2250 ACADEMIC UROLOGY POSITIONS

US. physician workforce requirement. Evidence from HMO staffing patterns. J.A.M.A., 272 222, 1994.

4. Jonas, H., Etzel, S. I. and Barzansk, B.: Educational programs in US. medical schools. 1993-1994. J.A.M.A., 272 694, 1994.

5. National supply and demand forecasts for urologists 1995-2020. Interim Report. Draft prepared by Health Demographics and Health Forecasting Group for the AUA, San Diego, California, November 1995.

6. Billi, J. E., Wise, C. G., Bills, E. A. and Mitchell, R. L.: Potential effects of managed care on specialty practice a t a university medical center. N.E.J., 333 979, 1995.

7. Fewer health professionals and schools needed says the Pew Commission. Amer. J . Health System. Pharmacy, 53 108, 1996.

8. Shapiro, E. and Hatch, D. A,: Pediatric urological manpower report. Pediatric Urology Manpower Committee of the Amer- ican Association of Pediatric Urology. J . Urol., 150 675, 1993.

EDITORIAL COMMENT

This article is of reference value in suggesting trends in academic positions in urology throughout the United States. The information is based on the results of a 2-year questionnaire directed to academic training programs in the country. A response rate of 86% of pro- grams canvassed was achieved, an extraordinarily high rate of re- turn for a questionnaire survey of this sort! Between the 2 years of the survey there was a 10% decrease in total positions offered. Nevertheless, the number of new academic positions per year ex- ceeds the retirement rate of academic physicians by a factor of more than 4. Regional differences are noted in the article, with new aca- demic positions more likely to be offered in the North Central, Western and Southeastern sections. Distribution of subspecialty

area heavily favors cancer, neurourology/female urology and en- dourology .

This apparent surfeit of employment opportunities for the aca- demic urologist flies in the face of all demographic predictions. mentioned, the Pew Commission anticipates a surplus of up to 150,000 physicians by the year 2005 (reference 7 in article) and Weiner suggests 165,000 more physicians than needed by the year 2000 (reference 3 in article). Comparing the average urologist per ~OO,OOO covered lives of 2.7 in health maintenance organization settings versus the 1992 United States supply where the number is 3.~100,000 there is every indication that we will need 1,000 fewer urologists in the year 2000 versus 1992. It is critical for there to be a followup to this article, investigating this apparent discrepancy, Otherwise, department chairmen may be lulled into a sense of undue optimism. As pointed out by the author, for example, the definition of faculty was open to interpretation and may include part-time, non. tenure tract positions.

Indeed, a number of departments in the country are expanding as a consequence of the development of health care systems by their universities. Such health care systems usually cover a broader gee- graphic area and may account for some of the new faculty offerings (particularly in the area of general urology, female urology and pediatric urology) cited in this survey. In some instances universities have hired already established urologists to fulfill their geographic needs to cover these systems. The expansion of academic depart- ments required by development of health care systems cannot ex- plain all of the optimism reflected in this survey. Therefore, it is imperative that the reasons for optimism be further explored.

Carl A. Olsson Department of Urology Col urn bia University New York, New York