From choosing a college major to pursuing a doctorate degree to selecting a specialty, we are constantly confronted with the need to narrow our career focus and define our meaning in life. Like a stem cell, we are initially faced with limitless opportunities, but progressively choose a direction that resonates with our identified interests and goals, which are often moving targets.
For myself, part of the interest to pursue an MD stemmed from the versatility of the degree and the ability to pursue a broad variety of interests, including clinical care, research, education, and administration, among others. Selecting a specialty in medical school can be challenging, especially for those who enjoy thinking about every organ system and who wish to remain involved with every discipline in the field: the jack-of-all-trades mentality. That being said, all physicians must inevitably identify some niche for themselves, however broad or subspecialized it may be.
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Urology was enticing to me given the range of techniques (endoscopy, laparoscopy/robotics, open surgery, medical management) and the patient diversity that it affords. It has allowed me to develop a broad skill set while gaining expertise in a focused area—perhaps a similar sentiment held by many urologists. Despite the lengthy training process to become a urologist, 5-6 years of residency go by quickly, and the need to select a post-residency path—ie, the decision to pursue or forego subspecialty fellowship training—seemingly arrives sooner than anticipated. Making that choice can be another challenging process as well.
Just as selecting a medical specialty requires some degree of soul-searching, a similar process is necessary for deciding what to do following residency. The decision to pursue a fellowship and the type of fellowship should ideally be made at least 2 years before graduation. Despite already being a specialty area, urology remarkably offers several subspecialty fellowship training programs, including andrology/infertility/male reproductive health, female pelvic medicine and reconstruction, oncology, pediatrics, trauma and reconstruction, endourology, minimally invasive surgery, and transplant. This means that an informed decision needs to be made with potentially limited exposure to some of these areas.
For residents who are still trying to figure out what to do next, start by envisioning the type of practice setting in which you hope to work, the responsibilities you wish to assume (eg, research-based or education-based activities), and the skills you hope to gain.
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Next, prioritize your career goals and investigate the means necessary for fulfillment. Evaluate the skills and exposure you will gain on completion of your residency training, and assess whether or not investing 1-3 additional years in subspecialty training will significantly enhance your skillset or provide “political” gains to achieve your goals.
For example, although not a requisite for an academic career, completing a fellowship may enhance your candidacy for an academic position or help carve a defined niche. Having a research and/or multidisciplinary didactic component in fellowship can also help mold the way urologists think about our field’s critical issues and gaps. In private practice, fellowship training could be useful by potentially improving your marketability or supplementing a surgical skillset.
If you are interested in pursuing fellowship but unsure which of the many options to choose, it may be a helpful exercise to set aside some protected time to reflect on the types of cases you enjoy doing, areas you like reading and thinking about, mentors you admire, and patients you enjoy working with. Likewise, it similarly helps to identify aspects of urology that are less appealing for a long-term career.
Try to immerse yourself within each subspecialty area within urology to see if it is a good fit—familiarize yourself with the contemporary literature, become involved with research projects, gain exposure to relevant operative cases and specialty clinics, attend any subspecialty conferences or educational sessions, and encourage discussions with attendings and fellows in each area. Taken together, these considerations may not only help equip you to make a more informed career decision, but also serve to better understand yourself as a budding urologist.
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