Most patients perceive physicians as highly compensated for the work they do. However, physicians' reimbursement for their work has been steadily decreasing. [A study recently published in the Journal of Arthroplasty by Foran et al](http://www.ncbi.nlm.nih.gov/pubmed/22245124) demonstrated that patients in their practices significantly over-estimated the amount that orthopedic surgeons are paid for total knee and total hip replacements: > "On average, patients thought that surgeons should receive $14,358 for THA and $13,332 for TKA. Patients estimated actual Medicare reimbursement to be $8,212 for THA and $7,196 for TKA. Most of the patients stated that Medicare reimbursement was 'much lower' than what it should be." When given the chance to comment openly at the end of the survey, many patients expressed concern that this significant under-compensation might lead to more orthopedic surgeons dropping out of Medicare in the future. This is of concern since over 50% of knee and hip arthroplasties in the U.S. are paid for by Medicare. This is not isolated to orthopedics but is an issue affecting all specialties. Medicare patients make up a significant component of most urology practices. Organized medicine is one way that we can all get involved in advocating for our patients and our practices. For Urology, the [American Association for Clinical Urologists](http://www.aacuweb.org/) is a great resource when it comes to getting involved. If you ever have the opportunity, I strongly recommend attending the Joint Advocacy Conference in DC that usually takes place in March each year. It is sponsored by the AACU and AUA, and it provides great insight into a lot of the decisions made in Washington and how they affect us in our daily practices.