Urology Attending AMA

[cpants]

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Tips and tricks for residents to prepare for their transition to private practice? Would a MHBA degree help at all?

I'm not sure what tricks or tips there would be. Certainly, educating yourself and understanding what it takes to be a small business owner is critical. I don't think that a masters degree would be necessary. Yes and MBA or masers in healthcare administration would probably help, but that would come at significant expense in terms of time and money. I don't think it would be worth acquiring more debt or lengthening your training, when you could probably get that knowledge through reading books on the subject and conducting your own research.

 

[cpants]

What is the longest operation you perform on a regular basis, and how long does it usually take?

Probably radical robotic prostatectomy and lymph node dissection. Usually takes 3-4 hours.

 

[cpants]

Do you operate on Gleason 8 prostate cancer without sending them to radiation oncology first?
Do you agree that surgery is inappropriate initial management for high risk prostate cancer?

I do routinely send most patients with high (and low) risk prostate cancer for a consultation with radiation oncology prior to deciding on treatment. Some refuse to go. Some end up deciding on radiation (or surgery) even when I don't think that is their best option. I see my role as giving them the information and my recommendations. The treatment decision is ultimately the patient's to make.

There are no hard and fast rules regarding prostate cancer treatment. Certainly, you cannot say that patients with Gleason 8 are best served by radiation alone, and that's not what national guidelines from AUA, ASTRO, NCCN say either. You need to look at the whole clinical situation -- patient age and status, clinical staging (grading, number of positive cores, imaging results, exam, PSA level), patient preferences, urinary and sexual function status, etc.

For example, for a man in his 50s with low volume gleason 8 and a low PSA surgery may be the best or at least an acceptable option. The patient needs to be counseled about the likelihood of needing multimodal therapy and there are very good predictive nomograms to help with that.

If they have locally advanced disease, Gleason 9/10, 12/12 cores positive, surgery is probably not the best option in my opinion. The older the patient and the higher the risk group and/or stage, the less enthusiastic I am about surgery.

 

[Frogger27]

The most burned out (and happiest) doctors, according to Medscape

What do you think about recent reports that have come out that Urology has one of the highest rates of burnout/career dissatisfaction? Should this be taken into account when med students are deciding between specialties?

This is definitely not what I have seen in my experience, but recent articles I have seen about burnout/future of Urology have been concerning

 

[cpants]

The most burned out (and happiest) doctors, according to Medscape

What do you think about recent reports that have come out that Urology has one of the highest rates of burnout/career dissatisfaction? Should this be taken into account when med students are deciding between specialties?

This is definitely not what I have seen in my experience, but recent articles I have seen about burnout/future of Urology have been concerning

I'm not sure about the validity of the survey, but I certainly know plenty of burnt out urologists. Like any field, it's critical to establish work/life balance. I think the most important thing you can do is set some limits on the amount you work. Especially in a field like uro where there is a shortage of providers and in most practices a wait list of patients waiting to be seen--there is always pressure to extend hours, work harder, work longer.

For me, I have set a few limits that for the most part keep my burnout and resentment to acceptable levels:
1. I never take work home with me. Sure I could see 5-10 more patients per day if I did my charts at night while at home, and probably that would even increase my income by 100k/year. But it's not worth it. Being present with my wife and family in the evening goes a long way to keeping me sane.
2. I never hesitate to block time in my schedule for self-care (doctor appointment, dentist, etc.), family events, educational opportunities.
3. I use my vacation time, and I arrange coverage for any patient issues while I am away.

 

[afib123]

if you apply to im as backup and another competitive field like urology and you have an im sub-internship on your transcript during 4th year, how would you recommend talking about that. would it be ok to say you considered both im and urology, and you went with urology?

 

[cpants]

if you apply to im as backup and another competitive field like urology and you have an im sub-internship on your transcript during 4th year, how would you recommend talking about that. would it be ok to say you considered both im and urology, and you went with urology?

Yes that would be fine, but I doubt anyone would even ask you about it.

 

[afib123]

I think the issue is more that if you have a bunch of uro subis, letters, research (aka. The things that make an application for a competitive specialty good), you are shooting yourself in the foot for the IM applications. The IM pds wont be fooled and you might end up rejected from IM programs that would’ve interviewed you otherwise. Interview seasons also overlap and the uro applicants I knew couldn’t even fit all their uro interviews into their schedule, let alone interviews for another specialty.

But for your IM subi question, say that knowing medical floor management is important to uro and you wanted to learn more. My school and others require Ms4s to take a medicine subi, so you won’t be the only one with it

I do have IM research and I will also have separate letters from the IM department so that should not be an issue. My guess is the only problem will be having sub-i's from a different speciality and research from a different speciality on the transcript and on ERAS during the IM interview. But hopefully as the other person commented, they won't notice or will think that I changed my mind.

 

[medicineman1234]

Show up on time. Be polite, friendly, professional to everyone -- a secretary or scrub tech can very easily get you black-balled. Read on high yield topics before the rotation and prepare for every case. Practice basic surgical skills like wound closure and knot tying before rotation.

Avoid any entitled attitude. Try to help the residents as much as you can. Never leave early.

This is basically an audition to see how pleasant you are to work with.

Where do you start when practicing the basic surgical skills? Is there a guide of somesort ? Sutures+chicken thighs?

 

[Frogger27]

I'm not sure about the validity of the survey, but I certainly know plenty of burnt out urologists. Like any field, it's critical to establish work/life balance. I think the most important thing you can do is set some limits on the amount you work. Especially in a field like uro where there is a shortage of providers and in most practices a wait list of patients waiting to be seen--there is always pressure to extend hours, work harder, work longer.

For me, I have set a few limits that for the most part keep my burnout and resentment to acceptable levels:
1. I never take work home with me. Sure I could see 5-10 more patients per day if I did my charts at night while at home, and probably that would even increase my income by 100k/year. But it's not worth it. Being present with my wife and family in the evening goes a long way to keeping me sane.
2. I never hesitate to block time in my schedule for self-care (doctor appointment, dentist, etc.), family events, educational opportunities.
3. I use my vacation time, and I arrange coverage for any patient issues while I am away.

Thanks for the response! just curious, how much vacation weeks/year do you usually take as an attending surgeon? How difficult is it managing coverage of patients in order to plan a break for yourself/family?

 

[DoctwoB]

Thanks for the response! just curious, how much vacation weeks/year do you usually take as an attending surgeon? How difficult is it managing coverage of patients in order to plan a break for yourself/family?

Not OP but weighing in. The job I’m looking at taking offers 4 weeks paid for first two years (salaried + RVU bonus as partnership track). After first two years pay is entirely RVU based and have 2 weeks paid/year (they credit you your average weekly RVU total) and up to 6 weeks unpaid. Most jobs I’ve seen that are employed are somewhere in the 4-6 week paid vacation range. Most private practices are more liberal with the number of weeks, but your pay is production based so will go down with more time off.

 

[cpants]

Where do you start when practicing the basic surgical skills? Is there a guide of somesort ? Sutures+chicken thighs?

Ethicon used to have a nice practice board. I would worry more about learning knot tying first rather than passing the needle. All you need is some suture to practice. Work on getting two hand tie down first using both hands. One-handed tying with both hands comes next, but you will be expected to two-hand tie as a med student. Suggest youtube for instructional videos.

 

[cpants]

Not OP but weighing in. The job I’m looking at taking offers 4 weeks paid for first two years (salaried + RVU bonus as partnership track). After first two years pay is entirely RVU based and have 2 weeks paid/year (they credit you your average weekly RVU total) and up to 6 weeks unpaid. Most jobs I’ve seen that are employed are somewhere in the 4-6 week paid vacation range. Most private practices are more liberal with the number of weeks, but your pay is production based so will go down with more time off.

Will vary. I have 5 weeks off and I generally use it. They still pay me my base salary during this time, but not making RVU's toward bonus so it is only semi-paid.

 

[cpants]

Thanks for the response! just curious, how much vacation weeks/year do you usually take as an attending surgeon? How difficult is it managing coverage of patients in order to plan a break for yourself/family?

Usually take about 5 weeks throughout the year. Coverage is straightforward. My partners want me to cover when they go away so we help each other out. Nurses know to bring patient care issue -- test results, calls, etc, to whoever is in the office or on call.

 

[chlorocruorin]

I’m an incoming M1 that has an early interest in urology. Are more urologists doing fellowships? Also, if i were to do a fellowship in oncology would I have to go into academics? Thank you!

 

[cpants]

I’m an incoming M1 that has an early interest in urology. Are more urologists doing fellowships? Also, if i were to do a fellowship in oncology would I have to go into academics? Thank you!

Many urologists do fellowships, and many do not. All depends on your goals and the strengths/weaknesses of your training program. By no means would you be limited to an academic setting after an onc fellowship.

 

[OrthoTraumaMD]

I mentor med students and a bunch of them made the leap into urology because it’s “surgery with a lifestyle.” So given that (not that I’m trying to lure them back or anything lol...) 2 questions:
1. Is there anything a urologist would come in the middle of the night for? (Barring a trauma patient going to the OR that has a bladder rupture and needs a suprapubic tube)
2. What’s your least favorite thing about your specialty?
PS. I love the urologists at my hospital. They are chill and funny as hell.

 

[cpants]

I mentor med students and a bunch of them made the leap into urology because it’s “surgery with a lifestyle.” So given that (not that I’m trying to lure them back or anything lol...) 2 questions:
1. Is there anything a urologist would come in the middle of the night for? (Barring a trauma patient going to the OR that has a bladder rupture and needs a suprapubic tube)
2. What’s your least favorite thing about your specialty?
PS. I love the urologists at my hospital. They are chill and funny as hell.

There are several emergencies we would come in at night for--most commonly: gross hematuria with clot retention, "difficult" Foley catheters, some kidney stones need urgent intervention (sepsis, bilateral obstruction, severe AKI), testicular torsion, Fournier's gangrene, trauma. That said, these are relatively rare compared to the emergency scenarios many other surgical specialties face.

Least favorite thing. Hmm. I don't really enjoy incontinence work and chronic pelvic pain issues. We end up seeing a fair amount of that stuff.

 

[chlorocruorin]

There are several emergencies we would come in at night for--most commonly: gross hematuria with clot retention, "difficult" Foley catheters, some kidney stones need urgent intervention (sepsis, bilateral obstruction, severe AKI), testicular torsion, Fournier's gangrene, trauma. That said, these are relatively rare compared to the emergency scenarios many other surgical specialties face.

Least favorite thing. Hmm. I don't really enjoy incontinence work and chronic pelvic pain issues. We end up seeing a fair amount of that stuff.

How do you like the patient population?. In my short experience with urologists I’ve noticed that usually it’s older men (~55+).

Is that generally true? If not, do you see a good amount of younger patients?

Thank you

 

[cpants]

How do you like the patient population?. In my short experience with urologists I’ve noticed that usually it’s older men (~55+).

Is that generally true? If not, do you see a good amount of younger patients?

Thank you

Definitely see lots of older guys, but I see young patients, kids, women too. I would estimate about 60% of my patients are men over 55 and the rest is a grab bag. Opportunities to focus on pediatrics or female urology with specialty training if you like urology but don't like old men.

 

[OrthoTraumaMD]

Are male patients weird about having a female urologist? I’ve gotten conflicting reports.

 

[cpants]

Are male patients weird about having a female urologist? I’ve gotten conflicting reports.

Some will be, but in general no. Depending on the complaint it may be more or less of a problem -- for example, erectile dysfunction or premature ejaculation might be tougher to talk about with a female doctor for some guys. I know one attractive female urologist who stopped doing vasectomies because the awake patients were frequently getting erections and she found it awkward. These are exceptions rather than the rule though, and I know many excellent female urologists with extremely busy practices.

 

[bornhuman]

Something to consider: Urology has elements of IM and Surgery, and makes for a compelling choice as surgical skills are perishable. Sure there are jokes and gallows humor, but if you set that aside, and consider the decades ahead it's a specialty that puts your mind, and skills (surgical) to a rewarding choice. Good advice on knots—tie tie tie, all the time. Great advice - Please try not looking at salary, money, and set your mind on a specialty that will keep you engaged, and enjoy lifetime learning.

MD class of `81
GS

 

[md_doc]

Hi,

Just wondering what are average RVUs for a general urologist to attain yearly? How difficulty is reaching 6-7000 RVUs? In other words, what are general RVU thresholds used for productivity bonuses and what should an average urologist reach each year?

Thanks in advance.

 

[Frogger27]

New M3 who just got step score back... pretty bummed as i got a 238. I know I’m below the 240 mark for a lot of programs, but what do you recommend as the best way moving forward to put together a competitive app? I started research M1 and have 10 posters, 2 small pubs and working on a first author large manuscript that is getting ready to submit. Mid tier USMD as well

 

[cpants]

Hi,

Just wondering what are average RVUs for a general urologist to attain yearly? How difficulty is reaching 6-7000 RVUs? In other words, what are general RVU thresholds used for productivity bonuses and what should an average urologist reach each year?

Thanks in advance.

65th percentile for MGMA is somewhere around 8500 wRVU last time I checked, so should be very doable if you are working full time.

 

[PatchAdams25]

@OrthoTraumaMD @cpants How does the lifestyle as an attending and compensation compare between Urology and Ortho?

 

[NotaCop]

@OrthoTraumaMD @cpants How does the lifestyle as an attending and compensation compare between Urology and Ortho?

Piggybacking on this, which docs are the better golfers?

 

[OrthoTraumaMD]

@OrthoTraumaMD @cpants How does the lifestyle as an attending and compensation compare between Urology and Ortho?

Lifestyle and pay is extremely dependent on your ortho subspecialty and practice type, so that question isn’t easily answered.

As for golf... hands down Ortho. Sorry, urology. 😉

 

[chlorocruorin]

Lifestyle and pay is extremely dependent on your ortho subspecialty and practice type, so that question isn’t easily answered.

As for golf... hands down Ortho. Sorry, urology. 😉

Can ortho spine go into private? Or is it common?

 

[OrthoTraumaMD]

Can ortho spine go into private? Or is it common?

Yes spine can be part of a private practice.

 

[cpants]

@OrthoTraumaMD @cpants How does the lifestyle as an attending and compensation compare between Urology and Ortho?

It will depend on the individual practices. In very general, ortho makes more with worse lifestyle is my impression.

In my experience orthopods have nicer golf clubs, but worse handicap.

 

[Frogger27]

You're doing well! I'm a MS4 applying uro, so take what I say with a grain of salt. But the step average is around 246 for uro, so think of yourself as being as far from the average as someone with a 254. Plenty of people will have above 254, so plenty will be below 238 (not exactly how the stats work, but..)

10 poster and 3 pubs is great. Continuing chugging and try to get stuff at the major uro conferences. You'll have more research than most people with research years, so I don't think that's something you should be considering. You should take step 2ck early, so anki throughout MS3. Get good letters. Aim for AOA. I don't think you're in a bad place

Thanks for the reassurance! Yeah that was my thought on research year, but I figured it may be helpful to show "more" dedication to the field or whatnot. @cpants Do you agree with above post?

Sorry to post this here on your AMA- it is hard to get Uro advice as the subforum is not very active

 

[NotaCop]

Thanks for the reassurance! Yeah that was my thought on research year, but I figured it may be helpful to show "more" dedication to the field or whatnot. @cpants Do you agree with above post?

Sorry to post this here on your AMA- it is hard to get Uro advice as the subforum is not very active

PM’d

 

[cpants]

New M3 who just got step score back... pretty bummed as i got a 238. I know I’m below the 240 mark for a lot of programs, but what do you recommend as the best way moving forward to put together a competitive app? I started research M1 and have 10 posters, 2 small pubs and working on a first author large manuscript that is getting ready to submit. Mid tier USMD as well

Yea, I agree that a 238 won't be a dealbreaker, especially with an otherwise strong application. Need to continue producing as much research as possible. Get that manuscript in ASAP!

Meet with PD at your institution to discuss your application, competitiveness, and locations you should consider for rotations. For someone like you, I would recommend focusing on a geographical area of choice and rotate at the mid to low tier programs in that area. Places where you shine on a rotation are anyone's best chance at a match.

 

[Frogger27]

Yea, I agree that a 238 won't be a dealbreaker, especially with an otherwise strong application. Need to continue producing as much research as possible. Get that manuscript in ASAP!

Meet with PD at your institution to discuss your application, competitiveness, and locations you should consider for rotations. For someone like you, I would recommend focusing on a geographical area of choice and rotate at the mid to low tier programs in that area. Places where you shine on a rotation are anyone's best chance at a match.

This is great advice, thank you!

 

[Matthew9Thirtyfive]

Oh man that’s awkward when your patients get a boner...
My patients are, thankfully, usually in too much pain from their fracture to comment on my appearance (though not always!)

I had a torsion when I was 18, and the urologist who saw me was a female who could have been a Victoria’s Secret model. EXTREMELY attractive. I considered it a miracle I was able to get through her whole exam and the fix without an erection between the raging hormones and a model putting her hands all over my junk lol.

 

[DoctwoB]

I had a torsion when I was 18, and the urologist who saw me was a female who could have been a Victoria’s Secret model. EXTREMELY attractive. I considered it a miracle I was able to get through her whole exam and the fix without an erection between the raging hormones and a model putting her hands all over my junk lol.

Well the excruciating testicular pain probably helped.

In all seriousness though while it feels embarrassing to the patient, for the doctor it’s a non issue. Patients can get erections from any manual stimulation of the genitalia. It’s happened to me as a male urologist and I’m certain many of these patients didn’t find me attractive.

 

[Matthew9Thirtyfive]

Well the excruciating testicular pain probably helped.

In all seriousness though while it feels embarrassing to the patient, for the doctor it’s a non issue. Patients can get erections from any manual stimulation of the genitalia. It’s happened to me as a male urologist and I’m certain many of these patients didn’t find me attractive.

Haha, yeah. I've been working in healthcare now for a while, and it's no big deal. But when I was barely an 18 year old, I was going to be super embarrassed. Of course, afterward I felt bad that maybe she was offended that I didn't get an erection. Because I was 18 and an idiot.

 

[cpants]

Well the excruciating testicular pain probably helped.

In all seriousness though while it feels embarrassing to the patient, for the doctor it’s a non issue. Patients can get erections from any manual stimulation of the genitalia. It’s happened to me as a male urologist and I’m certain many of these patients didn’t find me attractive.

Yea agreed. Boners happen.