Trends in Urology Advocacy: Analyzing 10 Years of Inflation-Adjusted Lobbying and Political Action Committee Expenditures

Purpose: To identify trends in urology organizations' political spending (lobbying and political action committees (PACs)) over the recent decade and better understand the specialty's representation among health professionals. Methods: Spending data were extracted from OpenSecrets.org. Professional organizations representing urologists or urology practices were included (n = 6). Professional organizations' lobbying spending on a per-urologist basis was calculated using the American Urological Association (AUA) Census. Patient advocacy organizations exclusive to urologic conditions were identified (n = 10). Urology PACs' activities included those by the American Association of Clinical Urologists (UROPAC), AUA PAC, and American Kidney Stone Management (AKSM PAC; n = 3). We compiled lobbying spending (2014-2023) and PAC activities (2013-2022, 5 election cycles). All values were adjusted for inflation to 2023 USD. Statistical analysis was performed using a Mann-Kendall trend test ( P = .05). Results: Over the study period, lobbying spending by all health professional groups was $105.9 million/y (10-year median) of which urology professional organizations made up $1.2 million (∼1%; 10-year median). Neither showed a significant directional trend. Urology professional organizations' annual lobbying spending per-urologist was $113 (10-year median), showing a declining trend when accounting for the growing number of urologists ( P = .025). Lobbying spending by urology patient advocacy organizations totaled $413,356/y (10-year median), showing an upward trend ( P = .003). Despite variations in PAC performance and introduction of the AUAPAC in the 2019 to 2020 cycle, total donations to federal candidates from urology PACs have steadily declined, decreasing from $815,851 in 2013 to 2014 to $367,381 in 2021 to 2022. Conclusions: Over the past decade, financial funding and contributions from urology-specific PACs declined, while lobbying expenditures by patient advocacy organizations significantly increased. Lobbying activity by professional organizations and societies remained relatively stable overall but decreased on a per-urologist basis. These descriptive trends reflect changing patterns of political engagement within the urology community.