FAQ - Urology

[WildWing]

We are working on a consistent set of FAQs for all specialties as part of a revamp of the Specialty Selector.

If you are a practicing Urologist, please share your expertise by answering these questions.

Thank you in advance for considering this opportunity to give back to the SDN community!

• What is unique or special about this specialty?
• What other specialties did you consider and why did you pick this one?
• What challenges will this specialty face in the next 10 years?
• What are common practice settings for this specialty?
• How challenging or easy is it to match in this specialty?
• What excites you most about your specialty in the next 5, 10, 15 years from now?
• Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
• What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
• What does a typical workday consist of in your specialty?
• What is the career progression for your specialty?
• How has your work impacted your life dynamics? What is your work-life balance?
• How does healthcare policy impact your specialty?

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[mestielest]

What is unique or special about this specialty?
The penile skin has no subcutaneous fat, that's quite unique in the human body. Apart from that, the urologic practice has a wide variety of ages (say pre-born to the elder of the elders), approaches (pure surveillance to emergency), instruments (micro to robotics to rough open), a sense of humor, and balls.

What other specialties did you consider and why did you pick this one?
General surgery and cardiovascular surgery. I picked urology because of more planned working style.

What challenges will this specialty face in the next 10 years?
Increasing number of urologists in the private practice and primary care in together with centralization of technology-dependent procedures to the tertiary center. Thus, we will completely lose "the middle class".

What are common practice settings for this specialty?
I suppose most will either try to get into private practice or into a tertiary clinic. It seems we are going in to a phase of either you are a primary care andrologist or a tertiary hospital robotic/endo specialist.

How challenging or easy is it to match in this specialty?
In most countries it's quite competitive.

What excites you most about your specialty in the next 5, 10, 15 years from now?
Smart phone controllable penile prostheses.

Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
A primary LUTS or ED, surveillance bladder tumor, and maybe some others can be managed via AI.

What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
A regular candidate for residency, an MD with USMLE results, should encounter no problems with this path. A reasonable one will be successful, more or less.
*Just to mention if you have any kind of mental conditions please get professional help. I also suffered a lot because of a late-diagnosis ADHD.

What does a typical workday consist of in your specialty?
Depends on where you are working. Private practice mostly based on outpatient surgery and office examinations. Community centers have more a workload of general urology (prostate disease etc). University hospitals usually have specific working groups; they do the same surgery everyday.

What is the career progression for your specialty?
Similar to others. I suppose urology has a wider practice area over sexology and associated areas.

How has your work impacted your life dynamics? What is your work-life balance?
Currently, I'm in private practice. Thus, flexible in terms of time but tough in terms of stress.

How does healthcare policy impact your specialty?
In Türkiye we have national public insurance. So, my essential problem is rivalry against the state itself. In the recent years public sector grew substantially in healthcare. Combining with increased economical pressure, private practice became quite unprofitable here. However, overall I can say most urologist can find a place to live, still. Upcoming years probably we are going to be able to survive.

 

[DoctwoB]

• What is unique or special about this specialty?
  • It combines medical and surgical management of an organ system, namely the urinary tract and male (and sometimes female) reproductive tract. This means we both operate as well as follow patients in clinic, so it is a great mix of medicine and surgery
  • We have incredible variety in surgical modalities, ranging from endoscopic surgery to microsurgery, to laparoscopic/robotic surgery, to major open surgery. Most surgical fields have an equivalent "medical" field that does endoscopy, we keep ours in house.
  • A well trained general urologist can still practice a very broad scope, and not just in rural or underserved areas. Fellowships are only necessary for those pursuing a highly specialized or academic career.
  • Our patients generally have excellent outcomes. Most urologic cancers will be cured with surgery. BPH and kidney stone patients have massive relief or improvement in quality of life from our surgeries. While surgeons who deal with cases of poor prognosis or severe disability, like neurosurgeons, are amazing, it is extremely rewarding to see how our patients benefit and do great after our procedures.
• What other specialties did you consider and why did you pick this one?
  • I thought about general surgery/surgical critical care. I preferred urology due to the type and variety of surgeries performed and post-residency lifestyle.
• What challenges will this specialty face in the next 10 years?
  • Shortage of urologists (great for urologists, not so good for patients who need one)
  • As more and more surgeries become endoscopic and robotic, graduating residents will become less adept at open surgery. Major open surgery may require fellowship training in today's trainees. This has less and less of an impact as we (and hospital systems, many are now offering 24hr robot access, etc) are more adept at minimally invasive surgery, but there will be niche cases where this skill atrophy is problematic and I can forsee a future where open surgery or "maximally invasive surgery" fellowships need to exist.
  • Honestly don't see many others beyond the factors that effect all of medicine, like declining reimbursements, paperwork, etc.
• What are common practice settings for this specialty?
  • All the usual suspects here ranging from true small group private practice to mega group private practice to hospital employed to academic. All have their pros/cons
  • In almost all cases, urologists will split their time between clinic and the OR or ASC. How much time you spend in each will depend on your referral patterns and specialization. I typically have 2.5 clinic days and 1.5 OR days a week. A busy oncologist may have 1 clinic day and 3 OR days. Relative to some other surgeons like general surgeons or orthopods, we tend to have a bit more clinic and less OR time, though again highly variable.
• How challenging or easy is it to match in this specialty?
  • Unfortunately very hard.
• What excites you most about your specialty in the next 5, 10, 15 years from now?
  • Lots of new toys. Urology is a very tech heavy field, and the last 3 years have seen widespread adoption of new thulium lasers, new/upgraded surgical robotics, new endoscopic tech for stone evacuation during lithotripsy, new minimally invasive BPH surgical treatments, etc.
  • Better treatment options for bladder cancer, current options leave much to be desired.
• Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
  • Not much of current use beyond some clerical work, like helping with inbasket management.
  • I can easily see a future of AI-augmented robotic surgery, where image processing and AI models identify anatomy and overlay it on your screen, possibly with the integration of molecular markers like PSMA-conjugated fluorophores to try to identify cancer/margins real-time during surgery, etc.
• What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
  • The usual for any surgical field. Willingness to work, calmness under pressure, assimilate information and act upon it, communication skills, efficiency, etc.
• What does a typical workday consist of in your specialty?
  • See patients in clinic or do cases in OR or combination of the two. If i'm on call for our group for the week briefly round on inpatient consults or post ops. Most urology cases are outpatient, so relatively few inpatients to see.
• What is the career progression for your specialty?
  • Entirely dependent on your practice setting. You could join a group, become a partner, and work the same job until you die or retire. You can take on more admin work if you desire, hospital department chief, etc though honestly in the private world that is seen as more of a burden then an aspirational goal. If you're in academics, you may be trying to climb the ladder of professorship or have the goal of being a chair, or you may find your niche and stick to it. For me I found a great job and plan on staying there until I retire. The thought of climbing the academic ladder kills my soul.
• How has your work impacted your life dynamics? What is your work-life balance?
  • Residency was long and tough. Urology is known as a better lifestyle field, but that typically doesn't apply to residency, which is a 5-6 year surgical residency. Once graduated, lifestyle has been excellent. I work 4 days/week, reasonable hours (though sometimes long days with OR). I take call 1 week in 5 and am well compensated to do so. Call is not bad, and pretty rare for me to go in during the night.
• How does healthcare policy impact your specialty?
  • We're all subject to the whims of the US healthcare system. Reimbursement cuts can effect your pay, even if you are salaried (it just takes longer). Current political views can unfortunately effect contraceptive or transgender care, or in the case of pediatric urology, can intrude on the already difficult management of disorders of sexual differentiation.