1. The Urology Workforce Shortage Problem
The United States (US) is facing a dramatic shortage of urologists, negatively impacting access to specialized care and exacerbating healthcare inequalities, particularly in rural areas. Advocating for this problem is essential for understanding its causes and providing potential solutions for planning and implementing effective interventions to mitigate its impact. Despite its significance, this issue remains underrecognized in the current discourse, suggesting a critical gap in advocacy efforts to prevent its consequences. The urologist shortage discussion is often framed as a concern for the future; however, the reality is that this issue is already manifesting today, although it remains frequently overlooked. Securing timely specialized urological care can be highly challenging. Rural populations across the US experience a pronounced struggle to find urological specialist care. An ecological study that leveraged data from the Department of Health and Human Services Area Resources (2006) and the United States Census (2004) found that 63% of counties in the US lack urologists.[1] According to the State of the Urology Workforce Census Book 2018, the national urologist-to-population ratio was 3.89 per 100,000 population, and the states of Wyoming and Nevada had the lowest urologist-to-population ratio of 2.59 and 2.40 per 100,000 people, respectively. In comparison, the national average of all physicians per 100,000 population in 2022 was 297, meaning that both states have figures that are less than 1% of the national physician average,[2] clearly demonstrating a dramatic shortage of urologists.
2. Why does this issue hold such significance and why is it projected to worsen in the coming years?
First, the US population continues to age, and the number of patients requiring urological care will continue to grow. Simultaneously, the urology workforce is also getting older. According to the American Urological Association (AUA), the percentage of urologists practicing beyond the age of 65 years has increased from 22.9% in 2014 to 29.8% in 2021, and over the next decade, many are expected to retire.[3] The demand for urological services is growing; nonetheless, for the 2025 Urology Residency Match, only 385 positions are available across various programs in the US. This production rate cannot match the approaching wave of retirements or the needs of the population, thereby creating a widening gap.[4]
3. What are the potential solutions and what should we do?
3.1. Advocate for the problem!
The first step is to acknowledge the scale and urgency of this problem. Collaboration between urologists, the AUA, policymakers, and healthcare organizations is essential to address this shortage and drive change by implementing effective measures and solutions.
3.2. Conduct more research
Research can be an excellent tool for raising awareness and illuminating the factors associated with the shortage to better understand the drivers behind the shortage.
3.3. Increase training opportunities
Expand residency training centers to address the scarcity of slots, as many qualified candidates are left unmatched each year.
3.4. Facilitate pathways for foreign graduates
This is one of the fastest ways to tackle this problem. There is a large pool of extremely well-trained urologists who, after completing the United States Medical Licensing Examination board exams and training in the US, need to return to their home countries because of Visa issues.
3.5. Leverage advanced practice providers
Increasing the number of nurse practitioners and physician assistants is vital for addressing this disparity and bridging the healthcare gap.
3.6. Incentivize practice in underserved areas
Improving incentives, such as the repayment program for young urologists to practice in underserved areas as well as offering higher compensation packages.
3.7. Promote telehealth usage
This cost-effective tool was shown to be extremely effective during the coronavirus disease pandemic, as it helped close the healthcare access gap, particularly in rural areas.
3.8. Support legislative efforts
Support for the Resident Physician Shortage Act and Conrad State 30. Last year, at the AUA Advocacy Summit 2024, urologists brought legislative asks to members of the House and Senate; this type of effort should continue and be reinforced in subsequent AUA Advocacy Summits.[5]
4. Conclusions: A call to collective action to ensure the future of urological care
Considering that the US population continues to age and the current urology workforce is getting older, the urology workforce shortage remains a problem that should be a priority. This is not a one-person or one-organization job. This requires communication and coordination among many stakeholders to address the problem simultaneously at different levels. Urologists, healthcare institutions, urological societies, and policymakers should collaborate to discuss and plan strategies to implement policies that will drive change and mitigate this problem.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Footnotes
How to cite this article: Nolazco JI. Urology workforce shortage: A present challenge, a future catastrophe. Curr Urol 2025;19(5):357–358. doi: 10.1097/CU9.0000000000000292
Conflict of interest statement
JIN is a member of the early career editorial board of Current Urology, confirms no involvement in any stage of this article's review process, ensuring unbiased editorial decision-making.
References
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- 4.Urology and Specialty Matches - American Urological Association [Internet]. Available at: https://www.auanet.org/meetings-and-education/for-residents/urology-and-specialty-matches
- 5.AUA ADVOCACY Policy Solutions to Address an Impending Urologist Workforce Shortage - American Urological Association [Internet]. Available at: https://auanews.net/issues/articles/2024/june-2024/aua-advocacy-policy-solutions-to-address-an-impending-urologist-workforce-shortage. Accessed January 3, 2025.