The supply of urologic surgeons in the U.S. has not kept pace with population growth, a trend that could be exacerbated by an aging urology workforce that is relatively older than surgeons in most other specialties, according to a new study.

From 1981-2009, the proportion of urologic surgeons dropped from 3.23 to 3.18 per 100,000 population, a 1.3% decrease. Only general and thoracic surgeons experienced larger declines during this period. By comparison, the number of colorectal, pediatric, plastic, and vascular surgeons per 100,000 population increased by 34.9%, 43.2%, 61.8%, and 157.2%, respectively.

Meanwhile, the urology workforce has aged. From 1981 to 2009, the proportion of urologic surgeons older than 55 years increased from 24.6% to 44% and the proportion older than 70 years increased from 3.4% to 7.4%. Among all surgical specialties, 6.1% of the workforce was aged 70 or older in 2009.

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In 2009, the average age of urologists was 52.5 years. Only thoracic surgeons were older, with an average age of 53.6 years. The average age of the surgical workforce overall was 50.9 years.

For the study, Raj S. Pruthi, MD, of the University of North Carolina at Chapel Hill, and colleagues, identified surgeons using a combination of American Medical Association primary and secondary self-reported specialties and American Board of Specialties certifications. They published their findings online ahead of print in Urology.

“The aging workforce suggests that the full-time equivalent supply is likely even lower than suggested by simple head counts, as physician work hours tend to peak in the 50-54-year age range, and decline thereafter,” the authors noted. “Aging and subsequently retiring urologists coupled with a reduction in the pipeline of new urologists portray a manpower supply that is contracting in the face of the growing and aging general population, which will require more, not less, urologic health services.”

In 2009, the U.S. had 9,775 actively practicing urologic surgeons, excluding residents in training. Projections from the U.S. Department of Health and Human Services forecast urology as the medical or surgical subspecialty requiring the greatest percentage increase in the coming years, with a projected need of 14,000 urologists by 2015 and 16,000 by 2020, the authors pointed out.

The study also showed that urology continues to be a male dominated specialty, with men accounting for 94.8% of the urology workforce in 2009. The number of female urologists, however, has increased substantially from 34 in 1981 to 512 in 2009, a relative increase of more than 1,000%, the researchers reported. Additionally, the study found that the proportion of the urologic workforce in group practice increased from 42% in 2001 to 60% in 2009. The study also documented that the urban concentration of urologic surgeons has remained stable from 1981-2009, with seven urologic surgeons in urban areas for every one urologic surgeon in a rural area.