Gary Kirsh, MD – A Pioneer of Community Urology

Gary Kirsh, MD, is the founder and chief executive officer (CEO) of Solaris Health, a private equity-backed medical services organization that is the largest provider of urology services in the United States. Throughout his illustrious career, he has been involved at the highest level in urologic health policy and advocacy. As one of the founding members of the Large Urology Group Practice Association (LUGPA) and long-term president of The Urology Group in Cincinnati, Ohio, Dr. Kirsh is keenly aware of and uniquely situated to advocate for physician issues at the community, state, and US federal levels.

GU Oncology Now spoke with Dr. Kirsh about his distinguished career and the evolution of urology practice in the United States. He offers valuable insights into the dynamic landscape of urological health policy, advocacy, and practice management. Additionally, Dr. Kirsh sheds light on the mission and operations of Solaris, emphasizing the importance of physician ownership and national scale in shaping the future of urological care.

Could you share a brief overview of your career in urology, beginning with medical school and any fellowships or residencies, reasons for becoming a urologist initially, followed by your time at The Urology Group, Solaris, and any other notable stops in between?

Dr. Kirsh: I completed my medical training in 1989. I attended medical school at the University of Chicago and completed my residency at Case Western in Cleveland, Ohio. Fellowships were not as common at that time, so I did not pursue one. I started practicing in Cincinnati because I had spent much of my childhood there. Initially, I joined another doctor in practice before we witnessed significant consolidation in our industry. In a relatively short period, I recognized my interest in the business aspect of medicine, which encompasses not only practice management, but also health policy because we are a heavily regulated industry.

In the 1990s, many metropolitan areas in the country saw urology practices consolidate regionally, a trend also observed in other specialties. This consolidation was driven by various factors, and it was necessary if we were to survive as independent practices. More doctors together meant access to capital, professional management, access to new  revenue streams, and scalability.

At the end of my residency, urologists were professionally content with their work and income. A typical day involved performing 1 major procedure, such as a transurethral resection of the prostate (TURP), and seeing about 10 patients. However, since 1990, reimbursement rates for procedures like TURP have plummeted by 90% after adjusting for inflation. This decline in reimbursement rates is not unique to urology but extends to various surgical subspecialties.

To navigate these changes, we learned to establish urology centers of excellence that encompassed various aspects of patient care, including  ambulatory surgery centers, specialized laboratory services, radiation services, and pharmacies. These centers provide comprehensive care tailored to urology patients. Since they are operated by independent physicians, they are also more cost-effective sites of care than the hospital setting.

These efforts also led to the development of advanced prostate cancer clinics, and other advanced oncology services, within regional urology practices nationwide. Urologists now play a leading role in treating advanced prostate cancer, often matching medical oncologists in expertise.

My career trajectory aligns closely with these industry shifts. In Cincinnati, The Urology Group was founded in 1996 and I assumed leadership of the group in 2007.

I also played a key role in founding LUGPA, a trade association representing independent urology groups. Forming LUGPA was necessary, not only for the sharing of best practice amongst the urology community, but also due to resistance from colleagues representing various competing specialties. They opposed our expansion into services traditionally under their purview. We had to engage in health policy advocacy to demonstrate the benefits of urologic consolidation into cost-effective, clinically advanced regional centers of excellence for patients. LUGPA provided a platform for urology practice leaders to collaborate and address industry challenges.

The next step was recognizing the need for a more unified approach to address the growing complexity of health care. In 2019, I joined forces with Dr. Deepak Kapoor, from New York, to establish Solaris Health, aiming to scale urology groups into a national practice in order to navigate continuously emerging challenges to independent practice. Despite facing delays due to the COVID-19 pandemic, Solaris was incorporated in June 2020 and has grown into one of the most significant  providers of urology services in the country. I currently serve as the CEO of Solaris, overseeing operations involving over 600 providers across 13  states.

The  trajectory of my career mirrors the evolution of the urology specialty over the past 3 decades, highlighting the dynamic nature of our field. My career journey has been  intertwined with the evolving landscape of urology practice, and I have been fortunate to help actively shape the  trajectory of urology, I believe for the benefit of urologists and our patients, rather than simply being swept up by it.

Was it during your tenure with The Urology Group that your interest in urological health policy and advocacy began to flourish?

Dr. Kirsh: My interest in health policy and practice management actually emerged early in my career. Shortly after joining practice, I took on administrative responsibilities due to  the need to streamline operations. Additionally, my background in political science fostered an interest in health policy, leading me to participate in various professional meetings and activities related to it. This interest only deepened when The Urology Group was formed, aligning with my natural inclination toward practice management and policy advocacy.

Furthermore, while my clinical focus primarily revolved around prostate cancer treatment, particularly innovations like brachytherapy and stereotactic body radiotherapy, as well as emerging therapies for advanced prostate cancer, my commitment to improving urological care extended beyond clinical practice into broader industry initiatives.

Can you elaborate on the value organizations like LUGPA offer to community-based urology today?

Dr. Kirsh: LUGPA and similar associations play a crucial role in fostering relationships, sharing best practices, and advocating for the interests of community-based urology practices. Effective advocacy, in particular, is vital, as evidenced by the impactful presence LUGPA has in Washington, DC, despite representing a relatively small specialty. These associations ensure our voices are heard in policy discussions that directly impact our practices and patients. I have had the honor, working through LUGPA over the past 16 years, to form meaningful and long-term relationships with policy makers from both sides of the aisle. I have also had the honor of testifying in Congress on health policy matters. I believe, through LUGPA, we have positively impacted patient care and access to independent urology.

Moreover, the formation of new entities, like the American Independent Medical Practice Association, underscores the ongoing need for collective action to preserve independent practice amidst evolving health care landscapes. While opportunities for advocacy and collaboration continue to expand, specialty-based associations remain essential for addressing our unique challenges and opportunities.

You mentioned that Solaris, despite being investor-backed, prioritizes physician ownership. Could you provide insight into the organization’s objectives and operations?

Dr. Kirsh: Solaris was formed to unite independent urology groups from various regions in a national, highly professionalized urology business that will lead urology care in the United States for generations. Our model emphasizes a balance between local autonomy in matters most important to physicians—clinical decision-making and the activities of day-to-day practice—with the need for national scale to navigate the future in a consolidating health care landscape. National scale can drive innovation and efficiency. Meaningful physician ownership—Solaris is majority owned by physicians—ensures we retain the entrepreneurial and innovative characteristics of independent practice. By integrating practices, standardizing operations, and fostering a culture of excellence, Solaris seeks to establish itself as the premier provider of urological care in the country, ensuring the sustainability of independent practice for years to come.

What are your professional goals for the next 10 years, particularly with Solaris?

Dr. Kirsh: My primary goal with Solaris is to build a sustainable, physician-driven urology enterprise that sets the standard for excellence in patient care. This entails  operational refinement and fostering a collaborative culture across our network. I aim to leave a lasting legacy in urological practice that positively impacts patients and providers alike.