. Future manpower was estimated on an annual basis by linear senescence of existing manpower combined with linear growth of newly trained surgeons. Case-volume estimates for the 4 surgical disease sites (prostate, kidney/renal pelvis, bladder, and testes) were obtained from the literature. The future number of major cases was determined from current volumes based upon the US population growth rates and the historic average annual change in disease incidence. Two models were used to predict future per-UOS major case volumes. Model 1 assumed the current distribution of cases between nononcologic surgeons and UOS would continue. Model 2 assumed a progressive redistribution of cases over time such that in 2043 100% of major urologic cancer cases would be performed by UOSs.
RESULTS: Over the 30-year period to "manpower steady-state" SUO-accredited UOSs practicing in the United States have the potential to increase from approximately 600 currently to 1,650 in 2043. During this interval, case volumes are predicted to change 0.97-, 2.4-, 1.1-, and 1.5-fold for prostatectomy, nephrectomy, cystectomy, and retroperitoneal lymph node dissection, respectively. The ratio of future to current total annual case volumes is predicted to be 0.47 and 0.9 for models 1 and 2, respectively. The number of annual US practicing graduates necessary to achieve a future to current case-volume ratio greater than 1 is 25 and 49 in models 1 and 2, respectively.
CONCLUSIONS: The current number of SUO fellowship trainees has the potential to decrease future per-UOS case volumes relative to current levels. Redistribution of existing case volume or a decrease in the annual number of trainees or both would be required to insure sufficient surgical volumes for skill maintenance and optimal patient outcomes.
Author List
See WAMESH terms used to index this publication - Major topics in bold
CystectomyEducation, Medical
Fellowships and Scholarships
Forecasting
Humans
Male
Medical Oncology
Models, Theoretical
Nephrectomy
Physicians
Prostatectomy
Societies, Medical
United States
Urologic Neoplasms
