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 State of Urology Workforce 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.

“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. Almost 50% of residents and 75% 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.


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“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. “And open communication when you’re talking about compensation is certainly important just to allay any concerns regarding academic debt, compensation, and buy-ins.”

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, adding that current residents and fellows who are looking for a job may be aware of this.

“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?’”

In addition, residents and fellows may be intimidated or deterred from considering private practice because they are not routinely educated on private practice business models and buy-in opportunities, Dr Jansen said. Interviewees may not fully understand partnership tracks, large practice buy-ins, and/or expectations of early buy-ins, he said.

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.”

And do not be in a rush. “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.

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. The 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.