1. 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

2. 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

3. 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”

4. 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 Lackland1269862116.306 Eglin287321436.502 WPAFB298721493.502 Travis24602123011.661481.9 Elmendorf1896294802 Nellis16461 01 Langley9741 10.661475.8 Lakenheath14301 01 Keesler841 01 Andrews14401 01

5. 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 Lackland639561065.815.661129.8 Eglin16272813.502 WPAFB15492774.502 Travis14092704.502 Elmendorf11552577.502 Nellis8241 01 Langley7191 01 Lakenheath6731 01 Keesler6121 01 Andrews5891 01

6. 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 09 -2-2 FY 10 -1 FY 11+1 FY 12

7. 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

8. 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

9. 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

10. 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

11. 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

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 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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14. 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

15. 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 CASES38296411746587071493

16. 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 44 841427 KIDNEY/URETER232125271043 BLADDER SURGERY Bladder exploration/repair3264244732 URETHRAL SURGERY Urethroplasty213 431217 GENITAL SURGERY 2216272230642135237 Total Trauma Procedures2926423849773458353

17. 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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