Able to avoid certain procedures?

[urologist to be]

Hello! I'm a medical student who is pretty much set on going into urology but I have a concern that I'm hoping to address with this post. Due to personal/moral/religious beliefs, I'm against the idea of performing non-medically necessary vasectomies as a form of permanent contraception (even if vasectomies have a chance at reversal, it's not high enough or reliable enough). I'd be happy to refer patients to someone who is willing to perform these (a colleague, co-resident, etc), but I'm wondering how easily I can work around this during training in residency. Will this cause issues with my program or will most programs be willing to accommodate? I'm assuming I shouldn't ask about this during interviews because it could bias a program against me right? How frequently will I even have to deal with this during residency? Thanks in advance for your insight.

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[DoctwoB]

Hello! I'm a medical student who is pretty much set on going into urology but I have a concern that I'm hoping to address with this post. Due to personal/moral/religious beliefs, I'm against the idea of performing non-medically necessary vasectomies as a form of permanent contraception (even if vasectomies have a chance at reversal, it's not high enough or reliable enough). I'd be happy to refer patients to someone who is willing to perform these (a colleague, co-resident, etc), but I'm wondering how easily I can work around this during training in residency. Will this cause issues with my program or will most programs be willing to accommodate? I'm assuming I shouldn't ask about this during interviews because it could bias a program against me right? How frequently will I even have to deal with this during residency? Thanks in advance for your insight.

There are a lot of threads in the OB forum about people feeling similarly about abortion and I imagine it would/should be treated similarly, although this is a far less common occurrence. You may need to provide additional documentation and support to graduate residency and be board eligible to meet required minimum cases. Personally I wouldn’t bring it up during interviews, as while PDs can’t legally discriminate based on religious beliefs it would be easy for them to choose to rank someone higher who wouldn’t require the headache of accommodations.

FWIW, vasectomy reversal is over 90% effective at restoring sperm to the ejaculate. Hard to get much better then that. While I am not here to question or debate your religious beliefs, given there is no other effective male form of contraception and a large part of Urology deals with sexual medicine I would question if this is the field for you.

Will you prescribe PDE5is to help men get erections they may use for extramarital intercourse or masturbation? Place penile prosthesis? What if the patient is gay? Prescribe vaginal estrogen to facilitate sexual function? Aid in assisted reproduction for unwed couples? There is a lot to consider if you want to provide good care for your patients.

 

[urologist to be]

Thanks for your detailed response. You bring up some good points and food for thought. The last thing I would want is for patients to not feel comfortable coming to me as their physician so I definitely have to consider how I will approach certain scenarios. I think personally I have a line between what I will do to the patient (relieve sexual dysfunction) and what they choose to do with it in their own time, which would allow me to treat patients without concerns on my part. I'm primarily concerned with actions I may directly perform to the patients. Most of the scenarios you mentioned are medically necessary for healthy enjoyable sex so I have no qualms, whereas vasectomies are usually not necessary. Anyway like you said we're not here to debate, and I really appreciate your insight into this matter. I will definitely keep everything you said in mind as I move forward.

 

[robellis]

Thanks for your detailed response. You bring up some good points and food for thought. The last thing I would want is for patients to not feel comfortable coming to me as their physician so I definitely have to consider how I will approach certain scenarios. I think personally I have a line between what I will do to the patient (relieve sexual dysfunction) and what they choose to do with it in their own time, which would allow me to treat patients without concerns on my part. I'm primarily concerned with actions I may directly perform to the patients. Most of the scenarios you mentioned are medically necessary for healthy enjoyable sex so I have no qualms, whereas vasectomies are usually not necessary. Anyway like you said we're not here to debate, and I really appreciate your insight into this matter. I will definitely keep everything you said in mind as I move forward.

What’s the reasoning behind refusing to perform a vasectomy?

 

[VA Hopeful Dr]

What’s the reasoning behind refusing to perform a vasectomy?

Some Catholic doctors refuse to provide any form of contraception.

 

[cpants]

Certainly you could choose not to perform vasectomies in practice as an attending, and many urologists do not. I also don't think it will be much of a problem to avoid in training. I don't remember if a minimum number of vasectomies are required for graduation, but if so it's only a handful and I bet you could get a religious exemption. Also you could "assist" on these cases to meet your numbers if that would not violate your morals (cut suture, close skin, whatever).

I definitely agree that you should not bring this up on interviews or rotations. Also be prepared that programs and attendings may not be very receptive to your opinion on this matter when it does come up.

Agree that you should consider other ethical scenarios and how you would handle them, because sexual medicine is a big part of urology. I can't tell you how many people walk in with crazy sexual practices and messed up situations, and you really have to check your judgment at the door.

 

[robellis]

Certainly you could choose not to perform vasectomies in practice as an attending, and many urologists do not. I also don't think it will be much of a problem to avoid in training. I don't remember if a minimum number of vasectomies are required for graduation, but if so it's only a handful and I bet you could get a religious exemption. Also you could "assist" on these cases to meet your numbers if that would not violate your morals (cut suture, close skin, whatever).

I definitely agree that you should not bring this up on interviews or rotations. Also be prepared that programs and attendings may not be very receptive to your opinion on this matter when it does come up.

Agree that you should consider other ethical scenarios and how you would handle them, because sexual medicine is a big part of urology. I can't tell you how many people walk in with crazy sexual practices and messed up situations, and you really have to check your judgment at the door.

He should bring it up why shouldn’t he? Programs should know what they’re getting and not take him if they disagree with his reasoning and beliefs..if no one wants to train him he should pick a different field

 

[cpants]

He should bring it up why shouldn’t he? Programs should know what they’re getting and not take him if they disagree with his reasoning and beliefs..if no one wants to train him he should pick a different field

I fully believe a catholic opposed to performing vasectomy can be a great urologist, but people are judgmental and there really is no reason to bring it up. This topic will at best be neutral and in some cases will hurt his chances.

 

[JeterIsStud]

I fully believe a catholic opposed to performing vasectomy can be a great urologist, but people are judgmental and there really is no reason to bring it up. This topic will at best be neutral and in some cases will hurt his chances.

Agree with this. I know a fantastic urologist who is catholic and does not perform vasectomies. However, he says he didn't bring it up until after he matched and is in academic urology now - and says that it likely would probably set you apart from the other applicants by bringing it up potentially in a negative way.