Medical students, residents, and fellows have submitted policy and advocacy posters to be featured in the 2025 Annual Urology Advocacy Summit Virtual Poster Session. Four outstanding submissions were selected to give a live presentation to hundreds of urologists at the AUA Public Policy Forum! This forum, held during the AUA Summit, offers medical students, urology residents, and early-career urologists the opportunity to display their public policy ideas and solutions to the challenges facing urologists and patients with urologic conditions. Congratulations to all the applicants for the 2025 Virtual Poster Session!
Rafael Aldaya
University of Florida College of Medicine
This poster builds on a study conducted at a regional academic medical center, which examined disparities in patient familiarity with and use of chatbots for urology-related concerns. Results showed that awareness of chatbots was significantly impacted by race, education, and insurance type. Although overall utilization was low, patients who used chatbots reported benefits, particularly for addressing symptoms (68%) and exploring treatment options (43%). The findings informed the development of this idea, advocating for the integration of technology to address pressing challenges in urologic care. The poster also highlights potential setbacks, such as gaps in technology access, patient discomfort with chatbots, and concerns about data security and misinformation.
Key points include:
Opportunities: Chatbots can provide timely answers to routine questions, improve patient engagement, and ease provider workloads. Challenges: Efforts must address awareness gaps, ensure data security, and promote accuracy in chatbot responses.
Policy Recommendations: Proposals include initiatives to improve chatbot education, equitable implementation strategies, and safeguards for patient privacy.
This poster aligns with AUA’s federal advocacy priorities by demonstrating how innovative tools like chatbots can enhance access to care and improve practice efficiency. This work seeks to engage policymakers, urologists, and advocates in meaningful discussions about the future of urologic care.
Emily Clennon
Oregon Health & Science University
State insurance barriers to vasectomy coverage are associated with restrictive abortion laws
This study sought to determine if state populations were granted equitable access to vasectomy procedures based on variations across state Medicaid policies. The secondary aim was to evaluatethe relationship between accessibility of Medicaid-covered vasectomy and state abortion restrictions.
Individual state-based Medicaid rules were assessed by publicly available data for all 50 states and Washington D.C. A novel scoring system quantifying restrictions to Medicaid coverage forvasectomy was developed utilizing state- specific Medicaid income eligibility criteria, presence or absence of extended family planning benefits, and any additional prohibitive vasectomy coverage policies (0 no restrictions, 4 most restrictions). Abortion access was quantified using the Guttmacher Institute's ranking of state abortion policy restrictions (1 most protective, 7 mostrestrictive). Fisher’s exact test was used to evaluate the relationship between vasectomy access score and abortion access.
For vasectomy access, eighteen regions (35%) had only 1 point assigned, 25 (49%) had 2 points, and 7 (14%) had 3 points. Only one state (Texas) had 4 points assigned due a consent form on top of the conventional paperwork. When comparing state Medicaid vasectomy coverage to state restrictions on abortion access, there was a statistically significant relationship (p=0.01).
The states with the most limited access to coverage were more likely to have the most restrictive abortion laws. Despite an increased demand for contraception and vasectomy access post-Dobbs, populations at higher risk for unwanted pregnancy encounter the most barriers to preventative contraception.
Brian Cortese
Vanderbilt University Medical Center
Impact of Narrow Networks on Access to Urologic Care and Quality within Medicare Advantage Plans
The poster explores the impact of narrow networks within Medicare Advantage (MA) plans on access to specialty care (with a particular focus on urology) and quality outcomes, with an emphasis on how it impacts rural and underserved populations. Narrow networks, characterized by restricted panels of in-network providers, have emerged as a cost-containment strategy but often result in limited access to high-volume centers and specialized urologic care. This is particularly concerning in urology, where complex conditions such as prostate and bladder cancer, kidney stones, and urinary incontinence require timely and specialized care. Some of the key highlights from the poster includes how narrow networks exacerbate disparities in access, with rural residents and racial and ethnic minorities facing significant challenges. Our actionable recommendations that summarize what we can focus on from a policy perspective include 1) strengthening network adequacy standards, such as revising time-distance and provider-patient ratio requirements to reflect the realities of rural healthcare, 2) enhancing telehealth integration to bridge access gaps and improve specialty care delivery, and 3) increasing transparency and oversight of MA plans to ensure equitable access.
Atieh D. Ashkezari
Northwell Health-The Smith Institute for Urology, NYITCOM
Doctor of Osteopathic (DO) Representation in Urology: Trends and Insights Across AUA Regions
This poster highlights the underrepresentation of osteopathic (DO) medical students in Urology residency programs, emphasizing the stark gap between the ~6% DO presence in Urology versus the national average of 18–20% across all specialties. By analyzing data from multiple residency programs and categorizing them by AUA region, we identify where DO students are most and least represented. We also compare programs that have DO faculty to those without, noting an apparent correlation between DO leadership and improved DO match rates.
Attendees will learn about key barriers facing osteopathic applicants—such as limited rotation slots, fewer mentors, and persistent misconceptions—and discover how simple initiatives, including the new hashtag #DosoUro, can elevate DO visibility and encourage mentorship. This poster ultimately aims to inspire programs, mentors, and professional organizations to address these disparities, increase access for osteopathic students, and create a more inclusive environment within the Urology specialty.
Peter Evancho
University of Maryland School of Medicine
AI in Urology: Bridging Innovation and Regulation for Improved Care
The poster explores the integration of artificial intelligence (AI) in urologic practice, highlighting its potential to improve diagnostic accuracy, streamline workflows, and enhance patient outcomes. It examines AI applications across various domains, including pediatric urology, bladder cancer diagnosis, and treatment of benign prostatic hyperplasia, while addressing ethical and regulatory considerations such as data privacy, algorithmic bias, and patientdoctor relationships. Key findings from a literature review, survey data, and stakeholder interviews provide insights into the current landscape of AI in urology and the shared perspectives of physicians and patients.
Attendees will gain an understanding of the transformative potential of AI, as well as the challenges associated with its adoption, including concerns about reliability, ethical risks, and regulatory oversight. The poster highlights the importance of educational initiatives and policy development to support responsible and equitable implementation of AI in urology. These takeaways aim to equip attendees with actionable knowledge to advocate for safe and effective integration of AI technologies, benefiting both the urologic workforce and patients.
Hailey Frye
University of Minnesota – Twin Cities
Need for Pain Management Policies: Uncovering Hidden Biases in Pain Management of Nephrolithiasis
Kidney stones are the most common urologic reason for emergency department visits. While recent studies have examined pain management strategies, there is limited research on how socioeconomic status (SES) and hospital factors impact pain management of acute nephrolithiasis. This study aimed to determine if SES, insurance type, primary language, or ED location influence the likelihood of receiving opioids for acute pain management for kidney stones.
A population-level database encompassing patient visits across a 14-hospital system was created. Adult patient visits in the ED with ICD codes of N20 were abstracted between 2019 – 2022.
Multivariable regression analysis showed that women, Black patients, elderly individuals, low-income or self-pay patients, and those treated in urban EDs were less likely to receive opioids.
These findings underscore disparities in pain management, suggesting potential implicit biases in care. The study calls for collaboration with emergency medicine colleagues and endourologists to create guidelines and policies for the pain management of nephrolithiasis. Attendees will walk away with a potential opportunity for advocacy within their hospital system to implement guidelines and ensure equitable treatment for kidney stones. Additionally, this project demonstrates a framework to develop a comprehensive database for urologists to identify other disparities in patient care and/or driving factors of physician burnout.
Emily Huang
Houston Methodist Hospital
Health policy, cost, and lack of access to specialized care are main barriers to fertility preservation prior to iatrogenic infertility. Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential. These include gonadotoxic chemotherapy and radiation as well as hormone therapies, brain or pelvic surgeries and biologic response modifiers for autoimmune diseases. Prior to initiating these treatments, fertility preservation by freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue can be the best option for patients who hope to use their autologous gametes for future reproduction. However, there are several barriers to being able to obtain these services, which we were able to identify by performing a literature review. We used the key terms “iatrogenic infertility”, “fertility preservation” and “health policy” to find journal articles of interest and found that patients have poor access to reproductive specialists for both geographic reasons and as a result of delayed referrals. There are several system level changes that can be implemented to streamline referral pathways. However, even after they are able to meet with a specialist, many patients quote financial reasons as the top reason to forego fertility preservation. We need improved affordability through better insurance coverage.
Using the AUA National Census Data, we evaluated intergenerational trends in the urologic community to evaluate the current state of the workforce.
Based on the 2023 census, baby boomers make up the largest percentage of practicing urologists. There has been a steady increase in female representation and LGBT+ individuals with each generational group. There is also increasing racial diversity in younger generations; however, underrepresented minorities in medicine, which include black and Hispanic populations, have not seen a significant increase between gen Xers and millennials.
When evaluating training and practice characteristics, younger generations are more likely to pursue formal fellowship training, correlating to a decreasing number of generalist urologists with each generation. The younger generations, especially millennials, were more likely to practice in metropolitan areas. When evaluating work setting, there was a steady decrease in solo practices and slight preference for employed positions including academic medical centers by the younger generations.
Interesting generational trends are evident in the AUA National Census Data. By analyzing them, we seek to initiate conversation about intergenerational differences that can be impactful and generate awareness of how to care for and maximize the efficacy of our workforce.
Farzaan Kassam
Montefiore Medical Center
Perceived burden and impact of prior authorization on urology practices and clinical outcomes
This poster highlights the data from the AUA 2023 Census, reviewing the perceived impact of prior authorization from urologists nationally. Over 14,000 urologists responded, demonstrating that practicing urologists under the age of 54 and in some form of private ownership felt that treatments were extremely affected by prior authorizations.
Isaac Kim
Brown University
The Key to Addressing Disparities in Prostate Cancer: Urologists in Advocacy?
The purpose of my presentation is to highlight specific barriers to prostate cancer care for vulnerable populations based on our previous studies and to propose a concerted intervention to address these barriers. Specifically, we state that prostate cancer outcomes among Black and uninsured men cannot be remedied without addressing the financial burden of seeking prostate cancer screening and care. To that end, we propose that an advocacy partnership between urologists and local governments, institutions, and communities will be critical in bringing the issue of long-standing racial and socioeconomic disparities in prostate cancer to the national stage and potentially put an end to them once and for all.
Michelle Li
UC San Diego
Bridging the Gap: Enhancing Access to Urinary Incontinence Care in Asian American Women
While research has explored barriers to urinary incontinence care among minority populations such as Latina and Black women, there are currently no studies evaluating barriers specific to Asian American women—despite this group comprising 3.9% of the U.S. population and 7.7% of women nationally. Although one study found that Asian American women are less likely to seek treatment for urinary incontinence even when symptoms interfere with daily activities, there are no studies that has identified specific barriers faced by this population. To address this gap, we propose a multi-step pilot project aimed at improving care for Asian American women with urinary incontinence. This approach will not only focus on educational resources but will also include systemic and community-driven solutions to ensure sustainable and scalable impact. Additionally, while the pilot project focuses on Asian American women, the framework is designed to adapt to other underrepresented or marginalized groups, broadening its reach and relevance. Our proposal includes employing multilingual patient navigators, developing culturally tailored telehealth platforms, and streamlining referral processes to reach specialists and receive appropriate care. The long-term goal of this project would be to develop cultural competency training, partner with Federally Qualified Health Centers to increase outreach in underserved areas, advocate for state and federal programs to subsidize for the cost of care for uninsured or underinsured individuals, and to develop incentives for providers to worse in underserved communities.
Kathleen Li
University of Rochester School of Medicine and Dentistry
Increasing PFPT/PFMT Access & Awareness
The poster highlights the barriers to pelvic floor muscle therapy (PFMT), which is a low-cost, minimally invasive intervention used to treat incontinence, pelvic floor dysfunction, and pelvic organ prolapse in peripartum patients. Financial barriers may include limited insurance, limited coverage of follow up visits, and increasing numbers of pelvic floor physical therapy providers who are out of network or who provide cash-based services. Other barriers may also include lack of PFMT at federally qualified health centers (FQHC) and lack of patient and provider discussion about PFMT. It is therefore recommended that the AUA support upcoming policies including H.R.2480 to increase Medicaid and CHIP coverage of PFMT, H.R.4829 to promote provision of physical therapy at FQHCs, and to increase student, provider, and patient education on PFMT. Future directions may include creation of a standardized approach for PFMT outcomes, promotion of multidisciplinary teams for pelvic floor health concerns, and more advocacy for insurance coverage of PFMT.
Sirpi Nackeeran
UC San Diego
Introduction:
The urologist workforce shortage affects all populations in the United States; however, it disproportionately affects rural patients. Despite rural practice locations offering higher salaries for urologists, these areas remain underserved. It has been previously demonstrated in the heavily rural state of Iowa that gaps in access can be filled by urologists traveling to rural communities from urban or suburban communities to provide care. In Iowa, visiting consulting urologists (VCUs) traveling to outreach clinics increased care from 57% to 84% of patients. This model can be promoted and incentivized for urologists in other states with large rural populations. Federal and states level grants can be used to establish outreach clinics to partner with academic centers and private practice groups in urban centers. This would facilitate the participation of urban urologists to fill gaps in care in rural settings. This program directly addresses the American Urologic Association’s legislative goal to address the looming workforce shortage in urology.
Population Affected:
Approximately 19% of Americans currently live in rural areas, and an estimated 13% live further than a 30-minute drive time to urologic care. These patients are likely to face delays in care for every aspect of urology, from stone disease, to female pelvic floor disorders, to cancer. Beyond states that are conventionally perceived as rural, states on the Pacific Coast also contain large amounts of rural residents. California, for example, has an estimated 2.3 million residents in rural settings. Distance to urologic care serves as a more significant barrier to patients from poorer communities. This program seeks to address the needs of patients who otherwise would face major delays in care for pressing urologic issues in rural areas.
Objectives
Patient out-of-pocket (OOP) cost represents a barrier to accessing treatment for erectile dysfunction (ED). We sought to evaluate OOP costs incurred by men with ED covered by Fee-for-Service Medicare.
Methods
The 2018 American Urological Association (AUA) guidelines were used to identify recommended ED treatments. Coverage policies were obtained from the Medicare Coverage Database. OOP costs were retrieved from the 2023 CMS Final Rule. For treatments not covered by Medicare, OOP costs were extracted from GoodRx® or published literature and inflated to 2022 dollars. Annual prescription costs were calculated using a published estimate of 52.2 instances of sexual intercourse per year. The estimated number of Medicare patients with ED (n=254,650) was used to evaluate healthcare system implications.
Results
Medicare has established coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no existing policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or extracorporeal shock wave therapy (ESWT; conditional/investigational recommendation; Table 1). Annual IA prescription is associated with the highest patient OOP cost ($4,022), followed by annual ICI prescription ($3,947), one ESWT treatment course ($3,445), IPP ($1,600; inpatient deductible), annual PDE5i prescription ($696), and one VED ($213; Figure 1). Among PDE5i, avanafil is associated with the highest annual OOP cost ($3,455), followed by vardenafil ($2,102), tadalafil ($723), and sildenafil ($459). One-year projections demonstrate IA is associated with the highest national healthcare OOP cost ($1.02 billion), followed by ICI ($1.0 billion), ESWT ($877 million), IPP ($407 million), PDE5i ($177 million), and VED ($54 million).
Conclusions
PDE5i and IPP are cost-effective options with strong guideline recommendations. Better understanding of patient financial burden may improve shared decision making with patients who suffer from ED.
Courtney Nguyen
*AUA2025 Public Policy Forum Presenter*
St Joseph Medical Center
"I'm not just a bill," takeaways from writing and getting Louisiana Senate Bill 439 adopted into law
This presentation provides a unique perspective as an aspiring policy writerphysician that outlines the process of writing a bill and advocating for it to eventual adoption as state law. During medical school, I joined the Louisiana State Medical Society, a state-wide physician lobbying group, as a way to merge my interests in medicine and policy writing. My policy group brainstormed and wrote the initial legislation regarding the state’s physician workforce shortage (Louisiana Senate Bill 439) that would eventually be adopted into law. I discuss: 1] the legislative process of passing a bill, 2] framing policy to various stakeholders, 3] involvement for medical students/early-career physicians, and 4] the importance of informed policy writing.
Chelsea Okoli
SUNY Downstate College of Medicine
Physician burnout is a critical issue affecting the healthcare system, especially in urology due to an aging workforce, increasing demand, and high stress levels. I propose a mandatory burnout screening program as a public policy initiative to improve physician well-being, reduce healthcare costs, and enhance patient outcomes. Urologists would undergo annual, confidential burnout screenings using validated tools like the Maslach Burnout Inventory. Results would provide real-time feedback about mental and emotional wellbeing. For mild to moderate burnout, immediate recommendations for coping strategies and wellness programs would be offered. In cases of severe burnout, urgent referrals to mental health professionals would be made to prevent serious consequences. The program would also suggest workload adjustments for those showing burnout signs, including modified on-call schedules and delegating administrative tasks. To encourage participation, the program would offer CME credits for screenings and mental health programs, along with financial incentives like discounts on insurance premiums, loan repayment assistance, and wellness-related tax credits. Healthcare organizations and institutions promoting burnout prevention would qualify for reimbursement incentives or federal grants to cover program costs.
Phyllis Parkansky
Lewis Katz School of Medicine
Gynecologic cancer treatments save lives but often result in urologic complications, such as incontinence, fistulas, and radiation cystitis. These complications drastically affect quality of life, increase morbidity and mortality rates, and impose significant healthcare burdens. Advocacy is essential to improve access to innovative treatments, expand multidisciplinary care, policy coverage of essential care. The 4 main ways my poster advocates for change are the following:
- Research into Precision Treatments: Expanding access to innovative therapies like proton therapy and robotic surgery can reduce complications and improve recovery outcomes for cancer survivors.
- Multidisciplinary Care Models: Funding survivorship clinics ensures holistic care for survivors, addressing both medical and psychosocial needs.
- Education and Awareness: Public campaigns and provider training programs close gaps in care by encouraging timely diagnosis and intervention.
- Policy Changes: Advocacy for expanded insurance coverage ensures equity in access to cutting-edge treatments and preventive measures.
Benjamin Pockros
University of Michigan
Patients with prescription drug coverage under a Medicare Part D plan have historically spent over $10,000 out-of-pocket per year for advanced prostate cancer medications. The Inflation Reduction Act is posed to make a historic impact to reduce prescription costs in the United States. Among many provisions, the law established a new cap on out-of-pocket spending at $2,000 in 2025. We analyze the impact for four major prostate cancer medications (abiraterone, apalutamide, darolutamide, and enzalutamide). The law could save some patients with advanced prostate cancer up to $9,000 each year.
Prescription drug costs in the US are an important health policy area of public interest and concern. Three in ten adults report not taking their medications because of cost. This presentation will discuss the implementation of the Inflation Reduction Act in 2022 and its significant impact on drug costs. Highlighting research now published in JAMA (PMID: 39254980) and Urology Practice (PMID: 37754065), this presentation will identify data demonstrating how the Inflation Reduction Act is saving patients with cancer multiple thousands of dollars each year starting in 2025, including patients with advanced prostate cancer. Key takeaways will also include the 10 drugs selected for price negotiations in 2025 and projections for drugs that will be selected for negotiation in 2026. The learning objectives of this presentation are: 1) to better understand the role of Medicare Part D and its effect on out-ofpocket drug costs, 2) to learn key provisions within the Inflation Reduction Act and how this may effect patients with urologic conditions, and 3) to evaluate the scope and impact of the Inflation Reduction Act in 2025 for patients with prostate cancer.
Dhruv Puri
*AUA2025 Public Policy Forum Presenter*
UC San Diego School of Medicine
This poster examines how six major medical societies—the American Urological Association (AUA), American Medical Association (AMA), American College of Surgeons (ACS), American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP)—align their advocacy efforts on legislative priorities, political contributions, and federal agency lobbying. By analyzing areas of convergence, this study highlights shared priorities such as administrative burden reduction, telemedicine access, physician workforce sustainability, and health equity while identifying specialty-specific priorities like cancer research, primary care financing, and childhood immunizations. Additionally, the analysis explores how these societies contribute to political candidates and lobby federal agencies such as CMS, HHS, and HRSA. The findings reveal significant overlap in advocacy goals and highlight missed opportunities for coordinated lobbying efforts that could amplify the impact on healthcare policy. A key takeaway is the potential for improved cross-specialty collaboration to strengthen influence on issues affecting physician practice, healthcare access, and patient outcomes. By identifying both commonalities and gaps in advocacy strategies, this study provides a roadmap for optimizing collective engagement in legislative and regulatory processes, ultimately enhancing the effectiveness of medical societies in shaping healthcare policy.
Erin Schnell
University of South Carolina
The poster addresses the critical shortage of urologists in South Carolina, highlighting the implications for patient care and potential solutions. Key highlights include:
Current Shortage: South Carolina has 4.1 practicing urologists per 100,000 people. The shortage is exacerbated by the aging workforce, with 30% of urologists over 65 years old.
Patient Outcomes: High patient loads lead to delayed care for conditions like prostate cancer, kidney stones, and bladder cancer, resulting in worse outcomes, increased mortality, and more complex surgical interventions.
Proposed solutions include increase residency training by advocating for more urology residency positions, advocate with hospitals to increase residency programs funded by Medicare GME to improve healthcare access and operational efficiency, discuss with policymakers to increase residency funding and create incentives for urologists to stay in the state, and implement telehealth systems to manage simpler cases and reduce the workload on current physicians.
The poster emphasizes the need for immediate action and collaboration among healthcare providers, policymakers, and communities to address the urology workforce crisis and improve patient outcomes in South Carolina.
Yash Shah
*AUA2025 Public Policy Forum Presenter*
Jefferson Health
Payment Bundles for Prostatectomy: A New Way to Improve Value for Prostate Cancer Care
U.S. healthcare costs exceed $4 trillion annually, and prostate cancer contributes $22 billion. Fee-for-service (FFS) incentivizes volume over value, leading to inefficiencies and inconsistent outcomes.
Transitioning to valuebased care (VBC) is a solution to improve efficiency and outcomes. Bundles provide a lump sum for defined episodes of care. Medicare’s Transforming Episode Accountability Model (TEAM) is targeting care coordination and equity.
The shift from FFS to VBC aims to improve care by incentivizing efficiency and outcomes. TEAM represents an evolution by incorporating longitudinal care and equity adjustments.
Bundles promote coordinated care for specific conditions, aligning reimbursement with comprehensive, quality care while mitigating overtesting and overtreatment.
Adoption of bundled payments faces hurdles, such as fair compensation for high-risk practices and the need for precise metrics. Without these, providers may avoid complex cases or reduce quality to cut costs.
Urology’s integration of surgical and office-based care positions it to lead VBC. Physician involvement in designing bundles can ensure alignment with clinical priorities.
Bundled payment models offer a promising approach to enhance PCa care while controlling costs, though their scalability and equity require refinement.
Sierra Tolbert
Mayo Clinic
Regional Variations in Demographic and Practice Factors of the U.S. Urologist Workforce
Understanding regional workforce patterns is vital for national policymakers to ensure adequate healthcare access and improve patient outcomes across different areas. By analyzing the distribution of urologists and their regional differences in representation, policymakers can identify shortage areas. We analyzed 2023 AUA Census data to characterize regional variation in the urology workforce. Post-stratification weighting was performed to adjust for non-response bias based on gender, primary practice location, certification status, and years since certification. Chi-squared tests assessed statistical significance. A total of 1,918 responses (13.5% of U.S. urologists) were included. Age distribution varied across AUA sections, with urologists ≥55 years old comprising 47% to 58% of the workforce varied by section. Significant associations were observed between AUA section and gender (p=0.02) and race (p=0.001). Women urologists made up ≥14% of the workforce in the New England and Western Sections versus < 10% in the Northeastern, New York, and Southeastern Sections. Non-White urologists were most represented in the Western (28%) sections compared to only 13% in New England. Practice settings differed tremendously by both urologist age and region. Better delineating regions lacking resources or those with an aging provider population allows for targeted investment in training programs and recruitment efforts. The differences in racial and gender representation in practice could impact patient-physician alignment and should be defined. Monitoring workforce trends may help policymakers better meet the needs of patients amid shifts in urological care delivery and workforce longevity.
Sasha Vereecken
Saint James School of Medicine
Association Between Financial Status and Matching into Urology Residency: A Cross-Sectional Analysis
The rising cost of medical education, with a median debt of $200,000 for medical graduates in 2022, has intensified reliance on loans and scholarships, significantly influencing career pathways. This poster examines the impact of socioeconomic factors, including income and debt, on matching success in the 2020-2021 Urology Match. An online survey of 386 urology applicants (73% response rate) for the 2021 Urology Match Year provided key insights into financial disparities and their effects on the residency application process. Findings revealed that individuals from low-income households were less likely to successfully match compared to their higher-income peers (80% vs. 89%). Debt levels had no direct impact on the number of applications or interviews; however, low-income applicants submitted fewer applications, secured fewer interviews, and had the lowest match rates. This analysis highlights the interplay between financial constraints and residency selection outcomes, emphasizing the systemic barriers faced by socioeconomically disadvantaged applicants. Addressing these disparities is essential given the increasing demand for urologists, driven by an aging population and provider shortages in rural areas.
Vivian Wang
*AUA2025 Public Policy Forum Presenter*
University of Pittsburgh
The current prior authorization (PA) system significantly hampers urologic care delivery. Manual, paper-based processes lead to: (1) treatment delays, with patients requiring urgent therapies, e.g. bladder cancer immunotherapy or overactive bladder medications, face weeks of waiting for approval, and (2) administrative overload, with providers spending 14+ hours weekly on PA tasks, reducing time spent with patients.
This proposal advocates for real-time electronic prior authorization (ePA) systems and for codification of the ePA mandate into AUA legislative priorities, similar to the current stance of the AMA. Given the appetite in today’s political environment for health insurance reform, there is a window of opportunity in the next legislative cycle to advocate for establishing real-time ePA systems as the national standard to: reduce wait times for patients, lower administrative burdens on providers, and enhance transparency/fairness in approval decisions.
The poster advocates for mandating real-time ePA systems via the following mechanisms:
- Require all insurers (Medicare Advantage and private payers) to implement real-time ePA systems integrated into EHR platforms.
- Mandate that ePA systems provide immediate approvals or denials for common urologic procedures/conditions, with max response time 24h for complex cases.
- Include financial penalties for insurers failing to meet these response deadlines.
- Ensure interoperability between ePA systems and EHRs to reduce work duplication for urologists.
Susanna Wang
Michigan State University College of Human Medicine
No-Fault Motor Vehicle Insurance Reform Impacts Patients with Spinal Cord Injury
Personal injury protection (PIP) is a specific coverage under the umbrella of automobile insurance that covers expenses for in-home nursing care and other resources not covered by one’s own health insurance in the event of an injury from a motor vehicle accident (MVA). Many people with spinal cord injury (SCI) due to MVA depend on this type of insurance. On July 1, 2020, Michigan drivers were no longer required to carry mandatory unlimited PIP for no fault medical coverage. We hypothesize that this change may have a negative impact on access to care for MVA patients with SCI because PIP has traditionally offered robust coverage.
342 patients were identified (PIP n = 121). Hospitalizations following legislation reform were at least 2 times higher in those without PIP as primary payer (-35% versus 51%, p=0.043). There was no statistically significant difference in ER visits.
Overall, PIP insured spinal cord injury patients had lower rates of hospitalization. We hypothesize this may be due to access to resources that protect against the need for hospitalizations and ER visits.
Kirolos Youssef
George Washington University School of Medicine and Health Sciences
This poster explores the impact of income disparities on access to standard-ofcare treatments and survival outcomes in muscle-invasive bladder cancer (MIBC). Analysis of National Cancer Database (2004-2019) data reveals lowincome patients are significantly less likely to receive neoadjuvant chemotherapy (NAC) and lymph node dissection (LND), resulting in poorer overall survival (median OS: 55.9 vs. 68.2 months for higher-income patients). The study emphasizes the influence of facility type, insurance status, and diagnosis year on treatment access. Patients treated at academic centers or diagnosed after 2011 were more likely to receive guideline-based care, underscoring the value of multidisciplinary healthcare. Private insurance and higher income were linked to lower mortality risks, highlighting systemic inequities. Key recommendations include expanding affordable insurance coverage, regionalizing urologic oncology care, and implementing patient education programs to empower underserved populations. These strategies aim to close treatment gaps, improve guideline adherence, and enhance outcomes for all MIBC patients. This poster provides actionable insights for healthcare professionals and policymakers, advocating equity-driven reforms to ensure life-saving treatments are accessible to all. The findings underscore the intersection of socioeconomic factors and healthcare, offering opportunities to improve vulnerable populations' outcomes and quality of life.