LUGPA Resident Newsletter - September 2021 
Integrated Practices | Comprehensive Care
September 2021

Gautam Jayram, MD

      Dr. Jayram

Dr. Gautam Jayram was born and raised in suburban Chicago and completed his urology residency including a year of research at the University of Chicago Hospitals. Following this he completed a fellowship at the Brady Urological Institute at Johns Hopkins. As a clinical instructor at Johns Hopkins, Dr. Jayram gained tremendous experience with kidney, prostate and bladder surgery with an emphasis on minimally invasive cancer surgery.

Dr. Jayram is very active in education and research. He is co-director of the Advanced Therapeutics Center where he treats patients with advanced cancers and participates in cutting edge clinical trials. Dr. Jayram has spearheaded the immunotherapy program at Urology Associates where patients with complex urinary tract cancers from across the region can receive novel therapies or trials which can significantly impact their life. He is a Clinical Associate Professor of Urology at Vanderbilt and mentors resident physicians during their training. Dr. Jayram has written numerous journal articles and book chapters and is an editorial contributor to the popular website Practice Update. He is passionate about integrating novel technologies and therapeutics in community urology and promoting high-value care in independent group practice.

In this video interview, Dr. Jayram talks about immunotherapy, patient quality of life, forming good relationships with nearby providers and how he became known as the busiest leader in robotics surgery in his region.  

Watch LUGPA's full interview with Dr. Jayram here.  


Partnerships with APPs will be crucial
to the success of an independent practice

by Josh Langston, MD 

A shortage of urologists has been well documented since the 2017 American Urological Association (AUA) report that indicated nearly 72% of U.S. counties have one or no urologist. In addition, nearly 52% of the physician workforce are over the age of 55 and 30% 65 years or older. Both the AUA and the Healthcare Resource and Services Administration (HRSA) have a stark prediction for the urology physician workforce, with the HRSA predicting that there will be a deficit of 3,630 urologists by 2025.

Furthermore, the demand for urologists continues to outpace the supply with many groups overwhelmed with more patients than their physicians can comfortably manage. What can practices do to address this? One solution is to increasingly partner with Advanced Practice Providers (APPs).

Physician’s Assistants (PAs) and Nurse Practitioners (NPs) are highly trained and versatile providers who can offer a wide range of care to urologic patients in outpatient, inpatient, and procedural settings, allowing urologists to extend their impact to a broader number of patients. Collaborating with APPs can create pathway driven care that can be reproduced within the patient population.

Currently, APPs are primarily used in the outpatient clinic setting, seeing patients independently from their physician colleagues. Excellent examples exist around the country of APPs managing advanced prostate cancer clinics, cancer survivorship clinics, men and women’s health clinics and metabolic stone management clinics, all in collaboration with their supervising urologists.

Current data indicates a significant rise in office-based procedures such as cystoscopy and prostate biopsies performed by APPs, speaking to their ability to develop this skill set to offload these high-volume procedures from physicians. To a lesser extent, APPs are utilized in inpatient roles - rounding on inpatients and seeing new consults. And some remain active as a first assist with physicians in the OR, most often with robotic surgery.

Proper training for APPs is key. Training guidelines for procedures have been published, and adequate didactic and hands-on education should be completed, documented, and verified before APPs begin practicing independently.

In summary, to meet the demands of patient care in the coming years, urologists will have to partner with APPs to manage a significant portion of our clinic-based visits and procedures, shifting the urologist role more to the OR and complex clinic patients. We should all be focusing on how to build the most effective care teams, centered around pathway driven care, to reproduce high-quality high-value care for our patients moving forward.


Josh Langston, MD
Urologist and CMO
Urology of Virginia
Virginia Beach, VA

      Dr. Langston

Undergraduate: Texas A&M University (2005)
Medical School: UT Southwestern Medical School (2009)
Residency: University of North Carolina (2014)
Fellowship: Institute of Urology, University College Hospital, London (2016)

Dr. Joshua Langston is a urologist and the Chief Medical Officer at Urology of Virginia, a 50-provider group based in Virginia Beach, VA. After residency training at the University of North Carolina – Chapel Hill, he completed a fellowship in Andrology & Male Reconstructive Urology at the Institute of Urology in London, England. His clinical practice focuses on men’s health and cancer survivorship, and he founded and directs Men’s Health Virginia, a division of Urology of Virginia.

In addition to clinical pursuits, Dr. Langston has a strong interest in health policy, advocacy, and physician leadership in medicine. He was selected as the American Urological Association’s 2017 Holtgrewe Legislative Fellow, spending time as a health policy legislative advisor in the U.S. Senate. He is a member of the Political Affairs Committee for the Large Urology Group Practice Association where he was awarded their 2019 Advocate of the Year award. He is Co-Chair of the Regulatory Affairs Committee and a member of the Political Affairs and Practice Management Committees for the American Urological Association. While in the U.K., Dr. Langston was selected to participate in the Executive Mentoring Program sponsored by NHS England for doctors with special interest in executive leadership in medicine. He serves on the Board of Directors for the American Society for Men’s Health, as well as several other boards and advisory groups.


LUGPA President’s Message:
The Resilient Spirit of Independent Practices 

"I have endured dozens
of hurricanes, tornados,
floods, and one of the
higher penetrations of
covid, and nothing
compares to what we
went through in February
of this year.
    – R. Jonathan Henderson, MD

I’ve been in independent practice now for 25 years and I’ve been going to LUGPA meetings for 13 years.  When I look at my LUGPA colleagues, I think to myself: it takes a certain kind of person to go into independent practice. And it takes someone even more wonderfully unique and special to stay in independent practice. 

Some physicians prefer to work at a hospital.  You are taken care of – protected to a large degree.  But the kind of people I see in independent practice are often audacious, self-reliant, and resilient. Resilient. That really says it all.

Little did I know how resilient my partners, practice, and I would have to be to weather this past year.  I have endured dozens of hurricanes, tornados, floods, and one of the higher penetrations of covid, and nothing compares to what we went through in February of this year.  It all started on Friday, February 12th.  We had news of an impending storm and we announced that the office would be closed that Monday. 

Read more


Health Policy Roundup  

As the leading voice of independent urology group practices in the US, LUGPA educates policymakers on the benefits of integrated urologic care. LUGPA's Health Policy and Political Affairs committees drive grassroots efforts by developing thoughtful analysis and engaging public officials through comment letters on major legislative and regulatory proposals. Here's a recap of some of LUGPA's recent activities.  


Ask The Experts, LUGPA Q&A

Residents are encouraged to send questions to Tim Richardson, MD, pertaining to a variety of subjects. Send your questions to [email protected] with the subject “Resident Newsletter, Ask the Experts Q&A” and answers will be published in the December 2021 Issue of Inroads.

      Tim Richardson, MD

Tim Richardson, MD
Urologist, Wichita Urology
Wichita Kansas


Dr. Richardson is a native of south central Kansas. He attended medical school at The University of Kansas from 1998-2002. He completed his urological surgery residency at The University of Nebraska Medical Center, 2002-2008. He is a partner at Wichita Urology, board-certified by the ABU and is a member of the AUA, AACU and SUO-CTC. He currently serves as Chair of LUGPA Forward and is on the LUGPA Membership committee. Within Wichita Urology, Dr. Richardson is the Advanced Prostate Cancer champion, is co-director of clinical trials, and director of the Xofigo infusion program. Dr. Richardson has served as a consultant, speaker and participated in numerous advisory boards regarding prostate cancer. Outside of work, he enjoys golf, running, skiing and other outdoor activities.


Managing Finances as an Early Career Urologist
Slides Now Available 


During the first five to seven years as a urologist of an independent practice, there is extreme variability with managing finances including taxes, investments and arrangements associated with partnerships.

Early career urologists often struggle with managing all the changes and unknowns related to financial issues.

Tim Richardson, MD of Wichita Urology Group and Chair, LUGPA Forward Committee, recently held a discussion about important finance issues that urologists of independent practices should be aware of early in their career. The slides from that session are available here.  


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