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The costs and benefits of fellowship training: analysis of the 2014 AUA Census
Philip J. Cheng, MD, Michael E. Zavaski, MD, Nawar Hanna, MD, David F. Friedlander, MD, MPH, Manuel Ozambela, Jr., MD, Steven L. Chang, MD.
Brigham and Women's Hospital, Boston, MA, USA.
Background:
For urology residents, pursuing fellowship training requires making early decisions that can have a dramatic impact on long-term job satisfaction. Therefore, it is important to characterize the clinical profiles of fellowship-trained (FT) and non-fellowship-trained (NFT) urologists.
Methods:
We performed a weighted analysis of the 2014 AUA Annual Census Dataset. The cohort was divided into FT and NFT urologists and further divided into 5 groups based on the year in which they graduated from residency (<1980, 1980s, 1990s, 2000s, 2010-2014). We evaluated, with descriptive statistics and regression analysis, outcomes including: primary practice setting, clinical hours, non-clinical hours, total work hours, number of patient visits, region of employment, and rurality of practice location.
Results:
The survey was completed by 2,204 urologists representing 11,703 practicing urologists in the U.S. The percentage of FT urologists has increased with every decade of residency graduation with over 50% of graduates after 2010 entering fellowship training; approximately half of FT urologists practice in academic institutions (Figure). Compared to NFT, FT urologists work equal clinical hours (45.3 vs 44.4, p=0.320), see fewer patients per week (87.2 vs 98.1, p=0.002), have longer non-clinical hours (10.9 vs 6.8, p<0.001) and longer total hours (56.9 vs 52.0, p<0.001). FT urologists are less likely to practice in a rural setting (OR 0.38, p=0.037), but more likely to practice in New England (OR 1.77, p=0.012).
Conclusions:
Urology residents are increasingly pursuing fellowships with over half of residents electing this option. Approximately half of FT urologists practice in a non-academic setting and they have a modestly smaller effort in patient care. Additional studies are necessary to clarify the impact of different types of fellowship training and the potential impact of changes in health care on the clinical profile of FT urologists. 
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