Dr. Amanda North
Appearances
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
This week on the Backtable Podcast. 85% of women in urology say that they have some sort of burnout. I mean, it's really bad, but only 17% are seeking professional help. And one of the things, again, this goes back to our advocacy efforts, is to understand the impact of state licensing requirements.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Absolutely. And it's been said that women maybe work fewer hours per week. And we've looked at that over the census over several years. And men and women urologists work the same number of hours per week. I want to be very clear on that. So this women are not seeing fewer patients because they're working fewer hours. They're seeing fewer patients because
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
because they're spending more time with each patient from the data we have in the census. And we can surmise from other publications that it may be that the women are seeing the more difficult and time-consuming patients, although we haven't been able to show that in the census yet.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yes and no. We've seen a trend towards employee practice over time that's been really startling. Like two-thirds of urologists are employees. Now, if you define...
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
employee as being a hospital employee but still being in private practice I think it can be a little vague to people am I in private practice if I'm not an academic maybe but when we look at the traditional the old school solo practitioner that almost doesn't exist anymore.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I tell the story all the time that when I was growing up, my pediatrician lived across the street and had an office attached to his house. And if we were sick, my mom would call him and he'd go run over and open his office and we'd go see him. Nobody does that anymore, right? Or almost nobody does.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I think a lot of people who are in solo private practice are running more concierge practices rather than the traditional old school way of, you know, hanging up a shingle and opening your practice. There are a lot of policy reasons why that's happened over time. And so we've been following that trend since the census started in 2014.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I think as we use our census data for advocacy purposes, the fact that so many urologists are now employees, and it's so hard. to be in certainly solo private practice, but in private practice at all is really interesting.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And, you know, it also has led us to ask more business related questions like regarding private equity acquisition of urology practices, for example, to try to understand how that's going to impact practice in the future, because it's something that we're starting to see now. And we need to be on the forefront of understanding what that means for the
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, I'll take that one because it goes back to how we structure the census every year. So we actually have a spreadsheet with rotating clinical topics that get asked on a cyclical basis. And so endourology and stones was up for this year. And then we partner with the Endourological Society and the data committee members who do endourology to solicit questions that are specific to endourology.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So you'll see in addition to the question about double J stents was a question about laser acquisition and trying to understand how quickly practices across the country are picking up new technology? And are rural hospitals picking up new technology or only academic centers? So these specific questions came from our endourology colleagues.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But the idea to put stones on this year's census, it was... It was Stone's turn to be on the census. So you'll see that there are different clinical topics. We try to do some that are related to hot topics in urology. For example, we recently asked about transgender care because transgender care has been a hot topic that was on last year's census. We felt that it was time to ask more about that.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But Stone's, it was Stone's turn this year. So that's why Stone's is on this.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So that's a great question. One of the things that I felt really strongly about when I became data chair was democratizing both the way that we create the census and the way that the census data is accessed by members. There was a feeling...
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I had from having been a member of the data committee and having had unprecedented access to census data, that it probably wasn't fair that I had access to data that other people didn't. So there are two ways for people to access census data. Well, three, actually. One is there are committees in the AUA that get access to data to do publications. So I'll give you an example.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I'm on the AUA Workforce Workgroup, which falls under legislative affairs. And the AUA Workforce Workgroup gets two papers worth of data from the census in order to write papers that support the legislative agenda of the AUA. So I'll give you an example.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
We published two papers looking at the impact of student loan debt based on census data, one for the resident fellow census, one for the practicing urology census that has now been used at the advocacy summit. many years in a row to support student loan debt forgiveness for urologists who practice in rural areas, right? And so we worked with the legislative affairs team.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
We work with the advocacy team to come up with what topics they want on the census, but then to also publish papers. So we have peer-reviewed published data that we can bring to Congress and say, look, this is an issue. Here's good, strong data to support that issue. So you can join AUA committees and volunteer your time and have access to data.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But the other two ways to access data is you can apply for data through the AUA website. If you go to the census part of the AUA website, you will see that you can apply for data. They do charge a fee to access the data. Depending on whether you just want raw data or you want statistical services, you work with the data team and they will help you figure out how much that costs.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And the other way is the way that Dr. Nielsen just mentioned, which is to apply for the data research program, which we're in the middle of reviewing the letters of interest from the second round. We had six awards last year, and we're in the process. I finished my preliminary review of all of my letters that I had to read today.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And we will award four census grants and two ACWA-related grants by the end of this year. And so that's another way for people to apply for data. And what you get from that data research program is you get the full support. You not only get the data, but you get the full support of the statistical team at the AUA, as well as a small amount of travel money to disseminate your project.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So to like attend the annual meeting and present your abstract. And the AUA gives you a small amount of money for that also. So we've had six awardees from last year and we're planning to have six more this year. So for anyone who hasn't heard of our data research program, I'm really excited about it because it is a way for anyone.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And we really do try to get, you know, junior level people access to the data through that program.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And both telehealth and the prior auth questions, We work in collaboration with the Legislative Affairs Committee. There is a telehealth subcommittee at the AUA who comes to our census planning meeting every year to advocate for our telehealth questions. But Brad Stein, who does a lot of the advocacy work for the AUA, he's full-time staff at the AUA.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I've been working with Brad for at least 10 years on these types of issues. And the one phone call that I make before we finalize the census questions is to make sure that Brad's team is has the data they need for the work they do in Washington DC on behalf of all practicing urologists. And telehealth and prior auth are two topics that they really advocated for us to put on the census this year.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
The prior auth questions came straight from Brad's team, word for word, based on some of their meetings with some of the other medical specialty groups with the kinds of questions they've been asking their members. And so just another plug for people to fill out the census. This data goes to Congress. period, hard stop.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
This is the data that the AUA needs to fight for things that are gonna make our practice lives better. Lawyers get paid hundreds of dollars for a 10 minute phone call with a client and they wanna take away any payment for a telephone only telehealth visit that we're doing because our patients don't have access to the technology to do it on video, really? I don't understand that at all.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so if you don't fill out these questions, we don't have the data that we need to go to Congress. And so with prior auth, the data is appalling. Over half of urologists said that prior auth at least moderately affects clinical outcomes. More than a third said severely. Peer-to-peer consultation is almost never with a urologist. I personally have never spoken to a urologist in a peer-to-peer.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And half of urologists are doing more than 10 prior auths in a typical week. This is a huge waste of everyone's time. It's bad for patient care. It is bad for patient care. It is bad for patient care. And if you spend any time on social media listening to patients deal with prior aughts from their end, it is horrific.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so, again, this data is super important to our advocacy team because this is what they use to go to CMS. And I've attended meetings with CMS where we talked about prior auth. And I'm talking about five years ago before COVID. I was invited to some of those meetings. Prior auth is a huge burden on everyone in the health care system except the insurance companies who want to gatekeep.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And when the insurance companies are making millions of dollars and urologists are taking salary cuts – Something is wrong, right? Our patients should not be paying the price for this. And again, this data comes from all of you filling out the AUA census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, we found, and as a caveat, we have asked the Maslach Burnout Inventory on the census. We ask every five years. So it was asked in 2016 and 2021. This was a quick question, are you experiencing burnout? So that we could then assess some of the factors associated with burnout, which was really the point of the burnout questions on this census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
These questions came to us from the Workforce Workgroup, who's been studying burnout for decades. almost a decade now. And 71% ever experienced burnout with one third saying they are currently experiencing it. And 12% experienced in the past, but are still experiencing it now. 85% of women in urology say that they have some sort of burnout. I mean, it's really bad. But only 17%
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
are seeking professional help. And one of the things, again, this goes back to our advocacy efforts, is to understand the impact of state licensing requirements. When our states ask us about whether or not we've had any mental health care, does that prevent people from getting mental health care? And it does, 43%. So we're working on a paper to try to look at this now.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
We're looking at the data now. It's in the beginning stages to look at which states ask these types of questions on their licensing of renewals. And if that specifically has an impact on whether or not people said that they were afraid for their state licenses, because every state is different and not all states ask those types of questions.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But I do think it's a big state advocacy issue to be able to go to the state legislatures. And again, the AUA has a state advocacy team. And so we want to be able to give them this data to help fight for us to be able to get mental health care. without it stigmatizing our ability to practice urology. So this data is super important on a state level.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
You know, these aren't even microaggressions, right? But we know that microaggressions have impact on people in their day to day lives. And I tell the story. I've been in practice 17 years and I still get asked questions. If I'm the nurse in the recovery room at the children's hospital on a pretty regular basis, which is kind of discouraging, given that I'm the chief of pediatric urology.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Now, you would think that that would come with some recognition, but no. But this kind of patient driven harassment is really upsetting. And I think there's a theory in our culture, I think, that people's behavior has gotten worse since COVID. We don't have data anymore. From earlier, these questions were submitted by Dr. Kathy Nam at Michigan as part of a grant that she's doing.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So she's going to be writing up these questions. They were included on the resident and fellow census and the advanced practice provider census also. So we should have some really interesting data from her in the future. But she had asked us if we would include them on the census as part of a grant she received, and we were happy to do so.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But it would have been interesting to know if this is spiraling out of control because we all stopped knowing how to behave when we stayed home from COVID for too long, or if this has always been the case. We do have older data on sexual harassment of women urologists back from the 2017 census. We asked those questions. It may have been 2018.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I may have my data wrong, but it was one of those two years we asked about sexual harassment. But it was specifically just sexual harassment. It wasn't specifically patient driven sexual harassment. So this is really interesting data. And I hope we're able to get follow up data in five years on this to see hopefully we're moving the trend in the right direction.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, and as we hop on the Dr. Krauser bandwagon, we've been teaching a course on burnout at the annual meeting. And a couple of years ago, we shifted the focus from burnout to wellness. And we added Dr. Krauser as an additional faculty member. And she actually helped us develop these questions for the census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So it's funny that we all mentioned her, but she does deserve a lot of credit because she was involved in getting these questions on the census this year. Yeah.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, and wearing loops too, right? As a pediatric urologist, we know that the traditional loops are terrible for your neck. There is a lot of concern that the ergonomics of the instrumentation for laparoscopic and robotic surgery is particularly poorly designed for smaller surgeons, which includes a lot of women. I'm a smaller surgeon myself with smaller hands.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so I think one of the concerns was to really understand the impact of the instrument design. I know we don't get into it that much, deeply on this census, but the impact of those instrumentations on women. And as we see, the women had higher rates of ergonomic injury. Great.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
No, just a last minute plug for people to fill out the census this year. It will be open through the end of September. The census opens at the annual meeting every year and it closes on September 30th. We have a new head of statistical services at the AUA, Lex Hessel, who is amazing because she comes to us with a background in survey design.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so she's been really helpful in terms of getting us to think about how to word questions in a way that will maximize the value of the responses we get. We've also democratized the way that we solicit questions so that there will be an email sent out with a form that people can fill out online if they have ideas for future census questions.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
We do keep a rotating schedule of some of the topics that we think should be asked, but we're pretty open-minded and especially for hot topics. Prior authorization was a hot topic this year because our legislative affairs people wanted it. But as you mentioned, locums is another really hot topic that we're interested in.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we love getting ideas from people from all various specialties and practice settings because I think it's really important for us in the future to have everyone's voice heard on the census, both in terms of the questions that we ask and then, of course, in responding to the census. So that'll be my little plug.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, so we just asked last year about OAB and stress incontinence. We are learning over time, because I've made all the mistakes you can make, that grouping topics together often makes sense. Hematuria and all of the cancers that come from hematuria have been grouped together. So kidney and Bladder cancer, for example, into one setting, trying to understand uptake of guidelines.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So are people, you know, there was a microhematuria guideline that came out recently. Are people following that? We'd like to know. So, you know, assessing the utility of AUA educational tools. We did ask last year about torsion treatment because we know in pediatric urology, Having patients transferred from long distances with torsion can be very detrimental to the future of their testicle.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we're working on a paper. We're looking at the data now. It's in the beginning stages to look at which states ask these types of questions on their licensing renewals. And if that specifically has an impact on whether or not people said that they were afraid for their state licenses, because every state is different and not all states ask those types of questions.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we do have a whole rotating schedule that our AUA staff does a really good job of keeping us on track with that for specifically for clinical topics. And then we do put some business and legislative related stuff in every year. So Maslach burnout inventory is every five years. So that'll next be on in 2026. So keep a lookout for that because that's always an important one. Thank you.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Social media and PR by Chi Ding. Administrative support provided by Jamila Kinabru.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Wonderful. Thank you, Dr. Nielsen. And thank you, Dr. Sutherland. So the census was originally the brainchild of Raymond Fang, who was the now retired head of statistical services at the AUA. And he brought the idea back in 2014 of doing a survey of all practicing urologists. And over time, the census has really grown. Originally, it was just looking at practicing urologists.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But now there are actually multiple censuses that get published every year. So the one that we're talking about is the 2023 Census of Practicing Urologists. But we actually publish... a census divided by AUA section. We publish a census with residents and fellows. We publish a census on advanced practice providers and also a census looking at international urologists.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So the census isn't just one thing. It's multiple publications and they are all available for free on the AUA website if you're an AUA member. So I'll just put a little plug there for that. And, you know, there's been a host of publications that have come out of these 10 years worth of census data. Going back to your question about 13.5% response rate and is that really representative?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
This is a question that comes up a lot when we publish papers using census data. And my counterargument to that is, are there any other surveys that have 2,000 urologists responding every year? And while 2,000 urologists may only represent 13.5% of our practicing urology community, it is a huge number of doctors who are responding to the census. every year.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
When the census data is published, it is weighted to represent all practicing urologists. And I, as a disclaimer, I am not a statistician, but we have people who are experts into statistical services who create the data that you see on the website, and it has been weighted to represent all practicing urologists.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So as a disclaimer, for those who want to just pull the census data off and publish based on that, doing their own statistics, it's actually not a good way to do it. It's better to get the data from the AUA, which you can do, because it has been weighted to try to represent our entire practicing urology community.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so I think that's a really important disclaimer when we're talking about a 13.5% response rate.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Obviously, there's going to be a response bias. And it's hard to say who has the response bias. At least half of the responses to the census respond at the annual meeting every year. So every year at the annual meeting, we have stations set up with computers and AUA staff, and we strongly encourage people to come fill out the census by giving them little freebies. super cute t-shirts.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I have a pair of AUA census sunglasses that are to die for. I wear them every day. And so we bribe people to come fill out the census at the annual meeting. So we do skew slightly heavily towards whoever attended the annual meeting that year, which is also how we get a lot of our international respondents, by the way. And then, of course, there's word of mouth. So I'm sure that
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
People who are active on the platform formerly known as Twitter are getting constant reminders because we tend to tweet. I think we still call it tweeting. We tweet and retweet the link to the census. So there is a little bit of a bias towards that. Our partner organizations, for example, my friends and colleagues in SWOO, are very good at encouraging people to fill out the census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So I wouldn't be surprised if we get a disproportionate amount of women because we really push the census through SWU, thanks to all my friends in SWU who have been helpful with that. So yes, there probably is a little bit of a bias.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
We know that people who are truly disconnected from the AUA are going to be less likely to fill out the census, but it's still a pretty large number of respondents overall. So given that any survey is going to be somewhat biased, I think the census is the best we're going to do, at least for now. Has it been pretty consistent over the years?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So I actually looked back in preparation for our talk today. And back in 2014, we had 2200 US respondents. And in 2023, we had close to 2000 respondents. So it's been pretty consistent. I think around the time of COVID, especially when the annual meeting was virtual instead of in person, we definitely saw a dip. I think there was also some email and survey fatigue around that time.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So there was a little decrease in response when the meeting was not in person, which is to be expected. But we've been pretty consistent over the years.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, this is something we've been looking at for a while. And interestingly, the percentage of women in urology has been flattening over the last couple of years. So we went from 7.7% when we did the first census. And then last year, it was 11.6%. And we only went up to 11.8%. And that could be a little concerning.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But when we see that 1% of urologists over 65 are women and 25% of urologists under 45 are women, we know that in about 5 to 10 years when that cohort of older men finally retire, we're going to jump up to 25% pretty quickly. And I feel pretty confident about that. But it's interesting because women in urology practice fundamentally differently from men.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And this is something I've been talking about for several years. Women are more likely to be fellowship trained. Now, younger urologists in general are more likely to be fellowship trained. But at every age group, women are more likely to do fellowship. Women are more likely to be in academic practice. Women are more likely to be in employed practice.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So even if they don't choose academic, they choose practice situations where they are employees instead of practice owners. And again... Younger urologists are more likely to be in employed practice, but at every age group, men are more likely to choose private practices where they may have ownership stakes in the practice compared to women.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
In terms of what fellowships women do, we know pediatrics and female urology are the two most highest percentage of women in each of those specialties. Perhaps not surprising. I mean, we know in pediatric urology, the percentage of women is quite high now, especially compared to the overall urologic population.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And we know women see fewer patients each week, but they spend more time with each patient. And this we think is one of the contributing factors to the gender pay gap. That we talked about from the census a few years ago, we actually published a paper on that. And there are a lot of factors involved in the gender pay gap.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But the fact that women see patients who require a little bit more time, maybe a little more TLC may have an impact on their ability to see as many patients as their male counterparts.