RCC Surgery Postponement May Be Safe

Private Practices Face Obstacles to Recruiting Young Urologists

Many urologists completing their training prefer academic settings, data show

BY JODY A. CHARNOW PRIVATE PRACTICES looking to recruit urologists fresh out of training have to take into account that these physicians may have different career expectations compared with previous generations of urologists, according to speakers at a session during the Large Urology Group Practice Association (LUGPA) 2020 virtual annual meeting.

Survey data from the 2019 Urologists in Training Census, which is conducted by the American Urological Association (AUA), suggest that residents and fellows in general favor work/life balance over compensation, and they lean toward employment in academic settings or hospitals.

Well-Balanced Lifestyle Sought “Residents and fellows really are just looking for opportunities to have a well-balanced lifestyle … and job satisfaction as opposed to rigorous hours and tough call schedules,” said Robert Jansen, MD, of Atlantic Urology Clinics in Myrtle Beach, South Carolina. This mindset, he said, may run counter to the expectations of older urologists, he said.

Dr Jansen reviewed findings from the 415 residents and 97 fellows who responded to the AUA census. He pointed out that only 35% of residents and 10% of fellows indicated that they are considering entering private practice upon completion of their training. In addition, 49.7% of residents and 73.2% of fellows anticipate taking an academic job following completion of training. Less than 40% of men and 2% of women residents plan to enter private practice. Among fellows, 13.6% of men and 0% of women are considering a private practice position.

“Many trainees in their programs do see themselves as part of a family,” Dr Jansen said. “There’s a lot of collegiality not just among each other, but also among their attendings. They would like to see this continue in their career.”

For both residents and fellows, the top 3 factors that influence their choice of future practice settings were family/ life balance/call schedule, geographic location, and compensation, he noted.

“Geography, interestingly, is equally as important as lifestyle, so this should be considered when you’re looking at your recruitment pool,” Dr Jansen said.

AUA census data show that 46% of all urologists report being employed in an institutional setting: 27% in academic hospitals, 16% in public or private hospitals, and 3% in Veterans Affairs hospitals. In addition, 78% of employed urologists say their job offers a good work/life balance compared with 41% of self-employed urologists.

“The consensus here is that the majority of all of urologists believe that a better work/life balance can be achieved through an employed model,” said Joshua Langston, MD, chief medical officer at Urology of Virginia.

“We have to ask ourselves, ‘What do the employed models have that attracts the next generation of urologists, and can we offer some of the similar benefits in independent practice?’”

Dr Jansen said a common question among interviewees is how much call they would have to take. “I think this generation is looking for a newer and a more efficient way of doing things, or at least asking the question, ‘Is there a better way?’”

Different Employment Tracks One of the most important considerations when trying to attract young urologists to join a practice is the creation of different employment tracks, said Timothy A. Richardson, MD, of Wichita Urology in Wichita, Kansas. “It doesn’t have to be the standard partnership track. That’s the only thing that really existed when most of us went into practice. But that’s simply not what some people are looking for today,” Dr Richardson told attendees. “Employment with a straight salary and no partnership needs to be an option, or part-time employment, or maybe just flexible call arrangements.” Potential recruits might prefer lower compensation in exchange for less call, he noted.

He advised listeners to start their candidate search 2 to 3 years ahead of anticipated need, and observed, “Most chief residents already have a job when they start their last year.”

He cautioned against being in a rush to hire somebody. “Don’t just get a warm body, be patient,” he said, adding that practices need to find urologists who fit the culture of their group in terms personality, work ethic, career goals, and other attributes.

Do Not Compete With Hospitals Compensation should be competitive with LUGPA practices, not hospitals, Dr Richardson said. “Starting salaries at hospitals are high, you can’t compete with that, so don’t try to,” he said. Individuals who are interviewing candidates should point out to them that hospitals offer high salaries for the first year or two, but then income often decreases over time, whereas income typically rises when a physician buys into a practice and becomes a partner.

Practices also should consider offering to pay moving expenses, signing bonuses, and stipends during residency or fellowship, Dr Richardson said. ■

Academic Settings Favored

Survey data from the 2019 Urologists in Training Census conducted by the American Urological Association suggest that residents and fellows lean toward employment at academic medical centers rather than entering private practice after completing their training.

80

60 ■ Residents ■ Fellows

49.7% 73.2%

40

35%

20

9.8%

0

Private practice Academic medical center

Source: American Urological Association. 2019 Urologists in Training Census.

RCC Surgery Postponement May Be Safe

DELAYING SURGERY for clinically localized renal cell carcinoma (RCC) of up to 6 months does not increase the risk of tumor progression, a finding that has implications for RCC treatment during the COVID-19 pandemic, a study found.

“During the current COVID-19 pandemic and subsequent recovery, urologists and their patients can expect delays in radical and partial nephrectomy for clinically localized RCC,” Eric A. Singer, MD, of Rutgers Cancer Institute of New Jersey in New Brunswick, and colleagues concluded in a paper published in Urologic Oncology. “In most patients with clinically localized cT1b tumors, surgery may be safely delayed for up to 6 months without significant sacrifices in overall survival.”

For patients with cT2 tumors, they added, “we must carefully weigh tumor characteristics and patient comorbidities when discussing surgical delay. However, our data suggests that most patients experiencing a delay of 3 months due to the COVID-19 pandemic will not experience worse oncological outcomes.”

Among patients with cT1b lesions, a surgical delay of 1-3 months and more than 3 months was significantly associated with a 13% and 55% increased risk of death, respectively, compared with undergoing surgery within 1 month of diagnosis, after adjusting for multiple potential confounders, the investigators reported. They pointed out, however, that these patients still have favorable overall survival. Patients with surgical delays of 1-3 and more than 3 months have 5-year overall survival rates of 80.1% and 70.9%, respectively.

Using information from the National Cancer Database, Dr Singer’s team studied 29,746 patients who underwent partial or radical nephrectomy for cT1b, cT2a, or cT2b RCC tumors. The median follow-up duration for patients with cT1b, cT2a, and cT2b tumors was 47.7, 33.3, and 35.2 months, respectively. ■