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Focused Practice Designation for Urologic Oncology

Posted: August 8, 2018

Dear SUO Membership,

The FPD comment period has expired. Thank you for your interest.

On behalf of the SUO Board of Directors, I want to bring to your attention an issue and potential opportunity for the SUO that we, as members, need to consider, discuss and ultimately decide upon.

As background, a Certificate of Added Qualification (CAQ) enables a physician to add to his or her skill set and qualifications, without completing an additional full fellowship training program. A CAQ consists of additional coursework, clinical education, and testing of a sub-specialized technique, procedure or area of medicine within the physician’s medical specialty. As you know, there is presently no CAQ for urologic oncology. The Societies for Pediatric Urology (SPU) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) have CAQs. Several years ago, the SUO considered adding a CAQ but it would have required us to give up control to ACGME, have to meet all 6 core competencies, stop billing for the fellows, etc.

The American Board of Urology is beginning a new designation, called Focused Practice Designation (FPD). The purpose of the FPD is to recognize an area of sub-specialization within a specialty without the onerous need for the formal process of CAQ. The SUO Board of Directors was approached by Dr. Gerry Jordan, Executive Secretary of the ABU, at the 2017 Annual/Winter Meeting to discuss whether the SUO would be interested in developing an FPD for urologic oncology. Dr. Jordan indicated that this is a way to recognize immersion in a subspecialty, but does not declare any special training or accreditation. The SUO is the first sub-specialty being offered a FPD, due to our significant infrastructure, fellowship process and Oncology Knowledge Assessment Test (OKAT).

The SUO set up an advisory committee to discuss this opportunity and think through the pros and cons. The question being considered was whether SUO needs this designation. The committee consisted of executive leadership of the SUO and AUA and SUO members representing LUGPA and the fellowship committee: Christopher Evans, Michael Cookson, Brantley Thrasher, Leonard Gomella, Robert Uzzo, Neal Shore, Michael Droller and Stephen Boorjian. The pros and cons were vetted and I present them below:

Pros:
  • SUO is the leader in this FPD endeavor and develops the benchmarks and creates standards.
  • It allows our OKAT to function as a standard educational tool for all our members.
    • This is a return on investment for the many years the SUO spent to develop this high cost, robust validated bank of oncology questions.
    • This would increase the relevancy of the test to members.
  • It keeps sub-specialization of Urologic-Oncology under leadership of SUO — not ACGME, Endo Society, etc.
  • It would strengthen SUO’s relationships with ABU and AUA
    • ABU will serve as our conduit to ABMS.
    • AUA will want to partner even closer on products and courses pertinent to oncology for CME and help with the OKAT.
  • SUO will lead this new effort for focused practice designations. Other societies may follow, or do it if we don’t.
  • It provides further sub-specialty branding for SUO members.
  • It will build the SUO membership, attendance, and enhance the value of our society.
Cons:
  • Small risk of losing control of the process, although SUO has been assured by the ABU that SUO would maintain control.
  • Small risk that 3rd party payors use this information to penalize someone who does not have this level of credentialing. Dr. Jordan stated that can never be predicted but he had not heard that with Gynecology or Internal Medicine and it would not be supported by ABMS.
  • Might be perceived as more work, effort, test taking and minimal gain by individual members. The question of necessity at the individual level remains.

The advisory committee concluded that the FPD would be of significant benefit to the SUO. SUO members who opt in will have FPD as an added qualification. It would come with some inconvenience for members, but would be optional. The pros outweigh the cons and doing the FPD would not be permanently binding or irreversible if the SUO determined that it was not serving our membership.

The findings of the advisory committee were discussed at the 2018 pring Board Meeting. Discussion led to the following recommended criteria for an SUO member obtaining the FPD (should the society go forward with this):

  • ABU certification/recertification
  • SUO fellowship completion and/or 75% urologic oncology by case log
  • OKAT examination completion initially and once every three years
  • SUO Annual Meeting attendance initially and once every three years
  • SUO member in good standing with dues paid in full annually

The Board agreed that the designation would strengthen the position of the Society and the OKAT, and would keep members more current on standards of care. Non-SUO urologists meeting the above criteria might be motivated to join the SUO and obtain the FPD. The designation would further demonstrate the oncologist’s expertise to patients, and differentiate their status from general urologists. Additionally, it would strengthen the necessity of a urologic oncology field separate from medical oncology.

Action item for SUO Members:

Based upon the above, the SUO has posted on our website this information with the opportunity for members to comment and provide feedback. The comment period will be open until October 1, 2018. This will provide us with enough time to review the comments prior to the winter meeting. Our expected course of action is to have open discussion and vote at the annual business meeting in Phoenix.

Sincerely,

Christopher P. Evans, MD, FACS
President, SUO