It’s no secret that recruiting a permanent urologist in 2023 is like trying to catch a greased pig. According to data from the leading physician job board practicelink, urology jobs see the fewest number of applicants per job posting of any specialty. Additionally, the AAPPR, which is an organization of physician recruiters employed by healthcare organizations, says that the median urologist recruitment cycle takes about 21 months. This means that about one half of urology searches are taking two years or longer.
I’ve had countless conversations with hospitals who feel like they are unable to recruit a urologist without having a multi-million dollar surgical robot, but in this article I’ll go into why that is not necessary and why that money could be better invested in other technology.
To start, let’s address the effectiveness of surgical robots in the field of urology:
Contrary to popular belief, the science on the effectiveness of robotic surgeries for urologic oncology is inconclusive. Since the FDA approved the first surgical robot in 2000, robotic surgery has seen unprecedented growth throughout the world, with urology as a key discipline. Robotic-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN) were the frontline urology procedures. Many other urologic procedures have since been standardized over time. However, there is no universal consensus in current research on the recognition of robotics as the standard of care. Although better operative outcomes have been reported for most robotic procedures compared to open and laparoscopic surgery, no superiority has been proven as far as oncologic outcomes are concerned.
Secondly, the assumption that adding a robot will increase hospital profit margins has not borne out in reality. A study that examined 167 California hospitals with valid financial information found no relationship between profit margins and the presence of a surgical robot. It’s true that hospitals with robotic surgical systems tended to report more favorable profit margins. However, multi-level logistic regression showed that this relationship (an association, not causality) became only marginally significant (OR=6.2; P=0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area.
You’re probably thinking to yourself, “those studies speak to a general level of uncertainty regarding the effectiveness of surgical robots, but how does that help me to recruit a urologist?” Simply put, knowledge is power and knowing these facts will aid you in your discussions with any potential candidates. Urologists tend to be very data-driven and scientifically-minded and so if you can explain in simple terms why your hospital doesn’t have a surgical robot, this is a great starting point.
Now, let’s get into the operational advantages of a hospital not having a surgical robot. One major advantage of not having a surgical robot is that you don't have to worry about scheduling conflicts or competition for operating room time. With only a limited number of robots available, hospitals often struggle to allocate enough time for each surgeon and OB/GYN to perform their necessary procedures. This can lead to delays in scheduling, which results in lost revenue for the hospital, fewer patients seen overall, and longer wait times for patients. If an investment is made in a cutting edge laser or other alternative equipment, there is no competition for time, allowing urologists to work more efficiently and provide better care to their patients.
Another reason that surgical robots aren’t necessarily a positive thing for a hospital is that it leads to more clashes with administration over how procedures are done. When a hospital invests millions of dollars in a surgical robot, they often have high expectations for its usage. However, the reality is that not all procedures require a robot, and urologists must choose the best approach for each individual patient. This can lead to tension between administration and urologists when the former is pushing for more robotic cases to justify the investment. Without a surgical robot, urologists have more flexibility to choose the best approach for each patient without the added pressure from administration.
Finally, not having a surgical robot can give urologists leverage to push for other equipment or technology that may be more beneficial for their patients. Hospitals are always looking to invest in the latest and greatest equipment, but sometimes the most effective solutions are not the most expensive ones. Without the pressure to use a robot, urologists can make a case for alternative equipment that may better suit their needs and ultimately improve patient outcomes. By having this leverage, urologists can work with hospital administration to make informed decisions about what technology will be most effective for their patients. This leads to better relationships between urologists and hospital administration, which ultimately means higher rates of physician happiness and retention.
Recruiting permanent urologists in 2023 is a challenging task, with urology jobs having the fewest applicants per job posting of any specialty and a median recruitment cycle of about 21 months. However, hospitals do not necessarily need a surgical robot, which is often assumed to be a requirement to recruit a urologist. Scientific research shows that the effectiveness of robotic surgeries for urologic oncology is inconclusive, and the assumption that adding a robot will increase hospital profit margins has not borne out in reality. Not having a surgical robot has operational advantages, including avoiding scheduling conflicts, providing flexibility for urologists to choose the best approach for each patient, and giving urologists leverage to push for other equipment or technology that may be more beneficial for patients.This can lead to a better working relationship between urologists and hospital administration, which can result in higher physician satisfaction, lower turnover rates, and ultimately, improved patient care.