I n t e g r i t y - S e r v i c e - E x c e l l e n c e Headquarters U.S. Air Force 1 SAFCS: AF Urology Services Lt Col Samuel Hakim Commander, Urology 59 MDW, Lackland AFB, TX

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 2 State of AF Urology Present Manpower Future Manpower Modernization Global and Deployed Urology

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 3 Current Urology Manpower FYO8 23 clinical authorizations 11 locations 20 urologists practicing in AFSC Delta: -3 Urologists “Doing more with less”

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 4 Urology Outpatient Visits FY07 (BDQAS SADR Oct 06-Sep 07) SADR (# visits)# 45U3 # visits per provider Deploy in this period# FTE # visits per FTE Lackland Eglin WPAFB Travis Elmendorf Nellis Langley Lakenheath Keesler Andrews

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 5 Urology Outpatient Visits FY08 (BDQAS SADR 1 Oct 07-3 Apr 08) SADR (# visits)# 45U3 # visits per provider Deploy in this period# FTE # visits per FTE Lackland Eglin WPAFB Travis Elmendorf Nellis Langley Lakenheath Keesler Andrews

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 6 Urology Manpower in Near Future Projected deficit/surplus FY FY FY 11+1 FY 12

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7 Longer Look at Manpower: Increased deficit beginning FY13 Not filling training pipeline Decreased applicant interest No retention beyond ADSC

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 8 How to correct Urology deficit? Allow USUHS grads civilian PGY-1 Could happen at a federal/VA facility Very difficult to find PGY2 urology positions

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 9 How to correct Urology deficit? Money is #1 reason for separation Increase financial incentives Median starting salary = $290k Increase bonus Incorporate bonus into retirement Modernize AF Urology capability

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 10 Need to Modernize AF Urology Capability AF capability not up to date No AF MTF with surgical robot Robotics becoming standard of care for prostate surgery Lack of robotics causes Loss of patients to network Perception of lower quality care at MTF AF Urologist job dissatisfaction

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 11 Global and Deployed Urology Honduras MEDRETE Balad AFTH

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 12 Honduras FY06: 2 weeks in Puerto Cortes Austere hospital Minimal services 102 outpatients 62 surgeries Trained 10 ADAF 3 staff urologists 2 anesthesia providers 2 residents 1 nurse 2 techs

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I n t e g r i t y - S e r v i c e - E x c e l l e n c e 14 Urology at Balad Only in-theatre location for comprehensive urological care Urologic imaging GU trauma Ureteroscopy Laser lithotripsy Most GU disease now managed in theater

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 15 Urology at Balad DATES IN THEATRE 5/0 5- 9/0 5 9/0 5- 1/0 6 1/0 6- 5/0 6 5/0 6- 9/0 6 9/0 6- 1/0 7 1/0 7- 5/0 7 5/0 7- 9/0 7 9/0 7- 1/0 8 TO TAL S STONE CASES

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 16 Urology at Balad DATES IN THEATRE 5/05- 9 / 0 5 9/05- 1 / 0 6 1/06- 5 / 0 6 5/06- 9 / 0 6 9/06- 1 / 0 7 1/07- 5 / 0 7 5/07- 9 / 0 7 9/07- 1 / 0 8 TOTA L S TRAUMA ENDOUROLOGY Cystoscopy/Ureteroscopy KIDNEY/URETER BLADDER SURGERY Bladder exploration/repair URETHRAL SURGERY Urethroplasty GENITAL SURGERY Total Trauma Procedures

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 17 Case 1 30 yo Iraqi female, 35 weeks pregnant GSW to pelvis (bilat large entrance wounds lower back) Hemodynamically stable after ER resuscitation Normal FHR No foley output

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