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 highlights the role that advanced practice providers (APPs) can play in filling the gaps created by the growing work force shortages in urology. Bunce is a physician assistant at Advanced Urology Institute in Naples, Florida.

Specifically, Bunce outlines the help that APPs may offer in the treatment of patients with benign prostatic hyperplasia (BPH), which she highlighted during a session at the most recent American Urological Association (AUA) Annual Meeting titled, “Choices That Matter: Optimizing BPH Care for Urologists, APPs and Patients.”

Bunce comments, “This is something that's going to help prolong physician longevity, which will also extend and help with the physician shortage. The amount of effort and energy that a physician can pour into their APP will have a return on investment greater than you could imagine.

Don’t forget to subscribe to Speaking of Urology® on 

, or anywhere that podcasts are available.

In this episode, Janelle Bunce, PA-C, highlights the role that advanced practice providers can play in filling the gaps created by the growing workforce shortages in urology. 

How APPs can bridge the gap in urologist shortages

Every year, young urologists start their long-awaited exciting careers after going through a few challenging years in residency. Dr. Bristol Whiles, who recently graduated from her residency in urology, talks about her trajectory in these hard times and brings us some interesting thoughts on how to overcome the difficulties that inherently residency brings us, but at the same time be productive and competent in what is expected of a great resident. Although it is common sense that a resident works incessantly, it does not mean that they cannot dedicate some time for their families and hobbies. The one-million-dollar question is: “how can they do that?”, and she talked us through some game-changer ideas, useful not only to residents, but generalizable to every profession. Brilliant in every way, she managed to excel not only in the triviality of the everyday assignments of a good urology resident but also showed above-average engagement in cutting-edge research at the university, which was a determining factor for her choice to engage in a minimally invasive surgery fellowship program. Finally, she gives some insights to younger residents that aspire to stand out and excel in their future careers.

On this podcast, Bristol Whiles, MD, discusses her urology residency experience at the Kansas University School of Medicine Department of Urology.

Dr. Bristol Whiles discusses her experience as a urology resident

® Assistant Editor Janelle Hart spoke with 

. She discusses why and how mentorship can be valuable at any point in a urologist’s career. Suskind is an associate professor of urology and obstetrics, gynecology, and reproductive sciences, and a chief of neurourology and female pelvic medicine and reconstructive surgery at the University of California, San Francisco.

“Open your mind to being both [a mentee and mentor,] no matter where you are,” says Anne M. Suskind, MD, MS, FACS, FPMRS.

The “reciprocal relationship” of mentorship in urology

 She discusses how and why urologists are succumbing to burnout and depression and suggests ways in which they can improve their mental health in their everyday practice. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California.

“We cannot give if our cup is empty,” says Diana Londoño, MD.

Consequences of burnout and depression in urology

. He discusses why it is so important as a physician to be educated on the tips and protocols associated with identity theft. Moyad is the director of preventative/complementary and alternative medicine in the department of urology at the University of Michigan Medical Center in Ann Arbor, Michigan.

“I thought identity theft was simple. You fix this 1 little thing. Today, what physicians and health care professionals need to be on the lookout for is [that] it's much different,” says Mark A. Moyad, MD, MPH, on the latest Speaking of Urology podcast episode. 

Dr. Moyad discusses the reality of identity theft as a physician

 discusses findings from the study, “Failure to Attend Urology Appointments: A Retrospective Analysis of a Single Urban Academic Practice,” which was published in 

. White is a urology resident at Maine Medical Center, Portland.

“I think one of the most surprising things to us as we started to look at the data is that we had a very low rate of no shows amongst telemedicine visits,” says Randie White, MD.

Urologist Dr. Randie White discusses appointment no-shows

study, “Impact of urology trainee debt levels on future practice choices and expectations,” for which he served as a study author. Harris is an assistant professor of urology at the University of Kentucky, Lexington.

“We really found it surprising the sheer amount of debt that our urology trainees are carrying,” Harris said.

Dr. Andrew Harris discusses debt levels in urology trainees

discusses the recent Urology Practice study, The impact of stricter guidelines on post-interview contact, restricted interview topics and differences by gender in the urology match, for which she served as senior author. Kielb is chief of reconstruction and neurourology and professor of urology, medical education, and obstetrics and gynecology at Northwestern University Feinberg School of Medicine, Chicago.

“I think the take home message is that when you're interviewing applicants in your program, take a step back and think about the questions you want to ask,” says Stephanie J. Kielb, MD.

Dr. Stephanie Kielb on curbing restricted questions in the urology match process

 discusses findings from a recent study published in Urology titled, Gender differences in authorship in urology: a five-year review of publications in five high-impact journals, for which she served as senior author. Kieran is an associate professor of urology at the University of Washington, Seattle.

Kathleen Kieran, MD, MSc, MME, discusses findings from a recent paper published in Urology.

Study evaluates authorship for women in urology

"Without interoperability, electronic insurance billing would be nearly impossible. Insurance payers, healthcare providers and claim clearinghouses all rely on interoperability at their core," writes Lisa Taylor.

Expert explains the crucial role of interoperability in medical billing

"Specialty providers can take three steps now to succeed with MIPS while prioritizing caring for their patients," writes Wayne Singer.

MIPS success: What specialists need to know

"The mental toll of excessive screen time is a pressing concern in health care," writes Neil Baum, MD. 

Urologist shares advice on maintaining a healthy screen-life balance

"The future of quality measurement is multiple different inputs to give us the best picture possible of the care we provide," says Timothy D. Lyon, MD, FACS. 

Study shows limitations of US News ranking system for urologic care

"All participants in the process must recognize that telehealth is a resource for rendering health care and not a different type of practicing medicine," writes Richard Cahill, JD.

Expert advice on safeguarding your practice when implementing telehealth

Jennifer Robles, MD, MPH, and Kara L. Watts, MD, summarize key takeaways from the 2023 American Urological Association Quality Improvement Summit

Dr. Robles and Dr. Watts share takeaways from AUA QI Summit

 summarize key takeaways from the 2023 American Urological Association Quality Improvement Summit. Robles is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee, and Surgical Quality Officer and Chief of Urology at the Tennessee Valley (VA) Healthcare System, and Watts is an associate professor of urology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.

Please provide an overview of the sessions presented at the 2023 AUA QI Summit.

 We really wanted this summit to be a combination of things. The priority was to provide practical tips for urologists about how to incorporate telehealth into their practice, how to do it better, how to do more of it, and how to reach patients. But the other half of it was really to talk about barriers to telehealth, and that includes national policy barriers, billing barriers, medical ethics, and questions and concerns about telehealth. We really tried to have talks and panels that addressed both sides - both how to incorporate telehealth as well as potential barriers to telehealth.

Both you moderated the session "How to Effectively Incorporate Telehealth Into Your Practice." Could you summarize some takeaways from this panel?

This was actually, I think, one of the highest yield presentations that we had in the summit. It was a lot of what we think urologists as well as attendees were looking for - [hearing from] people who are successfully incorporating telehealth into their practices, how have they done it and what have they learned in doing so? A couple of things really resonated with us that we were hoping to share here. We had a number of speakers from the majority of the [subspecialty] domains within urology. Dr. Helen Bernie, who represented men's sexual health, talked about the different conditions that she sees and evaluates within her practice. The main things that she had mentioned were that a lot of the conditions are entirely amenable to evaluation initially by telehealth with the exception of Peyronie disease and erectile dysfunction. She has found that in her practice, those are more amenable to being seen initially in person but then follow-ups might be better by telehealth. Dr. Julia Finkelstein, from pediatric urology, also has done extensive research in telehealth in pediatric urology and she talked about, basically, chief complaints related to testicular or penile conditions are better evaluated in person initially, but the remainder of conditions being amenable to telehealth. The other thing that stood out was most of our panelists have shifted away from doing full days of telehealth. Those who incorporate telehealth in their practice really do so in set blocks within their schedule. A lot of people showed really great examples of what this looks like. What the resounding theme was maybe a brief block either at the very beginning or the very end of their clinic day so that they can accommodate the in-person visits around that and have set times for that. The last thing I'll just add is Dr. Adam Gadzinski, who's both endo and uro onc in the Pacific Northwest and has done quite a bit of research in telehealth outreach in rural communities, made a really interesting point that 62% of counties in the United States don't have a urologist. It just underscores the importance of telehealth. There's such a shortage of urologists in the United States, and it continues to worsen. There's just a tremendous opportunity for telehealth and being able to increase delivery to patients in these areas or at least reduce their amount of travel time to get to see a urologist based on where they live.

 Another aspect that several of our panelists highlighted that I thought was really interesting was the fact that telehealth is really uniquely suited and really uniquely beneficial for patients who are seeing us for sensitive issues, which is a huge amount of patients in urology, a lot of patients are much more comfortable if they're at home, they're in private, they're not in a public waiting room. Second is for patients that maybe have mobility challenges, both pediatric patients as well as adult patients, it's much easier for them to do telehealth visits than to harness all the resources that they may need to make it to a clinic visit. That was something that I hadn't really given as much thought to but thought was really beneficial.

This transcription was edited for clarity.

Videos

"There's just a tremendous opportunity for telehealth and being able to increase delivery to patients in these areas or at least reduce their amount of travel time to get to see a urologist based on where they live," says Kara L. Watts, MD.

Michael Karellas, MD, discusses the potential uses of artificial intelligence in urologic cancers

AI and urologic oncology: An expert’s view

 discusses the potential uses of artificial intelligence in urologic cancers. Karellas is an assistant professor of urology at Yale School of Medicine a member of Yale Cancer Center in New Haven, Connecticut.

In general, technology is improving our day-to-day practice overall. I think that, across industries, AI is going to provide a great benefit to our day-to-day practice. But in the oncology world, the way it's helping us primarily right now is in the data research and some of the algorithms behind the scenes. But in day-to-day practice, we're not quite there yet, as far as having AI dictate your cancer care. As an extension of that, most of the cancers that we treat have guidelines that are established by national bodies that are evidence based. From that aspect, we rely on AI heavily or just database management in general, but the way the guidelines are structured, and for most cancers, there's a nuanced approach and an individualized approach for patients with their cancer care. Our challenge over the years has been to try to integrate the data with the patient care, and I think AI will help us with that, but we're not quite there yet in a day-to-day practice modality.

"I think that, across industries, AI is going to provide a great benefit to our day-to-day practice," says Michael Karellas, MD.

Dr. Sumit Saini discusses the urology work force and the need to increase diversity

Dr. Saini on increasing diversity in the urology work force

, discusses the current physician shortages and the need to improve diversity in the urology work force. Saini is a urologist a Allegheny Health Network in Pittsburgh, Pennsylvania.

We have to understand especially when we talk about urology in particular, there is a physician shortage. There is definite physician shortage, and as per the current data, there are only 38% of counties across the US who have practicing urologists. There is a definite shortage, so not just increasing the diversity, but we have to increase the work force itself. Increasing the work force means that we have to increase the number of residency programs and the positions, so that we have more people who can work and help and treat the communities. That's the broader picture.

Now, the second part is how are we going to improve the physician shortage? We can do [that] by accepting people who are internationally trained. They can increase the work force and they can work as practicing urologists, even if they are trained outside [the US]. In fact, recently, Tennessee passed a law in which they have actually allowed internationally trained physicians, not just urologists, but all kinds of physicians to practice, and they can skip or bypass the residency requirements to practice. That is going to improve the physician shortage. Now, when a person from a different country and trained in a particular work environment comes to the US in practice, it's going to increase the diversity because they have their own experiences, which is going to enrich the overall picture or overall outcomes. They can bring something new to the table. That's one way of increasing the diversity.

This transcription has been edited for clarity.

"There is a definite shortage, so not just increasing the diversity, but we have to increase the work force itself," says Sumit Saini, MD

Dr. Suskind discusses her role as associate chair of faculty affairs and diversity, equity, and inclusion

Begin Your Journey: Dr. Suskind on wellness and mentorship at UCSF

In this installment of “Begin Your Journey,” host 

discuss her role as associate chair of faculty affairs and diversity, equity, and inclusion. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina. Suskind is an associate professor of urology; obstetrics, gynecology, and reproductive services, associate chair of faculty affairs and diversity, equity, and inclusion, and chief of neurourology and female pelvic medicine and reconstructive surgery at the University of California, San Francisco.

Was your dad a psychologist or a psychiatrist?

Yes, wow, you have a good memory. My dad is a psychiatrist and psychoanalyst, and so I grew up in that kind of house where we always talked about our dreams and feelings. I was always fascinated, even from a very young age, about what motivates people. Why are we the way that we are, and how each of us is different. That's kind of the world I grew up in. I'm clearly not a psychiatrist, but I've been influenced by lots of different forms of thought.

What does the associate chair of faculty affairs and diversity, equity, and inclusion role entail?

It's pretty broad, and it's been open to interpretation, so I've interpreted it in ways that make sense to me. But it includes a lot of the traditional things like overseeing promotions, and making sure that faculty have the resources and everything that they need to be successful. I've been able to develop programs, which are a lot of fun. One of them, called an incubator pod, was formed during the pandemic, when we weren't really able to see each other in person too much or interact and people were really wanting that connection. The other thing is, at UCSF, we have faculty that practice at various different campuses, and so even on a day-to-day basis, we may not see people who practice across town very regularly. We also have a lot of basic scientists who work in labs, and we don't necessarily see them. So there was this kind of yearning for integration and getting together. So a whole team of people helped me [create] topical meetings among small groups of faculty every other month, and they're still continuing on to this day, and we provide different agendas of things that people can talk about, like mentorship, or promotions, negotiations, failure. We've had now 12 [of these], so there's a lot of different topics. It's really an opportunity to bring people together who wouldn't normally work together, have them share about their own experiences and learn from one another, have some sort of peer mentorship or other types of mentorships. That's been one of the things we've done. I've also developed mentorship programs within the department. This is one of the things that is most fun for what I do is we developed a mentorship program for all of our junior faculty. So for the first 3 years that people join us, there's a whole program set up for them to help assimilate them into the culture, get them the resources that they need, make sure that they're meeting their benchmarks and goals. And it gives me an opportunity to really understand what they're interested in, what lights them up, and help to hopefully guide them along a path that is what they would define as successful. And it's really fun to tailor that to everybody individually. And then I've been working more recently on getting others involved so that others have opportunities to provide mentorship, etc. We actually have a faculty member, Michelle Van Kuiken, [MD], who is our wellness champion, and so she also oversees a lot of additional wellness activities, and at UCSF there's a lot going on across campus in those realms as well.

"For the first 3 years that people join us, there's a whole program set up for them to help assimilate them into the culture, get them the resources that they need, make sure that they're meeting their benchmarks and goals," says Anne M. Suskind, MD, MS, FACS, FPMRS.

In this installment of “Begin Your Journey,” Scott A. MacDiarmid, MD, FRCPSC, introduces his latest guest, Anne M. Suskind, MD, MS, FACS, FPMRS. 

Begin Your Journey: Dr. Suskind on her interest in mindfulness

In this installment of “Begin Your Journey,” 

. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina. Suskind is an associate professor of urology; obstetrics, gynecology, and reproductive services, associate chair of faculty affairs and diversity, equity, and inclusion, and chief of neurourology and female pelvic medicine and reconstructive surgery at the University of California, San Francisco.

 Welcome everyone, this is Scott MacDiarmid, and welcome to our series entitled "Begin Your Journey." It's a physician wellness series; we try to make it very interactive. I really want to thank 

 for supporting this endeavor. It's nice having people like 

 really helping us speak about physician burnout. The goal of this series is to do anything possible to help create a world that lifts up health care providers who serve our nation, so they can be joyful and really love what they do. I love interviewing people and just listening, and it's really bringing on experts that have a similar passion to help create this world. Burnout is a public health crisis. There's not enough doctors and nurses loving their job anymore, and we have to take that quite seriously. And what Anne and I are trying to do today is to give some practical solutions, not just talk about the problem [but] give some solutions that may help some folks. You never know who you may help. I'm really honored to talk to Dr. Anne Suskind. She's the vice chairman of the department of urology at the University of California, San Francisco. She is associate chair of academic affairs and wellness; I want to talk to Anne specifically about that. She's a leaky bladder doctor like myself; we've both done fellowships. Mine was a long time ago; I think Anne's was less than 10 years ago in neurourology and pelvic floor reconstruction. She has a nice appointment in the department of gynecology as well. Anne, I've heard you speak to a mutual friend, so I sort of learned more about you. I'm going to use some of that in developing some of the things I've heard you say before, but tell us about you and your family and Nepal.

Thank you so much for inviting me to speak today with you. It's always fun to connect with like-minded people, and to talk about these sorts of topics, which are really just my true inner passion behind everything that I do. Like you, I love helping people to connect with their passions and to find and create the lives that they wish to create, both within the field of medicine and urology, and I mean, it's all the same everywhere, right? And so in all parts of their lives. You mentioned Nepal; that harkens back to my college years when I studied abroad and spent a semester in Nepal and really started to learn about different philosophies and traditions that a lot of people talk about, in terms of mindfulness and spirituality. That's always been something that's been a common thread of interest to me throughout the years, and I've continued to learn and study different traditions, and weave it all together because I think that our lives aren't siloed as urologists or doctors or surgeons or whatever we think of ourselves as. Those are roles that we play and important parts of our lives and certainly pieces of us that take a lot of our time and effort and energy, but first and foremost, we're human beings and we have full lives and many, many facets to what we do and who we are.

“I love helping people to connect with their passions and to find and create the lives that they wish to create, both within the field of medicine and urology,” says Anne M. Suskind, MD, MS, FACS, FPMRS.

Dr. Scott Sellinger discusses the benefits of private equity acquisition of urology practices

Dr. Sellinger on private equity acquisition in urology 

, highlights the growing trend of private equity acquisition in urology. Sellinger is a urologist at Advanced Urology Institute, an independent, integrated urology practice in Tallahassee, Florida.

Private equity in urology has really blown up over the last few years. It has trailed behind some of the other specialties in medicine that have already had similar patterns, so we've learned some from them. We've learned what works and what doesn't work. That's one of the benefits that we have in not being the first in that group. It boils down to [the idea that] like-minded urologists like to be together and work together and continue to find better ways to provide best patient care. We're in a difficult situation right now where our business continues to grow, our workforce is shrinking, and our costs are going up, yet our reimbursements remain fixed or go down. So, we need to be creative and find other ways to have business models that work. Private equity allows an opportunity to provide improved scale with large organization. We can learn from each other in many ways, and I think that so far, it's been very helpful in all regards.

“Private equity allows an opportunity to provide improved scale with large organization,” says Scott B. Sellinger, MD, FACS.  

, discuss the background and notable findings from the recent study, “Malpractice trends involving active surveillance across cancers.” Ho is a professor of surgery, the director of the head neck cancer program, and a co-director of the thyroid cancer program at Cedars Sinai Medical Center in Los Angeles, California. Daskivich is a urologic oncologist in the Cedars-Sinai Urology Academic Program and the director of Health Services Research for the Cedars-Sinai department of surgery.

 Active surveillance, as we know it in oncology, is a minimalist treatment option for certain cancers that are unlikely to cause harm or be lethal. It has been widely adopted in national treatment guidelines. There exists high level evidence supporting it as a sound and appropriate treatment option in selected low risk cancers. This includes prostate cancer, thyroid cancer, lymphoma, kidney cancers, and others. One gap is that adoption practice of surveillance has been somewhat haphazard across cancers, depending on the cancer type. We actually feel that one of the reasons for this discrepancy and a key barrier to adoption to active surveillance is perceived fear on the part of physicians for malpractice. We wanted to see if that was indeed the case. Given that there have been decades of experience with active surveillance, we wanted to see if there was indeed any truth underlying the possibility of malpractice for physicians that practice active surveillance.

 Physicians who are considering recommending active surveillance to their patients sometimes have a lot of concerns about medical legal ramifications if the cancer should progress while the patient is on surveillance. While we have data suggesting that active surveillance is very safe, there will be patients who will progress. In prostate cancer, the rate of progression to metastasis at 15 years approximately double that of patients who are getting upfront surgery and radiation. That data is from randomized controlled trial from the ProtecT trial. So, there will be a small proportion of patients that will progress on active surveillance. This study was intended to see if there were any successful medical legal cases that patients brought against physicians that held physicians liable for the progression that occurred while they were on active surveillance. This medical legal concern may dissuade physicians from recommending active surveillance. What we found was that there were no successful lawsuits that were prosecuted against physicians because they recommended active surveillance to patients. In fact, we actually found that there were more lawsuits that were directed at physicians who did not recommend active surveillance when it was an appropriate treatment strategy. So, we hope that the results of this study will reassure physicians that there will not be medical legal ramifications if they recommend active surveillance their patients in concordance with guidelines.

“In fact, we actually found that there were more lawsuits that were directed at physicians who did not recommend active surveillance when it was an appropriate treatment strategy,” says Timothy J. Daskivich, MD, MSHPM.

Experts on medical legal trends associated with active surveillance

, highlight key findings from the publication, “Utilization of ChatGPT for appraising letters of recommendation in urology residency applications: Ready for prime time?” Barrett is a medical student at Loyola University Chicago Stritch School of Medicine, and Baldea is an assistant professor of surgery and urology at Loyola Medicine in Chicago, Illinois.

 The main thing that we were surprised by was that at this point in time, ChatGPT couldn't give us consistent results. We would feed ChatGPT 1 letter of recommendation for 1 applicant written by the same person and ask it to score it 0 to 100 [and] give us some adjectives. And we would start a new chat, give it the same exact prompt and the same letter, and we found that there were discrepancies with what ChatGPT could give us. With that, it's hard to publish the scientific article if the data isn't reproducible. But I think that in and of itself is interesting to know what ChatGPT is capable of now, because I believe in the future it will be capable of being more consistent and being used for data analysis.

 The other thing that I was surprised about is I read about the idea that ChatGPT can have hallucinations, which is the term for when it just makes things up. But I was surprised at the degree to which it did that with what seemed like a somewhat simple task. If we fed it multiple letters at once and asked ChatGPT to compare them, it was unable to do that, and actually mixed them together and made up applicants that didn't submit to it. So, it really was not useful in that way.

"The main thing that we were surprised by was that at this point in time, ChatGPT couldn't give us consistent results," says Athena Barrett. 

ChatGPT’s use in assessing recommendation letters for urology residency

 discuss the content included in their recent book, “Prostate Cancer: Expert Advice for Helping Your Loved One.” Baum is a professor of clinical urology at Tulane Medical School, in New Orleans, Louisiana, and Mobley is an associate professor of clinical urology at Weill Cornell Medical College in Houston, Texas.

We tried to take prostate cancer from beginning to end, the end being men who die of prostate cancer. Fortunately, somewhere around 85% of men survive prostate cancer. About 15% of men who develop prostate cancer will die of the disease. The other 85% that have prostate cancer are either cured or died of some other condition. We wanted to take it from the very beginning to the very end that I just mentioned. So, we start off with screening, what's important in screening, prostate exams, PSA tests, other tests like that. And then we carried it through to if you have a diagnosis, what does this mean? How are prostate cancers graded? What's serious, what's not serious? And of course, we went on to all the different forms of treatment for either localized curable cancer or advanced prostate cancer.

 Well, one of the things that I thought that our book was so helpful, and since we're trying to appeal to our urologic colleagues, is that we would go through some of the aspects regarding what are the different treatment options. If the urologist tells the patient, you have the disease that's confined to your prostate, we need to remove that prostate gland. Well, there are other options that the urologist may not have the time to go through, and we wanted to give those options so that the patient and the partner were fully informed that there were different possibilities regarding treatment. Also, we went through the complications associated with each different treatment option. Again, the urologists may not have the time to go through that with each and every one of those options that are available. But we wanted the man and the partner to know that these were the situation. For example, very few urologists discuss the concept of watchful waiting or active surveillance, and that is a treatment option. And that is to follow the patient closely, and that means the patient accepts that they have to agree to regular follow-up every 3 to 4 months if they're going to do that. Well, we wanted them to have that knowledge and that information available to them. That is one of the benefits of our book. It's one of the hopes that our colleagues will recommend this book to their patients and their partners, so now they have a knowledgeable patient. And they can absolutely include in the records “patient received a book on prostate cancer, the chapter regarding treatment was recommended for their reading.” And I think that helps protect the urologist that they have disclosed everything that is available by leading the patient through the use of this book. I think that is a real benefit. I have shared the book with several urologic colleagues, and invariably, I get the response, "I sure wish this book was available long ago, because it is very helpful for me as a urologist to educate my patient." That's one of our goals or our objectives, and we want to emphasize that this is a book that supplements or complements the urologist and their discussion with their patients and partners.

"It's one of the hopes that our colleagues will recommend this book to their patients and their partners, so now they have a knowledgeable patient," says Neil H. Baum, MD. 

New book written to inform patients, partners about prostate cancer 

study, “Transition to Value-based Healthcare: Development, Implementation, and Results of an Optimal Surgical Care Framework at a National Cancer Institute–designated Comprehensive Cancer Center.” Lee is as an assistant professor in the Department of Urology at Fox Chase Cancer Center in Philadelphia, Pennsylvania, and a member of the Fox Chase-Temple Urologic Institute.

What are the next steps for this research?

I think we hit a little bit of a hiccup when the COVID-19 pandemic came; I think that altered a lot of spending and allocation of resources. But I think now that times have become more normal, we can pick up and continue that process. Our goal is to expand the cost analysis into our other procedures. In this study, we included prostatectomy, and it's one of the procedures that we looked to optimize further and to see how we're doing from a financial standpoint. Another field that we did not include is bladder cancer; we felt that bladder cancer had a lot of variability in how it's managed from a non-muscle-invasive to a muscle-invasive disease process. And I think expanding this into the bladder cancer space will go a long way as well.

What is the take-home message for the practicing urologist?

I think for the practicing urologist, as health care continues to expand and reach more people, we really have to shift our focus toward providing higher quality of care for our patients, especially urologists that are focused on treating an aging population [where there are] more issues. We know that these type of payment models—the bundled payments, the time-centered payment models—haven't been well investigated in urology, whether that [is due to] the complexity of the procedures or our patient population. But I think our paper is a good start. I think by applying these metrics that we've outlined in our manuscript, it's a perfect steppingstone in allowing urologists to take that step toward providing value-based care.

One of the things that I'd just like to mention is that health care is constantly changing, with legislation and how we manage patients. And as it changes, we as providers also have to change and adapt to that, because like I said, the way we're trending with the spending, it's really not sustainable. So we really have to develop a system in which we focus on value, and we are smarter in how we allocate that spending.

“I think by applying these metrics that we've outlined in our manuscript, it's a perfect steppingstone in allowing urologists to take that step toward providing value-based care,” says Randall A. Lee, MD.

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