Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019

•The proportion of urologists performing major open oncologic cases is declining, while the percentage of all urologists performing minimally invasive oncologic procedures is rising.•Those with oncology specialization and oncology fellowship have significantly higher odds of performing both open and minimally invasive oncologic procedures.•Oncology fellowship training alone was associated with over 2 times greater odds of performing major open oncologic procedures. The incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019. We examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission. We identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63–0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48–2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34–2.58, P < 0.001) and MIS radical pro