Navigating the Clinical Component
Centennial Urology Associates runs a hybrid practice model that combines clinic time, in-office procedures, ASC procedural work, and main OR cases including robotic surgery. The incoming urologist will see a high volume of bread-and-butter urology with strong unmet demand across the service area, and have the option to grow the robotic surgery line that Dr. Gardner does not currently cover. APP support handles initial consults and follow-ups, freeing the physician day for surgical cases, complex visits, and inpatient consults.
Patient Population
- Approximately 105,000 patients in the Roseburg metro service area
- Catchment extends across Douglas County and into the Mid-Oregon Coast where no urology providers practice
- Mixed payor base: Private insurance 70%, Medicare 15%, Medicaid 15% (Mercy-wide)
- Typical clinic patient: BPH, kidney stones, bladder cancer, prostate cancer evaluation, hematuria workups, erectile dysfunction, recurrent UTIs, and incontinence
- New patient appointments currently booked out close to one year
- Significant regional outmigration for robotic cases, female urology, and complex stones
Practice Structure
The practice operates with shared physician and APP responsibilities to maximize procedural capacity:
- Andrea James-Barber, FNP-C performs initial patient consultations and routine follow-ups in clinic
- Dr. Gardner reviews APP cases and steps in for procedure planning and complex visits
- Surgical packets, pre-op testing orders, and maps are issued to patients at the time of scheduling
- Pre-op testing completed two weeks ahead of surgery, with multiple confirmation calls from clinic, ASC, and hospital
- Add-on and same-week cases accommodated through open OR blocks and PMO governance
Procedures and Services
The practice covers the full range of general urology and is positioned to expand its robotic surgery footprint. Mercy Medical Center operates two Intuitive Da Vinci surgical robots, with robotic block time currently underutilized.
Procedures performed locally:
- Cystoscopy and bladder biopsy
- Transurethral resection of bladder tumor (TURBT)
- Transurethral resection of the prostate (TURP)
- Ureteroscopy and laser lithotripsy
- Percutaneous stone management
- Prostate biopsy
- Vasectomy
- Hydrocelectomy and basic scrotal surgery
- In-office urodynamics
Procedures with significant outmigration today, available for the incoming urologist to capture locally:
- Robotic prostatectomy
- Robotic partial nephrectomy
- Robotic pyeloplasty
- Female pelvic medicine procedures (pessary, sling, prolapse repair)
- Advanced stone management cases
Schedule and OR Block Time
| Setting |
Block |
| Main OR (general cases) | First Friday of the month |
| Main OR (robotic block) | Third and fourth Wednesdays of the month |
| Mercy Ambulatory Surgery Center | Every Tuesday and first Thursday afternoon |
| Clinic | Remaining weekdays |
Block time may expand as a second full-time urologist joins the team. Add-on cases and additional OR access are routed through PMO governance and have been accommodated without friction so far.
Call Schedule
| Call Element |
Detail |
| Frequency | ~8 days per month |
| Type | From home, telephone first |
| In-house requirement | Only when surgical intervention is required |
| Hospitalist role | Manages stable urology admissions, including most stone consults |
| Stipend for additional call days | Yes, per system policy (additional pay for extra call coverage) |
| ED workup support | Standard ED workup completed before urology consult is called |
Most overnight call volume is driven by kidney stone presentations, which the hospitalist team can stabilize and admit with telephone consult. Acute scrotum, obstructive pyelonephritis, and surgical cases trigger in-house response.
EMR and Clinical Tools
- Inpatient and outpatient EMR: MEDITECH 6.0
- Mercy Medical Center transitions to Epic in 2026
- Dictation and scribe support available per CMG standard
- Imaging and lab integrated through MEDITECH today and Epic at transition
- Two Intuitive Da Vinci surgical robots on site
Advanced Practice Provider Support
Andrea James-Barber, FNP-C anchors clinic operations. She holds DNP, FNP-C, DMP, and MEd credentials with 13+ years of nursing and outpatient experience.
- Independent clinic visits for new and follow-up patients
- Routine and post-operative follow-up management
- Surgical scheduling support with physician oversight
- Clinic-only role (does not provide hospital coverage)
The APP does not take urology call.
Support Staff
- Long-tenured medical assistant team
- Dedicated surgery scheduler with deep practice knowledge
- Front office receptionist with prior cardiology experience
- Most clinic staff have been with the practice since opening
- ASC and main OR staff are experienced with urologic surgery flow
Subspecialty and Focus Opportunities
Mercy is open to structuring the position around the incoming urologist's interests:
- General urology with full clinic and OR mix (default)
- Robotic surgery focus (third and fourth Wednesday block time available)
- Female urology and FPMRS focus as a bonus subspecialty (pessary, sling, prolapse repair) — currently a high-outflow service line referred to OHSU
- Endourology and advanced stone management
- Urologic oncology with robotic prostatectomy and partial nephrectomy emphasis
Clinical Collaboration
The incoming urologist will work closely with:
- Hospitalist team (handles stable urology admissions with phone consult)
- Emergency Department
- Anesthesia and the Mercy ASC team
- General surgery
- Nephrology (Centennial Kidney is part of the same medical group)
- Interventional radiology (two IR docs on staff)
- PMO governance for OR block management
Teaching, Research, and Behavioral Health
Mercy Medical Center is a community hospital, not an academic center. There are no formal teaching obligations, GME programs, or active research protocols tied to the position. Integrated behavioral health support is available through Mercy Behavioral Health for patients with mental health needs alongside their urologic care.