Geographic Mobility of Urology Graduates From Residency to First Practice in the United States.

Background: Geographical mobility of Urologists plays a crucial role in shaping regional healthcare systems; however prior research often overlooks mobility patterns of Urology trainees. In comparing distances traveled during career transitions and initial practice locations in relation to residency training sites, we hope to address gaps in understanding how training environments and social factors influence professional trajectories and discrepancies in care. Methods: Data on U.S. Urology Residency Graduates (UGs) from 2020 to 2023 was obtained from ACGME-accredited residency programs in 2025. Authors utilized a website analysis to collect location and training data from January 2023 through September 2023. First attending positions were identified by students through residency program alumni pages, Google/LinkedIn, and when available, linked institutional physician profiles. Primary outcomes were regional retention rates, travel distances, and socioeconomic drivers (analyzed by multivariate regression) during transitions from medical school to residency (T1), residency to fellowship (T2), and residency to the first attending position (T3). Retention rates were stratified by NIH funding status (top 50 NIH-funded schools vs. non-top 50). Results: A total of 659 Urology graduates (UGs) were examined. The Northeast retained the most UGs during T1 but retained the lowest UGs during T2 and T3. The West retained the highest UGs during T2 and T3 and consistently retained over half of their UGs during each transition. More UGs from T50NIH travelled over 500 miles (39%) than NonT50NIH (36%) during T1. Additionally, UGs from T50NIH institutions demonstrated higher T3 mobility. UGs took attending offers in areas with predominantly Caucasian populations, lower minority populations, less physicians, and more rurality compared to their training locations. Conclusions: The heightened T2 mobility may be due to specialized training at select institutions, while lower T3 mobility highlights shifting priorities as UGs transition to long-term career establishment. Higher T3 mobility from T50NIH institutions suggest graduates from research intensive institutions were more willing to relocate farther distances for their first attending positions. Increased rurality during T3 was demonstrated compared to T1 and T2, which are centered around urban training environments. The findings highlight the importance of strategically aligning urology workforce distribution with regional healthcare needs.