Thanks a lot for doing this! I'll start off with a couple questions that hopefully you won't mind answering:
1) Why did you pick Urology?
2) When did you begin to get exposure to it in med school? Is it important to begin making contacts early in Urology in order to maximize chances to match due to the early match?
3) What Step score would be your cut off for competitiveness?
4) Most important factors for matching?
5) Do you have to enjoy Renal anatomy/management to be a good fit in Urology?
1. I knew I wanted to do a surgical field, and spent time rotating through each of the surgical fields until I found the right one. Urology has a great variety of cases, across open, laparoscopic, robotic, endoscopic, and microscopic approaches. Patients generally do very well and many of our operations make a huge impact on their quality of life, such as relieving pain form kidney stones, letting them void from surgery for BPH, and so on. I found that I liked the bread and butter of Urology (stones, BPH, common cancers like prostate/kidney etc.) much more then I liked the bread and butter of some other surgical fields (e.g. spine for neurosurgery). I liked that there is a huge demand for Urologists to practice straight out of residency without needing to do a fellowship like most do in Ortho. Finally, while Urologists are surgeons and thus have some type A personalities, generally I felt that I fit in better with them personality-wise then some of the more intense surgical specialties.
2. I was a relatively late arrival, and didn't get any Urology exposure until middle of third year. The earlier you can get to it, the better, as this gives you more time to do research, rotate with the department, set up aways, etc. We have some students who have been doing research with us since MS-1 and that definitely helps get them exposure to the faculty and can help with letters and matching, assuming you did a good job. That being said, we understand that many people (like me) don't arrive at Urology until late, so it's certainly not a major disadvantage.
3. It's cliche to say, but for most places there is no strict step-1 cutoff and the whole application matters. For practical purposes, I'd say that below 240 is fine but you should have other strengths to show on your application, while above 250 is an asset to your application.
4. Most places look at the whole package. Urology is quite competitive(67% match rate my year, gotten a bit better since then) and so programs have the luxury of looking for a well-rounded application. In some order (will vary by the program), they want to see good step scores, clinical grades, meaningful research, strong letters of rec from people they know (Urology is a tiny field, so in academics basically everyone knows everyone) as well as be personable and interview well. They want to see good performance on a home (and likely away) subi. Most applicants will do at least 1 away rotation.
5. Renal anatomy is important, but much more from a gross perspective then the nephron anatomy that nephrologists focus on. We do a lot of renal surgery which involves knowing the vascular anatomy and surrounding retroperitoneal structures and how to approach them. Of course if you want to sub-specialize in infertility/microsurgery or female urology and never operate on a kidney again after residency, you certainly can.
