Future of Urology

[boanssi]

Hello,

I apologise if this particular question has been discussed on other threads, but for the past couple of months I've developed an interest in Urology and, as a consequence, I'm seriously considering it as a career option.

But... do you guys think this specialty will continue to be relevant in the coming years? Considering how other specialties are progressively taking over surgeries previously done by urologists (eg. urinary incontinence in women) and seeing how prostate cancer screening and treatments will probably change in the future, I'm asking for your honest opinion.

Thanks in advance

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[TallScrubs]

Who's encroaching on our surgeries? Uro-gyn? Not really, as they're also a fellowship of urology (I saw a regular gyn do a sling once.....it was painful to watch). Nephrostomy tubes? I think most urologists are super happy to not have to get their own antegrade access. May it take a hit like other specialties have? Sure, but to suggest it goes to the point of being 'relevant'? ABSOLUTELY NOT.

I was just discussing this with another uro resident today about how we think it will be one of the most dynamic specialties in medicine over the next 10 years. INSANE amounts of research right now prostate cancer, including: screening (the USPSTF recs on PSA didn't include a single urologist on the panel, btw), treatment for castrate resistant PCa, increased recs for active surveillance. Go read through a few months of the Journal of Urology, Urology, or European Urology and look at all the awesome research there.

 

[boanssi]

Thank you very much for your insight. I'd appreciate more comments on this topic.

 

[cpants]

I think urology is pretty unique in that there is not a lot of encroachment from other specialties. Sure there is urogynecology, but female incontinence and pelvic floor issues are so common and there are so few people in either of these specialties that there is tremendous demand for both urogynecologists and female urologists. I don't think that is a big problem. In terms of urologic cancers and endourology there is basically no encroachment from other specialties. Especially the endoscopic stuff is not at risk. No one else has the skillset to to take care of stones, endoscopic resections, etc, and there is really no danger of other fields moving into this. There is a huge shortage of urologists already and the deficit is just getting bigger every year. The job outlook is excellent. Could things change? Sure. But I think that urology is positioned a lot different than say cardiothoracic surgery or vascular surgery in that the bread and butter stuff is not on anyone else's radar.

 

[Slack3r]

What're some cons of urology?

 

[Mad Jack]

What're some cons of urology?

Being a surgeon, for one.

 

[cpants]

What're some cons of urology?

While the lifestyle is better than most surgical specialties, there are definitely some middle-of-the-night urologic emergencies and call can be tough. Some people don't like dealing with the male genitalia, which you will have to do...a lot. Other than that it's pretty solid. High demand, high compensation, good job security, great surgeries, excellent people in the field with lots of innovation and a good culture.

 

[DoctwoB]

What're some cons of urology?

(1) While Urology tends to have a great lifestyle for a surgical field post-residency, residency can be grueling. At my institution our junior residents definitely are putting in longer hours with more call them the general surgery residents, though the opposite is true of the Chiefs. That being said there is a ton to learn, as a graduating urologist has to be adept at endoscopy, laparoscopy, robotics, and open surgery.

(2) You are frequently working on or near genitalia. It's really not a big deal but some people are uncomfortable with that.

(3) most lay people will have no idea what you do or even that urologists perform surgery.

(4) every specialty has its subset of painful patients and urology is no exception. Interstitial cystitis, chronic pelvic pain, chronic prostatitis, etc. patients can be challenging to work with, though occasionally rewarding when you can really help them.

Other then that, it's almost ridiculous that there is a field with awesome and varied procedures, a great job market, great pay, and interesting pathology. Not only that, but we truly get to help people and see results in the short term. A TURP patient who can now pee or a stone patient who is now pain free is the most grateful patient you'll meet.

 

[TallScrubs]

Let me pose this question: how much do you or your classmates know about managing urologic issues? I can guarantee the answer is not much (not their fault) and the reason is because it doesn't have all that much overlap with other specialties.

And I agree with cpants and doctwoB--a nice, solid TURP is incredibly satisfying. So is an IPP.

 

[caffeinemia]

What're some cons of urology?

Uroscopy fluid in the eye. It happens.

 

[Slack3r]

So it doesn't seem like many cons...

 

[nonick123]

Is a good manual dexterity needed as the other surgical specialties ?

 

[cpants]

Is a good manual dexterity needed as the other surgical specialties ?

Yes

 

[boanssi]

Some interesting answers I'm reading here.
Let me ask you guys this: is there a demand for urologists to subspecialise, or do they keep seeing a wide variety of patients/diseases later on?

 

[cpants]

Some interesting answers I'm reading here.
Let me ask you guys this: is there a demand for urologists to subspecialise, or do they keep seeing a wide variety of patients/diseases later on?

There is demand for urologists of all kinds. There is a huge shortage of urologists in the whole country. The most sorely needed everywhere are general urologists. If you want to be at an academic center, particularly in a big city, you will likely need to subspecialize. If your goal is to get a high-paying secure job, you don't.

 

[Dr.Jekyll75]

What are the typical step scores in urology ? Is it highly competitive like derm and ortho?

 

[Leo Aquarius]

So it doesn't seem like many cons...

Here's what killed it for me: digital rectal exams.

As one patient after getting his DRE told the urologist I was rotating with, "Doc, I don't know why the hell you decided to do this" with a mild chuckle.

 

[TallScrubs]

Here's what killed it for me: digital rectal exams.

As one patient after getting his DRE told the urologist I was rotating with, "Doc, I don't know why the hell you decided to do this" with a mild chuckle.

Which is a dumb reason to exclude a great field. I've done plenty of DREs on other services: gen surg, IM, EM, FM.

 

[DoctwoB]

Here's what killed it for me: digital rectal exams.

As one patient after getting his DRE told the urologist I was rotating with, "Doc, I don't know why the hell you decided to do this" with a mild chuckle.

As above, I hope you didnt want to do gensurg, ob, family med, internal med, or GI either. It's a routine part of the physical exam for screening purposes or for anyone with a GI, GU, or OB complaint.

 

[Leo Aquarius]

Which is a dumb reason to exclude a great field. I've done plenty of DREs on other services: gen surg, IM, EM, FM.

It's one of the best decisions I've ever made.

 

[Leo Aquarius]

As above, I hope you didnt want to do gensurg, ob, family med, internal med, or GI either. It's a routine part of the physical exam for screening purposes or for anyone with a GI, GU, or OB complaint.

Let's see. DREs on a daily basis multiple times a day with every outpatient visit vs. DRE maybe once in a while on Gen Surg, OBGYN, and Internal Med. It's not even close. The urologists I saw did about 15 DREs a day, 3 days a week in clinic. 180 DREs a month.

Our Gen Surg attending did ZERO DREs during my rotation. Never saw the ObGyn docs to DREs, and my wife never had one when she was pregnant. Internal Med? 2 or 3 a week, if that.

You guys are jokesters.

 

[LostinLift]

What are the typical step scores in urology ? Is it highly competitive like derm and ortho?

Yes. Extremely competitive. Better match rate this year for U.S. Seniors, 77%, vs. 68% last year. But still terribly competitive.

http://www.auanet.org/education/urology-and-specialty-matches.cfm

 

[cpants]

Here's what killed it for me: digital rectal exams.

As one patient after getting his DRE told the urologist I was rotating with, "Doc, I don't know why the hell you decided to do this" with a mild chuckle.

Yeah, if you can't handle a DRE, I would look for something else. That said, GU is waaay less gross and involves way less poop and pus than general surgery or OB/GYN.

If you can't handle DRE's I would stick to something like.....psych?

What are the typical step scores in urology ? Is it highly competitive like derm and ortho?

Extremely competitive along the lines of ortho, derm, plastics, or ENT. The AUA runs its own match and does not publish average step scores. Although the hard data is not published, I will tell you that you need minimum high 220s on your Step I to even be considered. Anecdotally, most of our candidates last year were in the 230s-250s.

 

[boanssi]

I think urology is pretty unique in that there is not a lot of encroachment from other specialties. Sure there is urogynecology, but female incontinence and pelvic floor issues are so common and there are so few people in either of these specialties that there is tremendous demand for both urogynecologists and female urologists. I don't think that is a big problem. In terms of urologic cancers and endourology there is basically no encroachment from other specialties. Especially the endoscopic stuff is not at risk. No one else has the skillset to to take care of stones, endoscopic resections, etc, and there is really no danger of other fields moving into this. There is a huge shortage of urologists already and the deficit is just getting bigger every year. The job outlook is excellent. Could things change? Sure. But I think that urology is positioned a lot different than say cardiothoracic surgery or vascular surgery in that the bread and butter stuff is not on anyone else's radar.

Why do you think the demand for urologists is increasing?

 

[TallScrubs]

Why do you think the demand for urologists is increasing?

Two-fold. 1) The US population is crazy old right now and with age comes urologic issues. 2) The AUA has really kept the number of residency positions at a minimum as to not over-saturate the market.

 

[Dr.Jekyll75]

Judging from what everyone saying, urologist must have the typical 9-to-5

 

[DoctwoB]

Judging from what everyone saying, urologist must have the typical 9-to-5

I wouldn't say that. Any surgical field will have earlier days as the OR tends to start at 7 rather than 9. And while urology call may not be as bad as general surgery or ortho call, someone needs to be on call for the practice which means the occasional long night.

 

[womp]

As above, I hope you didnt want to do gensurg, ob, family med, internal med, or GI either. It's a routine part of the physical exam for screening purposes or for anyone with a GI, GU, or OB complaint.

We do DREs in ortho too, for the spine service (part of neuro exam). I hate doing them. Not going into spine, looking forward to never having to do one ever again after residency. I generally recoil at everything coming out of the perineum area.

I'm clearly not urology material. People here are pulling a fast one on the poor med students by telling them that other services do DREs too, so urology is no different. There's a big difference between doing the occasional DRE versus doing one on every other patient you see in clinic and most of your inpatients.

 

[cpants]

Why do you think the demand for urologists is increasing?

Because the average age of urologists in the US is 52.5 years old. Think about that. The mean age is nearing retirement. The urologic core population (ie. old people) is also growing rapidly as the baby boomers reach their 60s and 70s. We are not producing enough urologists to replace retirees....some estimate it at 50% of the urologists we need graduating each year. Demand is increasing; supply is decreasing. This makes salaries higher and job security excellent. Ask any urologist anywhere in the country and they are probably at least a month waiting list for an appointment. Even in high physician-density areas general urologists are getting offered big salaries and signing bonuses...no fellowship necessary. This is in contrast to many other procedural fields.

 

[cpants]

We do DREs in ortho too, for the spine service (part of neuro exam). I hate doing them. Not going into spine, looking forward to never having to do one ever again after residency. I generally recoil at everything coming out of the perineum area.

I'm clearly not urology material. People here are pulling a fast one on the poor med students by telling them that other services do DREs too, so urology is no different. There's a big difference between doing the occasional DRE versus doing one on every other patient you see in clinic and most of your inpatients.

I find it kind of hard to understand how people have such a hard time stomaching a DRE, especially surgeons. It is no big deal...at all. Glove up, do your exam, maybe see a tiny streak of poo on your glove which you then remove and wash your hands. Piece of cake. You want to see gross, try ENT clinic. Also, while I agree that we do plenty of DREs in clinic, I would say we almost never do one on an inpatient.

 

[TallScrubs]

I honestly cannot believe that having to do DREs is such a big detractor for so many people. Pulling a fast one on them? No. Plenty of other services do DREs, but through extension--plenty of other specialties do gross **** in their own right....I say get over it. Humans--particularly sick ones--are gross.

 

[JPA178]

Because the average age of urologists in the US is 52.5 years old. Think about that. The mean age is nearing retirement. The urologic core population (ie. old people) is also growing rapidly as the baby boomers reach their 60s and 70s. We are not producing enough urologists to replace retirees....some estimate it at 50% of the urologists we need graduating each year. Demand is increasing; supply is decreasing. This makes salaries higher and job security excellent. Ask any urologist anywhere in the country and they are probably at least a month waiting list for an appointment. Even in high physician-density areas general urologists are getting offered big salaries and signing bonuses...no fellowship necessary. This is in contrast to many other procedural fields.

I'm an incoming MS1 very interested in Uro - it's awesome to hear that there's going to be great job growth! I know it's important to get involved early, work on research projects, do well on the USMLEs, etc. But is there any other advice you might have for someone about to start med school?

 

[TallScrubs]

I'm an incoming MS1 very interested in Uro - it's awesome to hear that there's going to be great job growth! I know it's important to get involved early, work on research projects, do well on the USMLEs, etc. But is there any other advice you might have for someone about to start med school?

Yeah. Enjoy your time before M1. Study hard when school starts.

 

[JPA178]

Yeah. Enjoy your time before M1. Study hard when school starts.

Trying my best to have as much fun as I can right now! But I'm planning to hit the ground running for sure. The school I'm going to has a solid Uro department, which I'm happy about. I'm definitely planning to get involved in research.

 

[TallScrubs]

Trying my best to have as much fun as I can right now! But I'm planning to hit the ground running for sure. The school I'm going to has a solid Uro department, which I'm happy about. I'm definitely planning to get involved in research.

Make sure you are doing fine with the transition before you get involved with too much, nah mean?

 

[JPA178]

Make sure you are doing fine with the transition before you get involved with too much, nah mean?

Yeah I gotcha. Can't put the cart before the horse. Take care of the basics first (i.e. studying, learning, doing well in school).

 

[dr zaius]

As far as I'm concerned urogyn can take all of the IC, stress incontinence, and pelvic floor disorder patients they want. The other troublesome patient in urology is the chronic testicular pain guy. Overall though I would take these patients over the "difficult" patients of other surgical fields.

And seriously, if a DRE is disgusting to you definitely don't go gen surg. You will be digitizing and fiddling around with colostomies/ileostomies all the time, which are much more disgusting in my opinion. I'll take a urostomy over those any day.

 

[boanssi]

Is it feasible for an urologist to do more than one fellowship?

 

[cpants]

Is it feasible for an urologist to do more than one fellowship?

Possible...yes. A good decision, probably not. What fellowships are you thinking?

 

[DoctwoB]

Is it feasible for an urologist to do more than one fellowship?

Can you? Absolutely.

Should you? I can't think of a reason why. The Urology job market is excellent (except for maybe academic oncology), so you don't need it for employment reasons unlike rads or path.

Edit: Cpants beat me too it

 

[boanssi]

I was just curious (still a med student here).

 

[TallScrubs]

Urology is great (one of many reasons) because you can have a great career without having to specialize. Lots of great procedures that don't require subspecialization

 

[boanssi]

That may be true for now, but future urologists may be pressured to subspecialise in the future, I think. Wouldn't you agree?

 

[Merely]

Can you open up a solo practice? Also someone mentioned ent clinic as gross, care to explain?

 

[KinesiologyNerd]

Extremely competitive along the lines of ortho, derm, plastics, or ENT. The AUA runs its own match and does not publish average step scores. Although the hard data is not published, I will tell you that you need minimum high 220s on your Step I to even be considered. Anecdotally, most of our candidates last year were in the 230s-250s.

Sorry for the necro bump, and sorry if I'm beating a dead horse. What are your prospects with little to no research? I've always liked urology, but I never thought it would be possible... then I got a 258 on step 1. I'd like to at least do a block of it during surgery to check it out... but will I even have a chance if I do like it?

 

[cpants]

Research will help you a lot. If you just got your step 1 scores, you still have time to do research. I would get on that ASAP. You will probably still get some attention with a 258, but why bank on that? It's not that hard to get some clinical projects done and really make your application shine.

 

[KinesiologyNerd]

Research will help you a lot. If you just got your step 1 scores, you still have time to do research. I would get on that ASAP. You will probably still get some attention with a 258, but why bank on that? It's not that hard to get some clinical projects done and really make your application shine.

Thanks for the response. I'm doing my other favorite (ER) right now and urology in September so I'll definitely get some contacts for possible research during that rotation.

 

[devildoc8404]

For me, the DRE would be a much bigger deal if we did not have nitrile gloves. Given that we DO have them, and in plentiful amounts, I'm plenty happy with Urology.

(Rather less happy with residency in general... but it's part of the deal.)

 

[boanssi]

Sometimes I get the feeling (mostly from reading forums, to be honest) that urology is a one-trick poney, with most of its case volume related to prostate cancer patients. Am I thinking correctly or is there more to urology than prostatectomies?


P.S: I apologise for my english, I'm not from an english-speaking country.

 

[DoctwoB]

Sometimes I get the feeling (mostly from reading forums, to be honest) that urology is a one-trick poney, with most of its case volume related to prostate cancer patients. Am I thinking correctly or is there more to urology than prostatectomies?


P.S: I apologise for my english, I'm not from an english-speaking country.

You couldn't be more wrong. You're right that prostatectomy volumes will go down due to less screening and more active surveillance, but there is a heck of a lot more to Urology then prostate cancer. Even Just within oncology, there is kidney, bladder, ureteral, testicular and (rarely) penile cancer. Then there are many other entire sub-fields of Urology including endourology (mostly kidney stone work), neuro-urology and voiding dysfunction, reconstructive urology, female urology, male infertility and andrology, pediatric urology, etc.