Urology residency positions in the United States have traditionally been funded through Medicare payments

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Urology residency positions in the United States have traditionally been funded through Medicare payments to hospitals that participate in residency training. The federal funding in hospitals for residency training has been capped since 1997, even though there are 200 more positions in traditional urology residencies since that time. Hospitals have the prerogative to distribute these funds through their Graduate Medical Education Office according to local needs and priorities.

Medicaid is the second largest source of funding despite the fact that there are no federal requirements for Medicaid programs to contribute to graduate medical education. Pediatric training positions typically did not receive, which requires congressional renewal each year. This yearly renewal has left a cloud of uncertainty over new residency positions and has often been considered for budget cuts.

In the United States, the first accreditation council for graduate medical education (ACGME) accredited specialty within urology was pediatric urology. Pediatric urologists in the United States complete a urology residency after graduation from medical school. These programs are either 5 or 6 years depending on the program, but must include 1 year of training in general surgery. Interested urology residents will typically apply for fellowship positions the year prior to their final year of residency. These accredited 2-year fellowships began over two decades ago and this eventually led the American board of urology (ABU) to offer a Pediatric Subspecialty Certification Exam and pediatric subspecialty certification. The ACGME accreditation required 1 year of training, but the ABU-required 2 years of training to qualify for the pediatric subspecialty certification exam. This has led to a funding dilemma. The ACGME required clinical year funding is more straight forward; however, the second year required by the ABU can be either clinical or laboratory. Most of these positions are in children’s hospitals where Medicare Direct Graduate Medical Education funds may not be available, especially when the funds have been frozen for the last 15 years making institutions reluctant to create commitments to new pediatric urology fellowship positions. In addition, Medicaid funding for graduate medical education is non-existent in some states and tenuous in many others as has been discussed.

At our own freestanding children’s hospital, we have decided to offer a pediatric urology fellowship that requires residency review committee (RRC) approval. We sought information from program directors of already approved pediatric urology fellowship positions to learn how these positions were funded for the clinical year and the second, ABU-required year.

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