1. I had a pretty good idea I would end up doing something surgical. Stumbled upon urology as an MS1 doing some shadowing and never looked back!
1. I came into med school thinking ortho or neurosurgery. Quickly realized I didn’t want to have the life of the neurosurgeon attendings. With ortho, I liked the surgery but just never felt very excited about learning MSK pathology. Also couldn’t see myself specializing and being a knee or hip guy the rest of my career. Urology has an incredible amount of variety, great outcomes, and interesting diseases. The bread and butter for a general urologist includes robotic prostatectomy, transurethral resection of bladder tumors, ureteroscopy and laser lithotripsy for kidney stones, and of course a TURP. I’ve had many days in the OR that included each of these procedures. Treating cancer was another important priority for me, and urology is arguably the best specialty for this without requiring fellowship and subspecialization.
Urology has a separate early match through the AUA, which means we find out in January and have an extra couple months to relax and find housing at the end of MS4. Ophthalmology is the other specialty with a separate early match system.
Cancer (most common): prostate, bladder, testicular, renal, adrenal
I had a couple first author pubs and 2-3 second authors. Plus a handful of abstracts/presentations. All of this was in urology, but I don’t think that’s necessary as long as you have something urology related by the time you submit your residency application.
Did you take a research year/do you think taking one is common for students applying urology? Would you say the level of research productivity you had is comparable to that recommended in order to match into a top academic urology program?
Current M2 here (on the forum cuz my brother is applying). I am very interested in Urology. I was talking to an older Urologist yesterday at Loyola (I don't go there), and he saidthat 2/3s of his residents choose a fellowship. I was dismayed by this as I do not want to do a fellowship. I will be 30 when I start residency and the whole starting a family thing with income is important to me. He also said that most general urologist actually do rural care.
There may be variability between programs, but like I said earlier the majority of residents overall do not pursue fellowship. There are plenty of programs out there that will support you if you want a private practice career, and others that will push more for academics (and fellowship). The one thing you most want to avoid is a program that will leave you needing a fellowship because you weren’t well enough trained by the end of residency (which is rare).
This is definitely not true in my experience. I know many former chiefs who got great jobs in major and midsized cities without fellowship. There are even some general urologists at major academic programs - plenty of stones/BPH/men’s health to go around. There is a substantial shortage of urologists, which doesn’t just apply to rural areas. 72% of US counties have zero or one urologist.
Initially, to give students time to interview and arrange their first 2 years of general surgery training which did not have to be at the same institution as the urology years. Don't know how common this is nowadays (I was a member of the first urology match class back in the day)
1. General surgery is worse on average (with variation btw programs obviously). If you just think about the difference in your typical cases, it makes sense that gensurg has significantly higher volume of emergencies. Like I mentioned earlier, a single urology junior resident can cover a university, VA, and children's hospital by themself. General surgery would need an in-house team of residents at each of those hospitals, often in addition to an entirely separate team that covers Trauma. This all adds up to more time in the hospital per resident. All of the general surgery residents I know routinely work 80 hours, with plenty of 90-100hr weeks mixed in. There's just no end to the pain in general surgery... The other underrated side of choosing a specialty is that general surgery services can be a dumping ground. They get paged constantly for issues that don't require surgery (including a large portion of trauma). Surgical subspecialties tend to avoid this problem - ortho is notorious for admitting their post-op patients to medicine to manage their other chronic diseases, and I know we do the same thing. There’s something to be said for being a specialist who only needs to treat your field’s specific problem and defer everything else to the primary team (I.e. chronic illnesses, social issues, discharge plans, etc).
So since it is "home call", you do not get a post-call day off of service?
As a medical student, I remember dreading every day of my FM and outpatient IM/peds rotations. But I truly enjoy urology clinic. I think the difference for me is:
I think it mostly comes down to poor sample size. Urology burnout in 2019 was 54%, whereas in 2018 it was 44% (middle of the pack). Nothing changed in 1 year to cause such a dramatic increase, so I chalk the high variation up to sampling only ~100 urologists. It is completely disconnected from the reality I've experienced, where the urology attendings are usually the happiest and most laid-back surgeons in the hospital.
Correct, at the vast majority of programs you will not get a post-call day off. However, after a particularly rough night you may be told to go home and rest (depending on the culture where you train).
I'm not too interested in the basic science scene, but I know it exists out there in urology. Some examples that I'm aware of include male infertility (biology behind sperm development), prostate cancer genetics, urine tumor markers, and a whole world of kidney stone metabolism.
Thank you!
Not OP but I am a Urology resident. We work hard and put in long hours, but my attendings are supportive and fun to work with. Urology is a sensitive area, we deal with sexual dysfunction and cancer regularly. You have to be mature enough to navigate the issues appropriately, but I haven't met a Urologist who doesn't enjoy a good joke. I haven't been in a case where someone is screaming in the OR (even when accidentally getting deep into the IVC), or throwing instruments, which is in stark contrast to my GS rotations as an MS3. Urologists in general tend to be more laid back from my experience, though this may just be artifact from training in academic institutions. I'd imagine some private practice general surgeons are just as laid back as the Urologists I've worked with, but I didn't have the chance to interact with them in medical school. Residency is really not bad, people are supportive, we are treated well, but my n=1. I'm sure there are malignant programs out there, just as there are probably some really supportive, non-malignant GS programs out there.
1. You need a sense of humor to do this job. Doesn't mean you have to be obsessed with dick jokes though
When it comes to urology vs ENT vs ophtho, Intra-specialty differences > Inter-specialty differences. Some urology residency programs work >80hrs/week consistently, others have great call schedules and you can finish before 5pm every day. Same goes for ENT from my limited experience. Ophtho probably has it easier on average though.
In my experience the urology residency culture = not taking yourself too seriously, joking around and working hard. I can honestly say I enjoy coming in to work. We all just want to get our work done for the day, operate, and go home. I've never experienced a malignant vibe in any of my med school urology home sub-I, away rotations, or now in residency.
