Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

News Network

Virtual Tumor Board

Insights

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Live Events

Interactive Tools

Job Board

Partners

Subscribe

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

Twitter

LinkedIn

Spotlight

Peers and Perspectives

Clinical

1rem

, discuss key topics in health policy for urology and recap the American Urological Association’s (AUA) recent Annual Urology Advocacy Summit, which took place from February 26-28 in Washington DC. Rhee is the chief of urology for Kaiser Permanente Southern California, the president-elect of the AUA Western section, and the chair of the AUA public policy council. Galansky is a PGY-4 urology resident at Johns Hopkins University Brady Urological Institute in Baltimore, Maryland as well as the 2024 AUA Holtgrewe Legislative Fellow.

This discussion originally took place during a live X (formerly Twitter) Spaces event held by Urology Times. To begin their discussion, Rhee and Galansky highlighted the 3 legislative priorities of this year’s AUA Advocacy Summit: Medicare reform, the workforce shortage, and telehealth. They also discussed the meaning of the theme for this year’s meeting, which was “resilience.”

During the event, Rhee also reflected on how the AUA Advocacy Summit has grown since it first began, given that this year’s meeting was the final Summit under his tenure as Chair of the Public Policy Council. Galansky also provided insight on her experience becoming involved with the AUA, and shared how other young urologists in the field can get involved with advocacy.

Rhee and Galansky ended their discussion with hopes of future positive legislative change for the field of urology.

, or anywhere that podcasts are available.

In this episode of Speaking of Urology®, Eugene Rhee, MD, MBA, and Logan Galansky, MD, discuss key topics in health policy and recap the AUA's recent Annual Urology Advocacy Summit. 

Health policy in urology: 2024 AUA Advocacy Summit recap

 highlights the role that advanced practice providers (APPs) can play in filling the gaps created by the growing work force shortages in urology. Bunce is a physician assistant at Advanced Urology Institute in Naples, Florida.

Specifically, Bunce outlines the help that APPs may offer in the treatment of patients with benign prostatic hyperplasia (BPH), which she highlighted during a session at the most recent American Urological Association (AUA) Annual Meeting titled, “Choices That Matter: Optimizing BPH Care for Urologists, APPs and Patients.”

Bunce comments, “This is something that's going to help prolong physician longevity, which will also extend and help with the physician shortage. The amount of effort and energy that a physician can pour into their APP will have a return on investment greater than you could imagine.

Don’t forget to subscribe to Speaking of Urology® on 

In this episode, Janelle Bunce, PA-C, highlights the role that advanced practice providers can play in filling the gaps created by the growing workforce shortages in urology. 

How APPs can bridge the gap in urologist shortages

Every year, young urologists start their long-awaited exciting careers after going through a few challenging years in residency. Dr. Bristol Whiles, who recently graduated from her residency in urology, talks about her trajectory in these hard times and brings us some interesting thoughts on how to overcome the difficulties that inherently residency brings us, but at the same time be productive and competent in what is expected of a great resident. Although it is common sense that a resident works incessantly, it does not mean that they cannot dedicate some time for their families and hobbies. The one-million-dollar question is: “how can they do that?”, and she talked us through some game-changer ideas, useful not only to residents, but generalizable to every profession. Brilliant in every way, she managed to excel not only in the triviality of the everyday assignments of a good urology resident but also showed above-average engagement in cutting-edge research at the university, which was a determining factor for her choice to engage in a minimally invasive surgery fellowship program. Finally, she gives some insights to younger residents that aspire to stand out and excel in their future careers.

On this podcast, Bristol Whiles, MD, discusses her urology residency experience at the Kansas University School of Medicine Department of Urology.

Dr. Bristol Whiles discusses her experience as a urology resident

® Assistant Editor Janelle Hart spoke with 

. She discusses why and how mentorship can be valuable at any point in a urologist’s career. Suskind is an associate professor of urology and obstetrics, gynecology, and reproductive sciences, and a chief of neurourology and female pelvic medicine and reconstructive surgery at the University of California, San Francisco.

“Open your mind to being both [a mentee and mentor,] no matter where you are,” says Anne M. Suskind, MD, MS, FACS, FPMRS.

The “reciprocal relationship” of mentorship in urology

 She discusses how and why urologists are succumbing to burnout and depression and suggests ways in which they can improve their mental health in their everyday practice. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California.

“We cannot give if our cup is empty,” says Diana Londoño, MD.

Consequences of burnout and depression in urology

. He discusses why it is so important as a physician to be educated on the tips and protocols associated with identity theft. Moyad is the director of preventative/complementary and alternative medicine in the department of urology at the University of Michigan Medical Center in Ann Arbor, Michigan.

“I thought identity theft was simple. You fix this 1 little thing. Today, what physicians and health care professionals need to be on the lookout for is [that] it's much different,” says Mark A. Moyad, MD, MPH, on the latest Speaking of Urology podcast episode. 

Dr. Moyad discusses the reality of identity theft as a physician

 discusses findings from the study, “Failure to Attend Urology Appointments: A Retrospective Analysis of a Single Urban Academic Practice,” which was published in 

. White is a urology resident at Maine Medical Center, Portland.

“I think one of the most surprising things to us as we started to look at the data is that we had a very low rate of no shows amongst telemedicine visits,” says Randie White, MD.

Urologist Dr. Randie White discusses appointment no-shows

study, “Impact of urology trainee debt levels on future practice choices and expectations,” for which he served as a study author. Harris is an assistant professor of urology at the University of Kentucky, Lexington.

“We really found it surprising the sheer amount of debt that our urology trainees are carrying,” Harris said.

Dr. Andrew Harris discusses debt levels in urology trainees

discusses the recent Urology Practice study, The impact of stricter guidelines on post-interview contact, restricted interview topics and differences by gender in the urology match, for which she served as senior author. Kielb is chief of reconstruction and neurourology and professor of urology, medical education, and obstetrics and gynecology at Northwestern University Feinberg School of Medicine, Chicago.

“I think the take home message is that when you're interviewing applicants in your program, take a step back and think about the questions you want to ask,” says Stephanie J. Kielb, MD.

Dr. Stephanie Kielb on curbing restricted questions in the urology match process

 discusses findings from a recent study published in Urology titled, Gender differences in authorship in urology: a five-year review of publications in five high-impact journals, for which she served as senior author. Kieran is an associate professor of urology at the University of Washington, Seattle.

Kathleen Kieran, MD, MSc, MME, discusses findings from a recent paper published in Urology.

Study evaluates authorship for women in urology

"Remember that whether or not it's your first time down the aisle, marriage is a celebration. Don't let all the financial and administrative details that go along with your special day spoil it," writes Jeff Witz, CFP.

Money Matters: Financial considerations when getting married

"When determining which code you should use, you must consider your Medicare carrier’s published rules and commercial payer processing policies," write Jonathan Rubenstein, MD, and Mark Painter.

UroCuff coding presents a “conundrum” for billers

"Generative AI technologies may play a valuable role in providing prompt, accurate responses to routine patient questions––potentially alleviating patients' concerns while freeing up clinic time and resources to address other complex tasks," says Michael Scott, MD.

ChatGPT shows promise in responding to urology patient in-basket messages

"Donor-advised funds are a fast-growing charitable giving vehicle in the US because they are one of the easiest and most tax-advantageous ways to give to charity," writes Jeff Witz, CFP.

Money Matters: Using donor-advised funds to avoid paying capital gains taxes

"Early-career physicians should ask themselves whether they really need to purchase a home right away or whether they would be better served renting for a few years," writes Jeff Witz, CFP. 

Renting or buying: Which is the better option for physicians?

Dr. Carson on “Telehealth visit type and patient-reported outcomes among patients with cancer.”

Investigators evaluate patient preferences on in-person vs telehealth urology visits

 paper, “Telehealth visit type and patient-reported outcomes among patients with cancer.” Carson is a urology resident at the University of Washington in Seattle.

Your study found high satisfaction rates for both in-person and telehealth visits. Were there any specific aspects of the telehealth experience that patients particularly appreciated or found less satisfactory compared with in-person visits?

The satisfaction rates were high across the board for both in-person and telehealth visits, and while not significantly different from in-person, when reviewing the individual satisfaction-related questions, we were glad to see that patients strongly agreed that they perceived confidentiality and trust with physicians when convening new telehealth visits. And I think that finding is really important because it highlights that and supports telehealth as a platform that can create a positive patient-physician relationship even when they're meeting for the first time. We also noticed that more patients convening telehealth visits were less likely to feel that an exam was needed at every visit, and we thought that this may reflect inherent patient choice and visit modality.

The study focused on new patient visits. Do you think the findings would be similar for established patients, or might there be differences in their preferences or experiences with telehealth?

The focus of the study was new patients, but we also did assess patient satisfaction and cost for established patients convening telehealth or in-person visits, and similar to the new patients, we found high satisfaction scores in the established patient cohort for both visit modalities, but markedly lower costs for telehealth. We did note that fewer established patients using telehealth vs in person would choose that similar modality in the future, and we thought that this may be related to the nature of sampling during the COVID-19 pandemic for our cohort, in which there was a substantial increase in telehealth use because of in-person restrictions. Now, as established patients, it's possible that the visits preceding the pandemic that they had were in person, and this was their preferred visit modality.

What is the take-home message for the practicing urologist?

I would say the take-home message is that we found that from a patient-centered orientation, telehealth for new and established patients have comparably high satisfaction scores but provide substantially lower costs compared with in-person visits for patients with urologic cancer. And we don't expect or advocate for telehealth to replace in-person visits, but do see it as an important tool for urology providers to reach patients, particularly those who may struggle with access to care due to geographic constraints.

I'd say that we believe that these results can be extrapolated to patients with other cancers or health conditions, but do recognize that there may be aspects of urologic cancer that may be more feasibly managed by telehealth. Furthermore, our results may be specific to the large geographic region served by the institution in our study, and ultimately, we do need more research and more investigation to better understand the benefits and the limitations of telehealth on a broader scale and post license exemption waivers to inform clinical priorities for our health systems, as well as local and national telehealth policy.

Videos

"I would say the take-home message is that we found that from a patient-centered orientation, telehealth for new and established patients have comparably high satisfaction scores but provide substantially lower costs compared with in-person visits for patients with urologic cancer," says Daniel Carson, MD, MS.

Amy M. Pearlman interviews Stacy Loeb, MD, MSc, PhD (Hon), regarding what a typical week looks like for her. 

Dr. Stacy Loeb on what a typical week looks like for her

“Thriving in Urology” is a new video series hosted by urologist 

of the Prime Institute in Coral Gables, Florida. Each video will contain conversations on combating burnout by cultivating balance within one's work life. In this installment, Pearlman interviews 

regarding what a typical week looks like for her. Loeb is a professor in the departments of urology and population health at NYU Grossman School of Medicine and Perlmutter Cancer Center in New York, New York.

I want to talk about what's next, Dr Loeb. What does the next 5 years look like for you?

Honestly, I'm very happy with the current situation. I really love the combination of clinical practice and research. I love working with the residents and being involved in training the next generation. I really enjoy doing the radio and social media and working with a lot of patient groups, just to try to get more education out in the community and really try to make a difference. I'm not sure that much will change in the next 5 years. In the long range, when I retire, I have a lot of other ideas in terms of doing more volunteer work and things like that.

Walk us through a typical week, beginning from a Monday morning to a Sunday evening.

First of all, I always make time for physical activity. Monday morning, I probably would get up and exercise, and then I start my research day. Tuesdays, I'm at the veterans hospital, working with the residents there. That's really rewarding. My grandfather was actually a veteran with prostate cancer, so that was the whole reason I went into urology in the first place. I love the veterans and helping other veterans deal with prostate cancer and their families. Wednesdays, every other week, I see patients at NYU or have a research day. Thursdays, I'm also at the veterans hospital. And Fridays is a research day. And then weekends, obviously, time with family and friends, always fitting in exercise every day, doing some cooking prep for the week. I do a lot of volunteering with animal rescue, helping transport rescue animals to hospitals or to destinations to help them find a home. That's something that's on the list. And then interspersed here and there in these activities is the radio show, which is on Wednesday nights from 6 to 8, trying to fit in some other social media activities when there's kind of downtime, like waiting in line at Starbucks or whatever it might be. I guess, in short, that's pretty much my week.

That sounds like a fun week. So what's your message to the audience when it comes to this balance that you've created for yourself within your work life?

I think it probably looks very different for everyone, but just figuring out what you're passionate about and trying to make it happen. My specific career path is really not at all like my mentors, and I think that's fine, actually. It's great, because I'm doing what I want to do and not feeling constrained to go down any particular pathway. What you've done is really inspirational in making a complete career change, starting your own practice, doing your videos. I think it's important for everybody to really do some soul searching and figure out, what gives you tachycardia, you know? What makes you want to get up in the morning and get right to work because you're so excited about what you're doing? For me, this combination of clinical and research with some of these public media activities is really stimulating. That probably isn't the exact formula for everyone, so it's just about figuring out what that is.

Amazing. Dr Loeb, thank you so much for sharing your experiences with us today.

"My specific career path is really not at all like my mentors, and I think that's fine, actually. It's great, because I'm doing what I want to do and not feeling constrained to go down any particular pathway," says Stacy Loeb, MD, MSc, PhD (Hon).

Yair Lotan, MD, highlights potential future avenues for artificial intelligence (AI) to augment clinical practice in urologic oncology

Yair Lotan, MD, on potential future applications of AI in urology

, highlights potential future avenues for artificial intelligence (AI) to augment clinical practice in urologic oncology. Lotan is the chief of urologic oncology and a professor of urology at UT Southwestern Medical Center in Dallas, Texas.

I think there are a lot of potential applications. Some of it, of course, will require testing. It's hard to say there's going to be a commercial application unless there are companies willing to support this type of research and these applications. But there are a lot of areas in urology where there's still a lot of interobserver variability between pathologists, whether or not it's inside of pathology. So, cytology results, [where] there are 1000s of cells, [and] a pathologist may have a hard time looking at all of them, an AI program could quickly look through it and highlight the areas of interest. I think, looking for variant histology, which is sometimes difficult, [is another option,] if you could train a program for recognition. In China, they have a lot of facial recognition programs. You could have recognition programs for grade of cancer or for variant histology. These could be pretty low hanging fruits, I think, for training these AI programs, which really do a very good job with recognition, and probably do better than humans in most cases. In radiology studies as well, looking at subtle differences in the size of a lymph node, where you're asking a pathologist to differentiate a blood vessel from lymph node. I feel like those are probably going to be the applications that will come first.

I think, as I mentioned, early on there'll probably be ways to augment pathologists and radiologists. Eventually maybe in high volume areas or low access areas, they might be used more primarily, at least as initial screens. I do feel like the rate of adoption for this technology will be relatively quick, [or] at least quicker. It's in a lot of iPhones already and being adopted by large corporations to help with email and writing letters, documents, etc, that are [more] relatively wrote. I think that there will probably be much more accessible tools within the next 5 years, and almost certainly within the next 10 years.

This transcription has been edited for clarity.

“I think that there will probably be much more accessible tools within the next 5 years, and almost certainly within the next 10 years,” says Yair Lotan, MD. 

Emily Sopko, CNP, discusses her approach to patient education and counseling

Emily Sopko, CNP, on her approach to patient education and counseling in urology

 discusses her approach to patient education and counseling. Sopko is a nurse practitioner with University Hospitals Urology Institute in Cleveland, Ohio.

What is your approach for patient education, especially for conditions that might cause embarrassment or anxiety?

I think, again, I'm really in a unique position, because I came from bedside nursing, where you just see people when they're at their lowest, and always giving them the sense of, this is not something that nobody else has ever been through. I can't necessarily relate to it, but how many other patients have I coached through this with? Trying to keep a little light of things. I mean, that's the whole schtick in urology, right? You have to have a good personality to get to know your patient, get them to open up to you, actually tell you what their problem is, so that you can help them find a solution or get to the next step. Because urology, at the end of the day, to me, yes, there's cancer, but there's also so much quality of life, which is something that drew me to the specialty in general. I came from working in palliative care, and I really enjoyed helping people feel the best they could. This is another way to be able to do that.

Attitude is a big part of it. I think trying to get level set and say, "This may seem embarrassing, but I promise you, I'm not thinking less of you because of it. I'm wanting to help you so you can feel more confident about your life when you walk out of this hospital." That's probably the biggest thing that I would say to somebody who's interested in urology is, do you think you can get on another patient's level? Can you treat them with dignity and respect? Because that's what it comes down to when you're dealing with this body system; you really just have to respect the patient.

"That's probably the biggest thing that I would say to somebody who's interested in urology is, do you think you can get on another patient's level?" says Emily Sopko, CNP.

Emily Sopko, CNP, shares how she collaborates with other professionals in the urology department

Urology nurse practitioner discusses collaboration with the care team

 shares how she collaborates with other professionals in the urology department. Sopko is a nurse practitioner with University Hospitals Urology Institute in Cleveland, Ohio.

How do you collaborate with other members of the health care team, such as urologists, surgeons, and other nurses, in the urology department?

I love that part of my job. It's probably my favorite part. I like working alongside the residents, because they've taught me pretty much everything that I know about urology. The 8 years that I've been doing this, it's constantly seeing something new come along, but it's also great to be able to start to be able to teach the next generation as well. That group is who I work with the most often. I mentioned we have the 2 inpatient APPs as well, but generally the other APPs in our group are outpatient, so I don't see them as often. However, we work really well together. We're a very collaborative team, and I really appreciate that.

For my day to day, I actually grew up being a bedside nurse on the floor that our patients go to. So I took care of urology patients postoperatively as a bedside nurse, which is part of why I felt like it would be a good fit for me as a nurse practitioner. So being able to be a good liaison between the medical providers, the residents, and the attendings and what the bedside nurse knows and sees every single day, I'm in a really unique position there to be able to translate from 1 side to the other, vice versa. I think that's part of the thing that I really enjoy about my job the most, because sometimes those 2 parties cannot see what the other person's trying to say, but all it takes is someone to mediate that sometimes to make the communication factor go a lot smoother.

And in terms of working with our attendings, the greatest part about the institution that I work in, the department that I work in, we have a chairman who's really a visionary about how APPs are independent within the department, how they interact with the attendings that are part of faculty. The faculty is very respectful of what an APP can do. For the most part, they trust us. They train us so we do things the way they want us to do. And we have a really good collaborative relationship, because we have a good trust system in place. I'm happy with how the department has been developed over the time that I've been here. It's always been welcoming, as far as I know. But I feel like it just gets stronger, and then throughout the hospital, because I've been here for a while in this role, I think I've made a good name for what the APPs can do with urology, how we can interact with all the different surgical specialties or medical specialties in the hospital, education for the nursing staff about things like how to place a coudé catheter, which you might not learn how to do in nursing school, how to irrigate a bladder to remove big blood clots in a person who's got a really bloody prostate or something going on in their bladder. It's another nice piece that I get to bring to the table is I can offer in-services to the different nursing units or different hospitals within our system. And I really appreciate being part of a bigger picture team where it's not just me coming to work every single day, working with the same group of people on the same patients every single day. There's always a new challenge waiting for me around the corner and kind of making a name for urology in general and nurse practitioners and PAs as well.

"I like working alongside the residents, because they've taught me pretty much everything that I know about urology," says Emily Sopko, CNP.

Yair Lotan, MD, shares ethical considerations for the integration of artificial intelligence into urologic care. 

Yair Lotan, MD, on ethical considerations for AI in urology

, shares ethical considerations for the integration of artificial intelligence into urologic care. Lotan is the chief of urologic oncology and a professor of urology at UT Southwestern Medical Center in Dallas, Texas.

I'm not an ethicist. People have, at least in the common news media, they talk about [how] AI is going to take over, and there's a lot of scary stories. I don't think it's necessarily applicable to urologic applications. I don't think the AI program has a risk from a standpoint of annihilating mankind. But I do think it's important for people, when they're developing these programs, to think about how they might be applied. And also, what were the distribution of patients? Were there all Caucasians? Did they represent Black people and Hispanic people? Are we going to have algorithms that are relevant?

In the beginning of human pharmaceutical research, it was all done in men and then applied to women on the assumption that men and women were identical creatures and [had similar] biology, etc, and it probably impacted the dosing. Suddenly everybody's getting dosed based on what a 50-year-old White man looks like, and we're going to give the same dose to women and elderly, etc. So, I think we have to be conscious that when we're developing these tools that we're inclusive. We all recognize, actually, that in bladder cancer, White people are more likely to get it than Black people. So, almost by definition, it can't be completely inclusive, just because of proportions in society and for the disease itself are quite different. But I think we do need to make an effort to be aware of how these populations are being studied, how these algorithms are being made, and how they're being applied.

“So, I think we have to be conscious that when we're developing these tools that we're inclusive,” says Yair Lotan, MD. 

Emily Sopko, CNP, describes the most common procedures/treatments she assists with in the urology department. 

Emily Sopko, CNP, outlines procedures she assists with in urology

 describes the most common procedures/treatments she assists with in the urology department. Sopko is a nurse practitioner with University Hospitals Urology Institute in Cleveland, Ohio.

What are the most common procedures or treatments you assist with in the urology department?

Most of the procedures I do [are] something at the bedside. Often, we can do flexible cystoscopies for difficult Foley placements, or if we need to remove an indwelling stent at the bedside, I can assist with those things. I don't personally go into the OR, but we do have a couple of PAs in the inpatient setting who will go and do the robot assist portion of some of those cases. They can do the lap assist, and they can also help with those open cases. Perhaps, if there's not enough resident coverage, or a lot of times the residents like learning how to do the bedside robotic helping, but after a while, it gets a little bit boring for them, and they're ready to move on to something more challenging. That's where our PAs really come in handy; they love that. They love being at the bedside, assisting on the robot. They love to teach the residents how to do the bedsiding for the robot. So that's been a newer role with our team within the past 2 or so years, that we have been able to enhance our team that way. And the residents have really appreciated it. And I think our PAs are really satisfied with that part of the job, so they do a little bit more of that assisting.

We also do priapism takedowns. We'll do scrotal abscesses. Those are probably the major bedside procedures that I can think of in an inpatient setting. In the outpatient setting, we don't, as of this moment, have our own APPs that are doing independent office cystoscopies, but that's part of our future. We've gotten some feedback from our APP team, which is, including myself, about 12 strong, that they'd like to start learning to do those things. Some of our urogyn colleagues do PTNS for overactive bladder. They do injection teaching for testosterone, or erectile dysfunction. Those are really the majors that we do. We don't do any big procedures, per se. Over in pediatrics, they do help with circumcisions as well. That's a big part for the peds APPs is they can often just do those at the bedside completely independently, which is great.

"Often, we can do flexible cystoscopies for difficult Foley placements, or if we need to remove an indwelling stent at the bedside, I can assist with those things," says Emily Sopko, CNP.

Dr Stacy Loeb discusses sources of burnout in addition to ways she finds fulfillment in her career.

Dr. Stacy Loeb on obtaining board certification in lifestyle medicine

regarding sources of burnout in addition to ways she finds fulfillment in her career. Loeb is a professor in the departments of urology and population health at NYU Grossman School of Medicine and Perlmutter Cancer Center in New York, New York. 

Now, thinking about in the context of all these hats that you wear, what are some of the things that burn you out in a given day?

Obviously, there are a lot more administrative nightmares than in the past. I'm sure that everyone grapples with their Epic inbox or whatever medical record they may be using. It can be challenging, for example, when you have all these questions coming in through online portals, and this isn't something that we receive any dedicated time or compensation to address. But of course, people out there are anxious and scared and would like a response from the doctor. That can be a real challenge.

On the research side, a real challenge is just getting funding for research. Many of these federal grants, for example, may have a, let's say, a 14% or 18% acceptance. So you could spend 6 months working on a grant proposal—and I'm talking nights, weekends, giving up a lot of personal time—and then it doesn't get funded. That can be a very challenging process to experience—repeated failures or rejections on the research side, for things that you put a lot of work into. I think many of us, who work very hard, are used to seeing some product or something come out of very hard work. You work on a research project, and eventually it gets published, or you work very hard in your clinic, and you get through the day and you sign all your notes, and you feel a sense of accomplishment. So I think that having grants that don't get funded feels like something that you've worked on some of the hardest work you've ever done in your life, and then it's like a slammed door in your face.

What are some of the things that feed your soul, that energize you?

I mean, I think some of the things that caused us to be doctors in the first place: meeting with patients and their family members and really feeling like you can help them on their journey. Recently, I did my board certification for lifestyle medicine because I really wanted to focus more on the whole body, and also helping patients more holistically with things like physical activity, nutrition, sleep health, and mindfulness. So I think that that has helped to keep the spark, keep up excitement, to just bring this new area into practice and a different way to help people. And then for some of the grants that do get funded, working on the project and seeing the results and bringing them back into the clinic and talking to patients about it, and sharing them on the radio and on social media, all of that feels really rewarding, especially after having experienced many rejected grant proposals.

With this certification that you got in lifestyle medicine, do patients schedule a visit specifically to discuss your expertise in lifestyle modification related to prostate cancer?

They absolutely can. This is all very new, since I just got this board certification a couple of months ago. But yes, absolutely. This is something that can be integrated into any visit or a visit in and of itself. I do think that it's something that is just so relevant in urology, because so much of what we do has interlinks with the 6 pillars of lifestyle medicine.

If you take ED for example, obviously physical activity and nutrition are very important for erections, as it's such a surrogate for cardiovascular health. And then more and more, there are data on the links between things like obstructive sleep apnea and sleep disturbances with issues with sexual function. Of course, use of different substances, whether it's [tobacco] or alcohol, can affect erections. It's the same with mental health. If you're experiencing anxiety or inter-relational issues as part of a couple, that can all affect it. If we are not addressing these pillars of lifestyle medicine, I feel like we really wouldn't be providing the most optimal care for the patient. So I definitely think that getting away from just giving a pill or doing a surgery and helping people to improve their life as much as possible is just so important.

Absolutely. Now, my sense is that when people think about this lifestyle medicine conversation, that it's a barrier because we think that it has to take an hour to discuss all of those things, right? Is that true, or can you really get through the highlights of that conversation in a shorter period of time?

I think [you can]. I think even just assessing what area the patient might be willing to work on, that could be a way to shorten the conversation. People ask me all the time, "what's more important, diet or exercise?" And that's just not really an answerable question, because everything is important. From the perspective of lifestyle medicine, what is most important is what the patient is most motivated to work on in the here and now, because telling them about all these other things that they're not motivated to work on right now is unlikely to cause behavior change in the near term. And so I think if you really have limited time, then discussing which of these different aspects of lifestyle they may be most motivated to work on right now would be a very good place to start. Certainly, there are a lot of handouts. Even the American College of Lifestyle Medicine has handouts on all these different topics. I'm a big person in terms of either handouts or QR codes. I know you have these nice patient education videos. However you want to do it; there are certainly other ways to share information with the patients where you don't have to take up a lot of time in each individual patient encounter.

Absolutely. I was educating some men in a fraternity recently, and all I had to say was aerobic exercise is just as effective as Viagra for improving erectile function. At the end, I asked, “what's the next better decision you're going to make?” A guy raised his hand, probably 20 years old, and said, "I'm going to add aerobic exercise to my resistance training program." And that's all I needed to say. It took 5 seconds. People are so hungry for the information that you've recently had your certification in.

"From the perspective of lifestyle medicine, what is most important is what the patient is most motivated to work on in the here and now," says Stacy Loeb, MD, MSc, PhD (Hon).

Practice Management

Latest News