Urology workforce shortage and teaching residents at private hospitals

Hello, friends.
It's been awhile since I've posted, so sorry for the hiatus.

We have just released a paper in the journal Urology about teaching residents laser prostatectomy in the private practice setting.

Pubmed Citation for Paper

There is a serious shortage of urologists in America.  To compound the issue, there are only 225 or so urology residents graduating per year - well short of what this country needs.  Medicare dollars are also getting squeezed which means that the graduate medical education (GME) environment will only be more challenging (Medicare pays for the bulk of graduate medical education currently in this country).  Going forward, this means that the paradigm of the academic medical center being the sole nexus of surgical education may have to change.

In our paper, we show that residents can be taught cutting edge surgical techniques in a private hospital, in this case laser prostate surgery, without any change in the safety profile or surgical outcomes.  The only difference in cases with a resident was a slight increase in operative time (57 vs. 46 minutes).

More urologists need to be trained in the future to tackle the needs of our population.  Since GME dollars are fixed and are surely going to be tightened up in the future, institutions need to be creative about training opportunities.  High quality private practices can be a great resource to train the next generation of urologists.  In the future, I also see more private institutions creating their own residencies outside the confines of a Medicare system.

Our paper received an editorial...which was a great compliment to the impact of our article.

Pubmed citation for editorial

We composed an editorial reply please find a link below:

Our editorial reply (Pubmed citation)

I hope to continue posting with some regularity....though the periodicity is uncertain at this time.  It has been difficult in the past few months balancing family, my MBA program - only 2 classes left!, research, and a busy clinical practice.  However, there's a bunch of stuff going on in my urologic mission so I want to continue to share and educate.  Any words of encouragement and support are greatly appreciated!

Our laser prostate surgery research is in this month's British Journal of Urology

We're happy to share with the world our work in this month's British Journal of Urology.

Pubmed citation

Full Paper

The paper deals with laser prostate surgery for benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate.

Our experience with the procedure reveals that it is safe to perform this surgery with a discharge within hours of the procedure. This case series is important because having an ambulatory pathway can reduce hospital resource utilization, allow patients a more comfortable recovery in their home environment, and avoid further exposure to hospital based problems such as infections, errors, and falls.

In a laser prostatectomy, a laser fiber is used to destroy prostate tissue that is blocking a man's urinary flow.  An advantage from a laser based approach is less blood loss due to the sealing action of the laser.  This allows patients the potential for a same day surgery. 

The classic, surgical approach to BPH is the TURP or transurethral resection of the prostate.  As a opposed to a laser fiber, a cutting loop is used to shave away the obstructive prostate tissue.  Due the amount of bleeding postoperatively, patients are generally admitted to the hospital for at least one day with a bladder irrigating catheter.

Our research group is currently studying other aspects of advanced laser prostate surgery as well as the use of mobile apps in urology....so stay tuned!  More abstracts and papers to come...

Sharing our research at the NEAUA Meeting

Entrance to the Meeting at the Westin in Boston

I was at the 81st New England American Urological Association Annual Meeting in Boston last week.  The meeting was well attended with participants hailing from not only New England but also from many other parts of the US.  I had a great time catching up with colleagues as well as former residents I trained who are now colleagues (!).

At this year's meeting, I was also active as a member of the Scientific Program Committee, reviewing abstracts and helping the Program Chairs outline the format for the sessions.

My research group had a podium abstract at the meeting about laser prostate surgery.
Check out this prior blog post for more details about the abstract as well as my meeting involvement.

Drs. Ben Herrick (right) and Ron Yap (left) after our presentation.
See how relieved Ben looks?

Dr. Ben Herrick did a great job presenting our findings in the session.  The abstract was favorably received and marks the 4th time he has been able to share our research at a scientific meeting.  At this past American Urological Association Annual Meeting in May,  Dr. Herrick was first author on three abstracts for my group.  This is no small feat for such a large and competitive international meeting.  So kudos, Ben.  Keep up the good work!