How skillful are the new urologic surgeons after residency?

[kalf]

This is a general question but reflects my fears. After finishing residency which procedures can a junior attending manage confidently? I know that as the years go by, uro residents are more displeased with the volume of surgeries the do due to work-hour restrictions and the minimally invasive surgery that has taken its place to everyday practice. All of us want to operate with DaVinci but the reality is that very few manage not to "screw" during the procedure and the attendings usually take the lead again, leaving many residents just observing procedures.
So it is evident that only fellowships are left to gain more exposure in much more procedures!
What are your opinions about this reality?

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[cpants]

It will be highly dependent on the resident and the program. Generally, people grumble about the poor training of the new generation, but that has been going on forever.

I think your comment about DaVinci was probably true 5-10 years ago. The technology has matured enough that people at high volume centers should be well past their learning curves at this point. If the residents aren't getting console time, there really isn't an excuse for that. In fact the dual console setups and draw screens can really be used very effectively for training.

I think, in this day and age, a well trained general urologist should be able to handle almost any kidney stone or endoscopic case, all minor cases (circ, hydrocele), straightforward lap cases (ie. nephrectomy), robotic prostatectomy and simpler partial nephrectomies, basic female cases (slings, caruncles, possibly small cystocele repairs), basic peds (orchidopexy, circ revisions). Not everyone gets there, but many/most do.

 

[kalf]

Which fellowship would you recommend, in terms of high demand from the market?

 

[DoctwoB]

Female is definitely an in demand field, there is a ton of prolapse and incontinence in an aging population. Infertility/andrology is as well, though it’s tough to have a pure infertility practice without supplementing with general urology. Recon market seems good for now, though fellowship spots have expanded and I expect it to saturate pretty quickly. Peds fluctuates, but currently probably falls somewhere in the middle. MIS and Onc job markets aren’t as good if looking at academics, but plenty of demand in private practice, though expect to practice general urology as well. But truthfully the best demand I’ve seen is for general urologists.

 

[kalf]

What about endo uro? I have seen the curriculum of many training centers both in USA and outside USA (in endourological society page) and they combine robotics, lap procedures, ESWLs, PCNLs etc etc...When you finish this 1 or 2 year program you have a wide range of procedures to deal with, in other words much more patients. Comparing endouro and female which of the two would you recommend? Andrology and paeds are not so my favorite because of the drawbacks you said above. In Andrology you must adapt your practice and kids as patients require more attention (anxious parents are more prone to lawsuits). Uro Onc for me has to be combined with research and academic environment in order to make use the range of knowledge and skills you will get during your training.Generally, I believe that when someone aims a fellowship and then private practice, his/her fellowship has to deal more with benign diseases and some oncologic surgeries that are relatively easy to learn. For example an RPLND for me is quite risky in private practice as a junior attending. You have only one patient for 6-13 hours in the table, you are sweating like a pig from the stress and complications during the procedure are quite common! In the same time you could have other procedures, in various numbers, providing you much more money, with less stress! I know that general urologists are more in demand, but I insist that a fellowship gives you more opportunities to shape your own private practice. General Urologists dont have that luxury.

 

[cpants]

Job market for female urologists and general urologists are outstanding. Endourology fellowship is fine if you need additional training after residency. In my opinion a general urologist should be able to do all the procedures that an endourology fellowship focuses on. It's kind of like a general urology fellowship! It could be helpful if you want to go to an academic/tertiary center and be the kidney stone guy that does all the hard stones the general guys don't want to deal with.

Fellowship will never hurt you in terms of getting a job. However, most people can't get a job doing exclusively their fellowship training. There are just too many fellowships and not enough demand for fellowship trained people. It's a big investment of time and money, so make sure you are doing the fellowship for a valid reason -- need additional training, need specialized training in certain procedures you want to perform, academic interests. Wanting "more opportunities to shape your own private practice", whatever that means, does not seem like a good reason to do endo or any other fellowship.