"It is difficult to say what is impossible, for the dream
of yesterday is the hope of today and the reality of tomorrow",
Robert H. Goddard, U.S. physicist and pioneer rocket pioneer
(1882-1945)
It is a
great honor to serve as Chairperson of the AAP Section of Urology.
I have been a member of this section for almost 20 years and
have seen this organization evolve over that time. Reflecting
back to the first AAP meeting I attended, the specialty was
then pressing hard for certification by the American Board of
Urology. As we look forward to this now becoming a reality,
we must realize that many challenges remain ahead. As I sat
down to write this letter, I wasn't sure what the theme or message
would be. I decided to focus on the strengths and accomplishments
of our specialty as a whole, not just the AAP section.
Education
and research are areas in which our specialty has made significant
strides over the past few decades. This is natural given that
we are a relatively new discipline when compared to others.
There was much to learn and many areas in which we needed to
improve our understanding. One has to only briefly peruse the
program abstracts to confirm the high quality clinical and bench
research performed by our members. We have gone from lamenting
over the lack of quality research being conducted to the refrain
that there is too much research on the program! That is a good
problem for our program committees to have to worry about. Education
is an area in which our members are actively involved. Twenty
years ago, most pediatric urologists were employed at medical
schools or large children hospitals. Many were actively involved
in teaching residents, but given the small number of us not
every residency program was affiliated with a pediatric urologist
(mine was one of those). There are few residency programs today
that do not have a pediatric urologist on their faculty, and
if not, they are actively recruiting. Pediatrics is viewed as
an important component of resident education. Most notable are
the number of pediatric urologists who are currently serving
as residency program directors or chairs of their respective
programs. As a former member of that group, I can attest to
the hard work and commitment of those who continue in that role.
These individuals and all others actively involved in resident
education serve to stimulate the interest of their trainees
in our field; vital to the continued growth of our specialty.
Our pediatric
urologic societies have played an important role in the development
of our specialty. They started as small groups where individuals
with like interests could share their passion for the care of
children with urologic disorders. Lifelong professional relationships
and friendships developed through these meetings. As we grow,
it will be harder to maintain the informal atmosphere of the
early meetings, but they remain an important venue for us to
gather and exchange information, ideas and opinions. Two of
our major organizations, the AAP section and SPU, hold their
annual meetings in conjunction with their parent organizations,
the AAP and AUA. I often hear complaints about the lack of recognition
and support from these groups and that we should have an independent
meeting. It is important for us to continue to maintain our
alliance with the AAP. The leadership of the Academy was very
helpful to us in our push towards subspecialty certification.
However, there is much more that the AAP can continue to do
for pediatric urology. As a large section of the AAP, we must
realize that they speak for all providers who care for children.
The large size of the organization gives it a very powerful
voice. When members of Congress, large payers, and others need
an opinion on issues relating to pediatrics, they look to the
AAP. These parties would not likely seek out the pediatric urology
societies for input. Although dealing with the AAP bureaucracy
is frustrating to many of our membership, please keep this in
mind.
Our sister
societies, Society for Pediatric Urology, Society for Fetal
Urology and the American Association of Pediatric Urologists
are also very important. We all represent the same constituency.
All pediatric urology organizations need to present a unified
front when working together on issues that confront us. Fortunately,
the leadership of these groups meets twice annually at the Coordinating
Council to discuss these common concerns and develop plans to
solve them. From this group, the Advisory Council for Pediatric
Urology was constituted to work with ABU to help achieve subspecialty
certification. The annual meetings of the various pediatric
urology societies have different agendas and play different
roles. The SPU is important in its relationship with the AUA.
We need to remain actively involved in the AUA for similar reasons
as the AAP. They are a much larger organization and can represent
our group on important issues such as billing and coding to
name a few. We clearly are going to see some rough times ahead
in our interactions with payers as they seek to influence how
we practice our craft (the recent stance on endoscopic correction
of reflux is likely just the beginning). Only if we work together
as a group along with the AUA and AAP will we be able to have
an impact. Pediatric urologists are also an integral part of
the American Board of Urology. In addition to the communications
between the Advisory Council for Pediatric Urology and the ABU,
three pediatric urologists are members of the board including
the current president of the ABU (and AAP chair elect), Linda
Shortliffe. Input from pediatric urology to the ABU will continue
to be important in the future as they determine the qualifications
necessary to be certified to practice our specialty.
Additionally,
I would like to address our collaborations with international
societies. The joint meetings between the AAP and the European
Society for Paediatric Urology have been excellent venues for
sharing knowledge. More importantly, we have developed close
friendships with many of their members. We are planning an upcoming
meeting with the International Children's Continence Society
at our 2008 AAP meeting and, hopefully, this will be the beginning
of another close relationship. All of these groups have the
same mission which is to further the care of children with urologic
disorders. Sharing our research and innovative ideas will benefit
us all.
If there
is one last message I would leave the membership, it is to continue
to maintain the collegiality and hospitality of our meetings.
I can recall attending my first AAP meeting and knowing no more
than two individuals in the room excluding my mentors Panos
Kelalis and Steve Kramer at the Mayo Clinic. Everyone whom I
met was very encouraging and welcomed my participation. I call
upon all of our members, particularly our senior ones, to treat
new attendees at our meetings in the same fashion. It would
behoove us to consider mentoring some of these younger pediatric
urologists. I am sure we can all recall those who played an
important role in our development. We recently had a terrific
guest speaker at our meeting informing us that younger generations
are not "joiners" which could obviously present a
serious problem to our organizations. Without new members, our
specialty societies will wither on the vine. I would hope that
pediatric urologists will not be pegged into such square holes.
We should all do our part to ensure that young pediatric urologists
feel welcome in our organization and that they quickly realize
how their participation can have a positive influence.
I look
forward to working with the AAP Executive Committee during the
coming year. Feel free to contact any of us if you have any
issues that should be brought to the attention of the Executive
Committee. I hope to see all of you in San Francisco this fall.
Mike Ritchey
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