In this episode of The Expert APProach: Conversations in Uro-Oncology, the conversation expands beyond clinical care to explore leadership, advocacy, workforce evolution, and the future of independent urology.Host Joy Maulik, CRNP, sits down with Celeste Kirscher, CAE, MHSA, CEO of LUGPA, and LUGPA President Scott Sellinger, MD, FACS, who discuss how the definition of “independent practice” has evolved into a broader concept: physician-directed care. In an era of hospital consolidation and complex ownership models, LUGPA serves as a counterweight—supporting practices that remain led by physicians and focused on patient access and quality outcomes.A central theme is the widening gap between clinical work and health care policy. Most physicians, Sellinger notes, understandably prioritize patient care over reimbursement models, regulatory changes, and payer dynamics. This makes strong dyad leadership—physician and administrator working together—essential. Kirscher emphasizes that advocacy is everyone’s responsibility, even if not everyone feels comfortable engaging in it. Through structured advocacy efforts in Washington, DC, LUGPA helps clinicians translate bedside realities into policy conversations that directly affect patient access to care.The discussion also highlights the expanding role of advanced practice providers (APPs). Over the past 25 years, APP integration has grown from novel to indispensable. With workforce shortages and increasing patient demand, APPs now function across office, hospital, procedural, and leadership settings. Both guests affirm that utilizing clinicians at the top of their licensure is no longer optional—it is necessary for sustainable, high-quality urologic care.Technology and innovation round out the conversation. Artificial intelligence is expected to first transform administrative workflows—scheduling, billing, and operational efficiencies—whereas clinical AI applications in radiology, pathology, and precision oncology continue to mature. Sellinger underscores the importance of germline and somatic genetic testing in advanced prostate cancer, noting that despite clear guideline recommendations, testing remains underutilized nationwide. Expanding access to precision medicine remains a critical opportunity.Finally, Kirscher highlights LUGPA’s commitment to educating residents and early-career urologists—not only in clinical excellence but also in the business and leadership aspects of practice. The message is clear: choosing a physician-directed path does not mean going it alone.The episode closes on a powerful reminder from Sellinger about why urology remains deeply rewarding: its breadth, its diversity of patients, and—most importantly—the ability to offer meaningful solutions that improve and extend lives.This conversation reinforces that sustaining independent, physician-directed urology requires more than clinical skill—it demands advocacy, leadership development, workforce integration, and a commitment to shaping the future of health care.

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