Choosing Urology

There are many reasons to pursue a career in urology. At least seven, in fact:

1) Surgery.  This is important. The life and medical practice of the surgeon is very different from the non-surgeon. People going into surgical fields classically mention qualities like enjoying working with their hands, valuing teamwork, and/or wanting to be captain of the ship. Truly, though, it just comes down to a gut feel: do I see myself being in the operating room a day or two a week for the rest of my life or not? If you like surgery, urology has to be on the list of career choices.

2) Broad range of surgeries. The next thing to consider is whether you like the types of surgeries performed by urologists. Urologic surgeries vary greatly from 10-hour cystectomy with neobladder operations to 30-minute vasectomies, circumcisions, or cystoscopies. Thus, one of the most appealing aspects of urology for many people is the wide variety of procedures. Performing the large surgeries (aka "big whacks") early on in your career and tapering to the shorter procedures as you get older is well within reason. Many urologists, especially those in academia, elect to become experts in a particular aspect of urologic surgery, such as kidney surgery, prostate surgery, or penile surgery. Another important advantage of urologic surgeries is the quality and range of preoperative imaging (eg. cystoscopy, ureteroscopy, pyeloscopy, and urography, along with CT/MR). As a result, each operation begins with a clear objective and plan, and explorative laparotomies have almost no place in urology. This makes for a much more gratifying surgical experience.

3) People. It may seem simplistic to generalize about the types of people who go into a particular specialty, but nearly everybody finds that they tend to fit in with doctors in certain fields and not in others. If you liked the urologists you have worked with, think about what it was you liked about them. Urologists tend to be the "friendly, funny, and happy surgeons." Of course, this is an immense generalization, but there is something to the stereotype. And it is just this stereotype that attracts many medical students into urology. Career choices are often disproportionately influenced by a doctor or two who take a particular interest in a given student. It is therefore important not to place too much weight on one rotation in which you loved/hated your experience. Know, however, that if you thought the urologists were a fun, down-to-earth group of surgeons, you probably had the most common experience. Hey, you'd be laughing a lot of the time, too, if you were dealing with all things urologic all the time.

4) Lifestyle. Although money can't buy love and happiness, anyone choosing a specialty clearly considers their future income and lifestyle. Surgical subspecialties as a whole tend to do very well monetarily, and urology is no exception. The surgical lifestyle does often mean early mornings, but depending on what you are looking for, the work-week can be very much tailored to your desires. In fact, urology allows a much more flexible (and potentially less rigorous) lifestyle than many other surgical specialties--particularly general surgery. This is mostly due to the rarity of urological emergencies, meaning nearly every procedure can be scheduled in advance. What is important is this: there is the option to devote yourself to your work if that is your passion, and if you are looking more for "The Good Life," urology provides that opportunity about as well as any medical field. In addition, know that there is tremendous job availability in urology--the limited number of urologists trained each year puts them in short supply.

 5) Research and technology. One large (and growing) branch of surgery not yet mentioned is laparoscopy. For whatever reason, urologists are on the leading edge in laparoscopic surgery. It is now considered standard of care to perform donor nephrectomies laparoscopically, and innovations with laparoscopic prostatectomies and cystectomies are ongoing. In addition, urologists are embracing robotics surgery. At some hospitals, robotic nephrectomies are already being performed. Thus, urologists have taken a leading role in advancing surgical technology--something anyone technically inclined should consider. In a similar vein, there is a booming interest in urologic research. Many urologists feel their field has missed the boat as far as evidenced based medicine goes, as there have not been enough well designed studies to evaluate treatment regimens for common diseases. The upside of this is that there is a tremendous amount of research to be done, both clinical and lab-based, and many residency programs are looking for people interested in furthering this research.

5) Clinic. The majority of urology is practiced in the office setting. Not only can most urologic illnesses be treated medically, but surgical cases come out of clinic. The juxtaposition of clinical and surgical practices is one of the unique aspects of urology. Clinic entails diagnosing urologic diseases, differentiating who needs surgery from who doesn't, initiating medical treatment, and often discussing very personal issues. The opportunity to establish long-term relationships with patients and become an important part of their lives can be a very attractive part of urology for some people. Keep in mind that clinic is the center of nearly every urologic practice.

6) Specialization. Specializing in urology means knowing one field--one body system--inside and out. You are the expert on all things urologic, but relatively useless when it comes to other parts of medicine. Thus, one of the draws of urology for many is the opportunity to take a very focused part of medicine and be an expert in that area. Many internists feel uncomfortable dealing with urologic issues, thus almost everything in the urologic arena gets sent to the urologist. Specialization is an important issue in and of itself, and may not be the right choice for people with a "jack of all trades" mentality.

7) Flexibility within urology. The flip side to the issue of specialization is the fact that, within urology, there many, many facets. Some people decide to sub-specialize within oncology, or transplant, or infertility, or transplants, and some decide to be "general" urologists, with no specific sub-interest. For those who have thought about pediatrics, the decision to pursue a career in pediatric urology does not need to be made until late in residency. The same goes for other sub-specialties. Going into urology therefore allows a great deal of room to figure out what exactly it is that interests you, and you can chose late in residency (i.e. a good four or five years out of medical school) what kind of career you envision for yourself.

Now, although it may seem shocking to you after reading the above that not everybody goes into urology, there are, actually, at least a few reasons to decide on another residency. Below are 4 "why not's."

1) Surgery. Surgery is obviously not for everyone. If you have an immediate, visceral reaction any time you set foot in the OR, that's a bad sign. On the other hand, if you stand in the OR and think "hmm, this is really boring," you actually may be right. Being a third year medical student in the OR means a lot of retracting and a lot of being ignored. The key is to try and imagine yourself as the surgeon. If you still think "this sucks," it's on to something else.

2) Training. Surgical training can be brutal. Mornings are early. Afternoons become evenings. And sleep is hard to come by. Urology training programs are all either 5 or 6 years (depending on whether there is a year of research), and all programs include one to two years of general surgery training. It is a difficult residency, at least for the first three years, and you have to factor that into any decision. Of course, becoming a cardiologist or gastroenterologist also involves six years of training, which is to say that medical training takes a long time no matter what you go into.

3) Genitalia. It is important to put this topic out there. Dealing with genitalia and issues surrounding genitalia is not for everyone. You need to feel comfortable talking about and "handling" these issues. You can probably get used to anything with time, so it's hard to say that this should have a huge impact on your decision.

4) Men. Urology is a male dominated field. For those who are looking for more of an even split among the sexes, urology doesn't really fit the bill. Data from 1995 published in the Journal of Urology (Bradbury 1997) stated that women made up 4.2% of urology residents and 1.2% of board certified urologists. These numbers have certainly grown with time, but women remain a significant minority. Importantly, however, same article from the Journal of Urology surveyed female urologists and revealed that 94% would encourage other women to enter urology. Women are certainly coveted by residency programs, as there is a tremendous need in the community for urologists who are female.  Visit Society of Women in Urology website for more details.