You want to do what?!

An overview for spouses, parents, and friends of future urologists

 

All urologists-to-be are met with near-universal blank stares when they tell their families and friends what field of medicine they are going to pursue (the rest of the responses are some version of “congratulations, neurology is a fantastic field. . .”). There are, in fact, many reasons bright, talented medical students choose a career in urology—read on to understand some of what the field is about.

Urine-ology?!

Urologists treat diseases of the genitourinary (GU) system in men, women, and children.  This includes cancer (of the adrenal, kidneys, bladder, ureters, prostate, testes, and penis), male infertility, birth defects, kidney stones, incontinence, kidney transplantation, and erectile dysfunction.  These problems may require surgery, medications, or both.  Aspiring urologists are often asked if they are going to be the kind of urologist that does surgery. In fact, all urologists are trained to perform surgery and it is typically a significant part of their practice.  They may spend anywhere from one to three days a week operating and the rest of their time seeing patients in clinic.

Urology is traditionally on the cutting-edge of surgical technology and has led the way in minimally-invasive surgery. This can range from “cystoscopy” (a small camera inserted into the urethra to view the bladder) to “ureteroscopy” (inserted the same way, but passed all the way up the ureter and into the kidney, typically to break up stones) to "nephroscopy" (a complex camera is inserted into the kidney through the patient's back) to “laparoscopy” (surgery performed in the abdomen using small instruments and a camera). Most recently, urologists have pioneered the use of robotics in laparoscopic surgery.  The DaVinci robot has four arms, one for a camera and three for specialized instruments, and each is placed through small incisions into the abdomen.  The surgeon sits at a console adjacent to the patient that provides seamless control of the instruments and better-than-Avatar 3D visualization.  This is most commonly done to treat prostate cancer (robotic prostatectomy), but is increasingly used for kidney and bladder surgery.  

In fact, the breadth of procedures that urologists perform is arguably the most diverse of any field in medicine.  One day the urologist may spend treating kidney stones using lasers, while the next he/she will remove a patient's bladder, construct a new one from the intestinal tract, and connect this new "neobladder" to the patient's kidneys and urethra.

Some of the problems urologist treat, though not life-threatening, are very inconvenient and embarrassing (think: urinary incontinence). Perhaps more so than many other specialists, urologists are usually easy to talk to and capable of putting their patients at ease. They enjoy developing long-term relationships with their patients. Indeed, unlike other surgical fields, urologists often follow their patients for a lifetime.

Additionally, Urology—at least in theory—can offer a better lifestyle than other surgical specialties. The few urologic emergencies include testicular torsion, kidney stones blocking the flow of urine, and traumatic kidney, bladder, or genital injuries. Furthermore, unlike many other surgical field, the urologist often has the option to tailor one's career with age.  Some urologist choose to "slow down," as they get older and perform more "medicine" than "surgery," as their career progresses.  Almost no other surgical field offers such flexibility.  

Since urologists are the only physicians that address issues of the male genitalia, you might imagine that many urologic stories are quite funny.  Although they may not make good Thanksgiving dinner conversation, the urologist often gets a fascinating and unique glimpse into the human experience.

Fortunately, the job market for urologists is excellent and compensation is competitive.  Although most current urologists are male, there are now many more women entering the field. There is a significant need for female urologists given that nearly half of urologic patients are women, and some patients have a gender preference for their physicians.  Overall, the number of urologists retiring is currently far higher than the graduating from residency each year, and as the population ages, many urologic diseases will become far more common.

The Match 

After medical school comes residency, a training period that is part education, part on-the-job training, and part just hard work.  There are 114 urology residency programs in the United States.  Programs have one to five resident positions per year, and fewer than 270 spots are available each year.  Most years, over 400 applicants apply, thereby making urology one of the most competitive specialties to enter.  In fact, some of the best and brightest medical students have entered urology over the last few decades, further fueling the innovation, creativity, and vitality for which the field is known. (As an aside, modern interventional cardiology was actually pioneered by a urologist (one of two to receive a Nobel Prize)!  Werner Forssman inserted a ureteral catheter (basically a very long straw) through a vein in the arm into his own heart, despite the belief of the times that such manipulation could prove lethal:  click here to read more.)

You can see a map of the residency current programs at Residency Program Links page.  Since the process is very competitive, it generally entails looking for a residency position across much of the country. Finding the program that is the "right fit" may mean moving to a new city or state.  In fact where one spends 5 or 6 years of their life entirely hinges on this rather unpredictable Match process.  For more information on the components of the application, see Urology Residency Guide on this website.  Many programs are based in university medical centers, and, relative to other medical specialties, there are relatively few urology programs.

Although in many ways residency is more like an apprenticeship  than school, the application process is unlike a typical job application. Medical students apply through a central electronic service to all the programs that interest them.  This service opens on September 1. Applicants then receive interview offers from programs, and interviews take place from October to December. The interviewing period is a very busy and expensive time that involves significant travel squeezed into the final year of medical school.  Interviews are typically last one day, sometimes with a dinner the night before.  After completing their interviews, applicants make a rank list of the programs they have visited, in order of where they would most like to train.  It is not possible to be matched at a program not on this list.  Residency programs make their own lists of the people they have interviewed in the order that they would like to select them.  The lists are reconciled by a computer, with all applicants being placed at the highest possible program on their list based on the number of positions at each program and the ranking of applicants by the program.  The results are emailed out on a pre-specified date in January. Residencies start sometime between June 20 and July 1.

Residency

Although the title of MD is attained with graduation from medical school, residency is the key step to becoming a practicing physician. The hours are long, currently “restricted” to a national limit of 80 hours per week at the hospital. All residency programs also have “on call” requirements.  These vary between programs and are divided among the residents so there is always someone “on call” for emergencies.  This includes weekends and holidays. Residents do receive a salary, typically in the range of $40-60,000 depending on location and seniority.

Urology residency lasts five or six years, depending on the program. For a five-year program, the first year (Post Graduate Year 1, or PGY1) is a general surgery “intern” year.  The goal of this is to gain basic operating skills (such as suturing or sewing), learn to take care of patients in the hospital, and discover the wonders of sleep deprivation.  The second year of residency (PGY2) is typically the first full year of urology training.  As one progresses through residency, there is more responsibility over other less experienced residents as well as in patient care. The fifth (PGY5) and final year of training is called the “chief year.”  Chiefs often have administrative duties in addition to completing their education and finding a job. Six-year programs typically have some research time added in. After residency, some residents may go on to a “fellowship” for an additional 1-3 years of training if there is a subspecialty of urology they find particularly interesting.

 

This page was written by Emma Jacobs, MD

Dr. Emma Jacobs will complete her urology residency at Indiana University in 2015. The content of this article was approved by her parents and mother-in-law.