An in-house clinic will take not only time and energy, but resources as well. The good news, though, is money might not be one of them. Many urologic specialty clinics can be created without much cost. If a practice has basic urology equipment and rooms to see patients, that should cover it.

“You don’t need a free-standing space with a big sign,” Dr. Elliott said. “You don’t need a lot of capital to do a very good job.”

Dr. Albaugh said anything he needs is already in a urology office. The only specialty equipment he needs is a cart. Patient education is a major component of the care he provides, and he keeps his teaching materials, questionnaires, and folders on a cart that rolls with him everywhere he goes.

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Dr. Albaugh’s group created a video library where patients can go for information after their appointments, and he wrote a book, which is available to patients, dealing with reclaiming intimacy and sex after prostate cancer.


The one factor that seems to make all of these clinics run smoothly, remain profitable and perform efficiently is the team approach. The key positions for the team appear to be a qualified group of nurse practitioners and physician assistants.

At Mayo, all cases are reviewed by a physician or a surgeon, but each patient first meets with a nurse practitioner or physician assistant who has extensive experience in female urology. They either treat the problem or know the correct tests to move the patient forward. This allows the surgeons to see their patients while a nurse also sees between 10 and 20 patients a day.

“The nurse practitioner is trained in this and can do counseling and spend time with patients to go over things like overactive bladder and frequency and things that are time-consuming that I don’t have time to do,” Dr. Elliott said. “It is a better use of our time to see screened patients.”

At HealthEast, the team provides much of the education and testing that physicians used to perform. Dr. Portis said they are able to run two or three protocols extremely efficiently instead of the 20 they would do at a general clinic.

Dr. Albaugh works with a team of providers that can include urologists, gynecologists, endocrinologists, and cardiologists. But he acts as gatekeeper, spending the first 60-minute appointment with each patient or couple. He determines the problem and underlying factors and lays out different potential solutions.

“You need to know whoever is going to provide education on the team, it is time-intensive,” he said. “You have to have personnel to provide in-depth, one-on-one healthcare that the patients need.”