Dr. Matthew Nielsen
Appearances
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Thank you very much.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I perceive that an element of it is that to the extent that a urologist coming out of training has a particular interest in a certain subspecialty area, and many are going to communities that already have a relative abundance of urologists, that to be able to have that practice, it is challenging in a lot of communities for a person to have that subspecialty practice element without the fellowship.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Whereas the distribution of urologists is such that those who go into practice in a smaller community may be more inclined to do a little bit of everything just by nature of how it works. And I think it's a good question that, to my knowledge, we haven't really gotten into in the census. But these conversations always lead us to things that might be important questions for us to ask.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, I think that the information that we get at in the census asks the respondent what their primary area of practice is, and then also questions about are these subspecialty areas part of your practice. And so for the answer to the primary area of practice, 12% identify, 12.3% identify oncology, 6.7% identify pediatrics. and 5.1% identify endourology and stones.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But at the same time, as many of us know, one of the things that draws people to the field is the diversity and the opportunity to cover all these areas. So nearly two-thirds, 65% of respondents, have oncology and endourology and stones as part of their practice, and over half, 56%, have ED. Yeah. As part of their practice.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, yeah, we don't know the answer for that. You didn't ask that. We didn't ask that specifically.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, I think, to your point, there's a lot of research on practice patterns and a lot of health services research in the field. But there are many questions that people are just sort of curious about to have a sense of what is the sort of prevailing norm in the specialty that we really can't get at from other data sources.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So, you know, claims data, BMR, you know, things like that, even with our aqua registry, which is, you know, an incredibly rich resource. Some of these factors in terms of, you know, what kind of laser is being used, you know, what is the sort of specific way that you're managing this or that pretty common practice is an opportunity that we have in the census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so that's where, as Dr. North was saying, there, you know, this through this rotating cadence of subspecialty areas over the years. were able to cover a lot of different areas and get insights that are questions that can't be answered through other readily available data sets. One of the other applications and advantages of these kinds of unique data within the space was
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
are that those responses can then be mapped back to respondent characteristics. And so many people in the field have availed themselves of the census data as an opportunity to do research. And that has been a very productive thing for the field, has given us beyond the really, really rich resource that is the publication that comes out for the census every year, specific resources
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Thank you so much for having me. And that program is an opportunity on an annual cycle for folks who have those sorts of questions to ask in CensusData or AquaData to put a proposal forward that could be an opportunity to do some research with support of AUA Statistical Services.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Thank you, Dr. Salomon. It's really terrific to be with you today.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, great question. And this is another topic that gets into what Dr. North was alluding to, how we try to use the census to help us inform our very effective advocacy work, bringing important topics like this to Capitol Hill in the Advocacy Summit every year, where we have data from this real-world practice sample that is the census.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So from this last year's 2023 data, about 10% of the total visits were video, was reported by about 23% of the urologists overall. And the rates of this are still, though those numbers are small, those are still significant. significantly higher than many of our colleagues in surgical specialties. And so I think it's also noted that a number of the visits, about 10%, were audio only.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And this is something that, you know, many of us encounter in our practice for a variety of different, you know, Patient technology barriers, broadband barriers, having the opportunity to be reimbursed for that time that is, you know, excellent patient care delivered over the phone is something that's still important to a lot of our members and their patients.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Work in this space, I think, gets into some of the opportunities we have as we think about and try to problem solve for the distribution problem we have with over-concentration of urologists in some communities and a real desert of urologists across much of the country, how we can keep that message on point of the opportunity for these telehealth modalities to provide access in a more equitable way across the country.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, great. Thank you so much, Dr. Sutherland. So this work is, as you mentioned, housed primarily in the AUA's data committee. And AUA has a wide variety of committees covering the waterfront of the issues in our education and research mission, as well as public policy, advocacy, and all the areas touching urologic patient care and education.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Within the Science and Quality Council, we try to coordinate the activities across the Guidelines Committee, the Quality Improvement and Patient Safety Committee, and the Data Committee. And the census is one of the crown jewels of the Science and Quality Council and a really big effort of the Data Committee.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, I think, you know, we were excited to have these questions in the censuses here. And I love that you had Dr. Krauser on this topic. She has just been such a great leader for our field and really bringing this to light. I mean, I honestly don't remember, you know, when I was going through training, anybody ever talking about it.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But I, you know, people had, you know, sore necks and sore backs and other, you know, other things that were reflecting the issues in play here. But I am excited for the field and for the next generation of the field to have this front and center and be able to get some information out there.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So, you know, so I think that we, with this have an opportunity to just, you know, just by raising awareness of it, and, you know, raising awareness and connecting people to the resources that are out there.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
There's a society of ergonomics in surgery that is, you know, really thinking about this as, I mean, it's a patient access issue, you know, to the extent that we can take care of ourselves as surgeons and keep ourselves in the game that much longer, aside from our, you know, physical health, it's also for the good of our patients.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
were excited this year to celebrate the 10-year anniversary since the census has started. Dr. North is one of the leaders of this effort who has been leading the way in the census for many years, even before she assumed her current role as chair of the data committee.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So I think it's a really important topic that we're excited to have as a part of this.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
43%.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
As a data committee member and as just an active leader in the AUA, she has been a driving force behind how this has grown over time. along with many others on the AUA staff and many other urologists across the country who have really come together to help us figure out what those important questions are. So we are really grateful to Dr. North and all of those who've led the efforts.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, I'd say, you know, thank you so much for the opportunity to come on. Dr. North, you know, just briefly alluded to it there, but just to sort of call it out, in addition to her amazing leadership and all the physicians who were on there, we're really grateful to the AUA staff who make the magic happen behind the scenes.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And so when you go to the annual meeting and fill out your census next year, please thank them as well, because this has been a great resource for us. It's really...
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
a unique data set that we control you know we can we can sort of you know think of these questions as dr north said a theme hopefully across the the conversation today is democratization both of access to data you know having people bring their good ideas you know we solicit questions every year and the the opportunity to do research on these uh data sets is there
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And then finally, to the theme of burnout that we talked about towards the end, I just would encourage all of our listeners to really reach out and get involved with activities with the AUA. It's a nice antidote to burnout to be able to make friends across our subspecialty areas across the country. and make a difference for our field.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
As Dr. North said, a lot of these things have impacted our policy and advocacy agendas and have given us really great insights.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So I would just encourage everybody out there to look at your AUA emails that give a constant stream of opportunities to get involved, either with our committees on the Science and Quality Council or elsewhere, because it is, at the end of the day, a really lot of fun, and we love our community of urologists.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
As the chair of the Science Equality Council, I am involved and supportive of this, but I think the credit for this work and the really detailed behind-the-scenes work that has made this such a valuable thing really is due to Dr. North and others who've been more focused in that data committee space.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And Ness Smith-Zavidoff. Design and digital marketing led by Brian Schmitz. With support from Devante Delbrun.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
It's a really sort of fascinating insight, and I think it's helpful for all of us to sort of see beyond what we're used to in our day-to-day routine, both for folks in academic practice and in community practice, to get a glimpse of what practice is like broader across the nation.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So about nearly 90% are in the bucket defined as actively practicing, which in the survey responses is practicing at least 25 hours a week. That recognizes that many people who are maintaining an active practice are in that category, but this is the way that the answer is coded there.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
The urologists are distributed across the country in uneven ways geographically in terms of the urologist to population ratio with New York, Dr. North's home state, having 5.7 urologists per 100,000 population, and North Dakota having 2.75 urologists per 100,000 population. So Looking at the absolute populations of those states, the numbers are even more dramatic and profound.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Right. And that, you know, that points back to information that, you know, we've seen from other data sources that the majority of U.S. counties do not have a urologist. So the distribution problem that we have in the specialty is something that these data highlight.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
A lot of the workforce is getting into the later part of their career with the largest age group in the census being over 65, almost 30 percent of the urology workforce is There's also been some interesting changes over time in terms of as we have become a more diverse field, the number of women in the over 65 age group is relatively small.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But we're excited about the fraction of women in the younger cohort of the age group where we have about 25 percent among respondents less than 45 years old.