The opportunities for physicians in men’s health are tremendous. As with most career moves, blindly entering a field is ill advised. Rather, I recommend that the thoughtful young urologist carefully consider the following steps and pointers.
Men’s health is a rapidly evolving specialty involving multiple fields beyond the historical organ-centric focus of the prostate and penis. Cardiovascular health, endocrine disease, and mental health are examples of what a practice focusing on men’s health should include.
The men’s health physician is increasingly expected to have a larger breadth of knowledge in multiple domains beyond the core curriculum of urologic residency. Ideally, men’s health will evolve with multidisciplinary clinics and creative ways of delivering holistic care to men.
The gap between male and female life expectancy is well known, and numerous strategies to help close this gap have been proposed. Many of these strategies involve the very physicians who see and treat men on a day-to-day basis. Hence, the opportunities for physicians in men’s health are tremendous. As with most career moves, blindly entering a field is ill advised. Rather, I recommend that the thoughtful young urologist carefully consider the following steps and pointers.
Know yourself and know what aspects of medicine appeal to you. Understand the types of patients you prefer to see and the types that you don’t. Men’s health involves more time in clinic seeing patients with less time in the operating room. Surgical cases are typically shorter, with a focus on quality of life issues.
Consider if you find the field of men’s health stimulating and something that will keep you challenged in the future. Will you be able to relate to patients and offer “outside-the-box” information, beyond the scope of classical urology, during an office visit? Are you flexible enough to consider entering a field that may look very different from its current state in 20 years? Introspection is critical to understand your own preferences and how they align with the current state of men’s health.
Learn the field and appreciate the physical, mental, and emotional aspects of men’s health. Realize that a man is far more than his penis or prostate. You’ll need to think more broadly and understand the concept of the inter-connectedness of disease, lifestyle modifications, and mental health. Understand the challenges that prevent men from seeking medical care and have an approach to offer personalized medicine. Many men don’t like to see the doctor, nor do they like to take medication. Many are brought into the office by caring or concerned loved ones. Understanding male sensitivities and vulnerabilities will enable you to engage these patients more completely.
Educate yourself about men’s health initiatives that have been implemented elsewhere and their approach to men’s health (table). Spend time with urologists who are involved with men’s health to understand the details of what it is like to have a men’s health practice.
Find the right mentors who will offer you frank, unbiased advice. The master-apprentice approach to training in residency continues to offer benefits to those training in men’s health. Studies conducted in medicine at the University of Toronto have shown that having a mentor results in faster academic promotion, and mentorship is now offered to all new staff surgeons (Med Teach 2014; 36:608-14; Implement Sci 2014; 9:122). My experiences with mentorship as a resident, fellow, and now attending surgeon have been overwhelmingly positive and greatly helped me during my first few years in clinical practice.
A strong mentor is invaluable not only to provide clinical and career advice but also to serve as an example of how someone has flourished and become a leader in his or her field. Mentors can offer personal life guidance and should be honest with their feedback such that the mentee isn’t misinformed about where their strengths and weaknesses lie. Your mentors will stay with you throughout your career, so it’s important to recognize this relationship and cultivate it.
Get the right training by filling the need at your center with skills learned elsewhere. A urology residency program will provide the skills necessary to become a general urologist, but it won’t necessarily give you the skills required to become a men’s health specialist. Formal fellowship training is a great way to acquire specialized skills elsewhere and bring them back to your practice. I personally left Canada to pursue a 2-year fellowship at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College/New York Presbyterian Hospital in New York.
As men’s health evolves, fellowships will allow you to come into the field from different angles, including sexual dysfunction, voiding dysfunction, reconstruction, infertility, or even a clinical area that is completely non-urologic. In addition to the gained clinical expertise, going away to see how others do things in a different health care system or local environment provides immeasurably valuable insights. Training elsewhere will give you perspective and new ways of delivering care.
Understand your local milieu to better understand where you fit in. A men’s health practice will only be successful if you meet the needs of the patients. This means determining who else is practicing in this space and where the current demand is. Find out who is doing what in the community, what has been done successfully, and what has failed. Once you determine who your colleagues are, find out how you can collaborate or fill a specific need they identify. Politics of some form are inevitable and you must learn to navigate them.
Figure out what your unique skills are and how you can fit in with others in practice. The Canadian Men’s Health Foundation and the American Society of Men's Health offer great resources for urologists and patients, and can help you identify potential collaborators in your area.
Carve out your niche by doing clinically what you were trained to do and following your passions. As a young urologist, it is critical that you cultivate skills and offer something previously unavailable in your community. Make your goals known to other urologists and primary care physicians so they can help facilitate. Collaborate with others with a similar interest at a national or international level to share knowledge, clinical experience, and research initiatives. Consider further formal or informal training once in practice to help further foster your niche.
You will likely become well known for doing a handful of things really well. That is how sub-specialization works, but you cannot work in a silo. To truly excel in the broader field of men’s health, you will need to collaborate with partners in other areas to create a network. Your niche as a “men’s health expert” will have natural limitations, and while your insight into more specialties will help your patients, knowing when to refer among your network will also be of great importance.
Get out there by becoming involved with local advocacy groups, primary care, and other sub-specialty teams. Local advocacy groups such as prostate cancer groups, cardiovascular or diabetes networks are great organizations to get involved with, and focus on issues relevant to men’s health. Making yourself known to primary care teams through speaking and networking opportunities helps to educate fellow physicians and build your practice.
Meetings and networking with industry partners, nurses, and physiotherapists are recommended to develop comprehensive multidisciplinary care that you can offer to your patients. I partnered with the Canadian Urological Association and helped to organize a Men’s Health Summit, an annual 1-day meeting targeted at specialists and primary care doctors with a focus on diverse topics such as male overactive bladder, prostate cancer screening, cardiovascular health and exercise, sexual health, the aging male, and diabetes. Personally, I maintain a social media presence that I use to educate others and stay educated on the latest urologic news.
Starting your own men’s health practice is a bit like taking a dive into the ocean; you can prepare yourself for its vastness as best you know how but you really don’t know what you’ll encounter until you get there. By knowing yourself and learning about the field, then acquiring the right mentors and training, you will be able to understand your local milieu and carve out your niche. Then it’s just a matter of getting out there.
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