#16: Urology Resident Interview - Lifestyle, Competition, and Hospital Interactions

welcome to another episode of the Zach Kylie show today I have the special honor of being with Haley Foss who's a resident in urology here at Thomas Jefferson University so Haley grew up in Minneapolis Minnesota and went to undergrad at St Olaf College a small liberal arts school about an hour south of the Twin Cities she went to Medical College of Wisconsin in Milwaukee and ultimately matched out in Philadelphia at Thomas Jefferson University for Urology residency she graduated summa [ __ ] laude from Saint Olaf and was induced into Phi Beta Kappa in medical school she was AOA she studied abroad twice in undergrad and recently went on a Pediatric Urology medical mission trip to Amman Jordan that's pretty cool so as always we're going to start off with some statistics around Urology and then we're going to see what she thinks about them okay so entering residence characteristics so step one score average of an entering USMD student so all residencies average together is 232. the step one average for Urology was 249. the step two score average overall was 245 and then compared to Urology was 249. the 2021 match percentage was 80 in urology compared to 92.8 percent overall for USMD students International students matched at a 24 rate compared to the overall International match rate of 59 percent salary rise the average salary of a physician is 339 000 overall across all Specialties the average academic medicine associate full Professor median salary in urology is 471 thousand four working hours the average physician Works 51 hours a week while the average Urology attending Works 58 hours a week in regards to burnout the burnout report says burnout percentage was 48 across the board and 49 in urology and the main reason for urology's Burnout they said was too many bureaucratic tasks any insights first thoughts on these stats I mean it all sounds pretty much what I thought it would sound like it is a more competitive field to match into in terms of what your step score needs to be your grades in school how many people are matching um I mean most of the programs are anywhere from two to there's a few programs that have five residents in a class but it's overall a smaller class that people are matching into which I think kind of contributes to the competitiveness of it um but yeah whether that's right or wrong I'm not sure in terms of just going based off step scores do you remember was it pretty competitive when you applied was it like a different match rate were you told different numbers or it was I was probably told about those numbers my year actually ended up being a pretty good match rate I think it was in the 80s or 90s my year but it always kind of Ebbs and flows a little bit so if there's one year that's a really good match rate I think more people tend to apply seeing that match rate and then the next year it's lower just because more people applied yeah yeah that makes sense have you seen a like increase in popularity of Urology or decrease in popularity of Urology since you've been a resident or not really it's kind of state standard I think as far as I can tell it stayed pretty even Keel um but I don't know the exact numbers but in terms of Thomas Jefferson usually has a lot of people apply to Urology so they usually have like up to eight students applying which is actually a lot for a school yeah how many spots does Thomas Jefferson have every year three a year three wow and I think they get a ton of applicants yeah that's crazy I want to ask about this trip to Amman Jordan yeah that's really interesting did you is this the first time you've done this why did you do this what is it yeah so I have studied abroad before but I've never done like a medical trip across um so one of our pediatric urologists down at Dupont he is from Jordan originally so he got connected with this group called The Children Of War Foundation who are based in LA and they do a lot of mission trips they kind of started out bringing children to Children's Hospital of La providing them care there and then they would send the kids back to wherever they were from um and then they started doing their own missions where they would send Physicians places so they had this trip planned to Iman Jordan that was actually supposed to be I think one or two years ago and then with covet it got kind of ixnade um so he was connected to them through that and they had room for a couple residents to go so me and one of my Chiefs went over and we were basing them on and we triaged a lot of kids most of the kids we were operating on were Syrian refugee children who were in The camps nearby um and kind of went over and just operated on as many kids as we could and it was a great experience wow what is the main thing you're seeing over there so a lot of the stuff we were doing isn't necessarily like the big like life or death surgeries a lot of it was like hypospadias repairs where what is that where the medius isn't at the very tip of the penis it's like a little bit down the shaft which can kind of affect quality of life depending on how severe it is um we did some circumcisions that were for like phimosis not just cosmetic and phimosas isn't is not a fun thing right that's when kind of the foreskin is just stuck to the top yeah just you can't retract it back okay yeah so it's just like really tight it can cause like recurrent infections for kids or be painful um and what else did we do we did some orchupexis where if the testicles aren't completely descended down we can keep them there some hernia repairs um things like that was there like a lot of people like did you were you running out of time to do all to provide all these surgery you were yeah so I think they didn't necessarily anticipate our our hit rate on cooking surgeries so we triaged I think 60 kids yeah and it probably could have operated on at least 45 of them we got through 30 surgeries in like the five days is it like a full or kind of thing or is it it's a fully kitted or so this one was I think a lot of medical mission trips are a little um they don't have quite as many resources there Amman is actually like a medical like tourist Hub of the Middle East so a lot of people come from countries around the Middle East to get their medical care there wow so they have a lot of private hospitals and there was one that gave us access to their operating rooms and we used their emergency room um to triage kids who came in um so we were they had their anesthesia staff and their or like nursing staff and we even admitted some kids overnight for observation so that part was really nice that we had like all the tools we needed I was going to say post-op do these is there like a are there beds around there I guess there are that's awesome yeah honestly the hospital was really nice like parts of it were nicer than Jefferson yeah um so that part was great and there were some things we brought on our own like different like tiny sutures and stuff so the so so then I guess the reason they need you guys is I guess they don't have the Specialists there or the people that can do the procedures okay well they don't have a ton of pediatric urologists in the region and also we were doing this pro bono got it so they would need people they might have like some of the staff they can do some stuff yeah um but they're working at like private hospitals yeah they don't necessarily just like provide a bunch of free surgeries for the Syrian refugees in the region um but there a lot of the stuff like the other team we're doing two were really complex and they probably didn't have people over there who could do it did you like the trip it was great yeah yeah and you were there for how long a week two weeks about I think it was eight or nine days eight or nine days okay that's awesome and what was did you get time to explore the area you did okay yeah we did a little bit which was great yeah it's a beautiful country yeah um we did one hike it was called Wadi mujib and it was like this Canyon where you're like basically hiking in like this little creek River so part of it like the water is just up to your ankles and other times you're like completely swimming like through this big cavern and there's waterfalls and that's awesome and then we went to um Petra as well which is in the southern like deserts of Jordan which is actually where they filmed one of the Indiana Jones movies if you want to check it out I'm like go to picture that yeah no highly recommend I won't get a chance to provide uh some pediatric surgery help but I will check out so why did you pick why did you go into Urology so it's actually interesting I in so there's nobody in medicine in my family yeah so I didn't have like going in I wasn't like oh my dad's a surgeon I want to be a surgeon which I think is a lot of it happens for a lot of people are like you see people in medicine you kind of get a sense of what you might like so I was thinking going in there maybe you want to do medical oncology but I was like pretty open to everything um I thought I would like surgery but that I wouldn't want to do it as a career so when we were picking the order of our third year rotations I purposely put surgery first because I thought it was going to be like one of the harder hours and I would just get out of the way and everybody said to not do the specialty you want to go into first because you don't look as good when you like don't know what you're doing I remember that yeah so I did surgery first and I was like oh man I like really like being in the operating room like this is a problem so I I loved surgery and one of the interns on my colorectal surgery rotation was actually a Urology intern because we do six months of general surgery our first year um when I was talking to him he was like Hey if you like surgery at least go look into Urology and like see what it's like before you make your final decision and the way I had organized my schedule I didn't really have room to put an elective like early enough in my ear for it to make sense with the Urology match um but we had at Medical College of Wisconsin it was nice we had a lot of Thursday afternoons off during our clinicals for just like your own personal time there's random Thursdays we would have to do some stuff but I used a lot of those Thursday afternoons to go Shadow so I would go like into the clinic or into the OR with different urologists and just really liked the variety in it um truthfully at the beginning when he said look into Urology I was like do women even do Urology like I don't know if that's a thing it's gonna be weird like people don't want to see a female um but there are a few like female tendons there and I got the sense that it was like not a big deal at all which it totally is not there's more and more women going into it I think that's the same initial thought some people think with like OB GYN right yeah like oh guys there's not gonna be that many guys in there but I think the numbers are they're coming closer to the middle on both in both respects yeah exactly the overall like if you look into the workforce right now with attendance I think it's only nine percent female it's around that number um but it's increasing and I would say there's some residencies that are 50 50. wow we have four women out of 15 so decent numbers more than nine percent yeah yeah exactly so do you think if you didn't have that initial experience with that Urology intern you would have ever discovered Urology it would have had to be like happenstance yeah because truly I didn't even really know that Urology was like a surgical field I thought it was going to be really narrow where they don't have a lot of variety in their practice just because I thought it was so specialized um but then when I started shadowing I realized like how many different things they do there's a lot of Clinic procedures there's a lot of just like Medical Care they follow a lot of patients who they never operate on and you're following them their whole life for their Urologic Care um so there's that aspect to it there's a lot of like Endo Urology procedures where it's same day surgeries there's big robotic procedures there's big open procedures if you really want to get into all that stuff um so you can really tailor your practice to to what you want it to be was there like a moment when you were doing the shadowing or where you're like I know it this is Urology for sure gung-ho all the way you're gonna do research fourth year I'm going to load up with my Urology or was it kind of like a slow burn or how did you know because it's tough to go into surgery and say oh y'all try Urology but then be like Oh I'm definitely doing Urology right no it is hard and I think there's I don't know that there's necessarily like this is the only thing for me I don't know that that is ever like completely true for someone um I think I could have been happy in multiple things um but I knew I liked surgery and then when I got to Urology I really loved the people a lot of a lot of the urologists I've worked with are really down to earth just like the subject matter you're dealing with every day you're talking to people about really private aspects of their life a lot of the time and so a lot of people are just really down to earth and easy to talk to um and I liked the variety of their procedures we have a lot of fun toys neurology a lot of lasers new new stuff coming out all the time um so I I liked it as much or more as other surgical fields and liked that I would be kind of sub-specialized from the get-go as opposed to General Surgery where you do general surgery and you almost have to do a fellowship to sub-specialize after that um so kind of a combination of all of that I was like yeah let's go for it yeah but you did you know right away because I think the first thing we're told is medical students in our second or third year is decide like medical or surgery right medicine or surgery kind of thing did you know for sure like right what you didn't know okay no I think that's kind of a crazy thing that people say yeah for some people I think it's totally true um but there's also like medical Fields where you're doing a ton of procedures so I don't think you necessarily have to know like surgery or medicine and I think I went into it like looking for that like Oh I thought I was going to be like a medicine person per se like I was thinking medical oncology or maybe GI and thinking like oh that everybody says like you you either know right away that you want to do surgery or medicine and I was like wait but I like both of them yeah um so I don't think you necessarily have to go one way or another and I think it's okay to like both and I don't know and a lot of people say too like if you think you would be happy in anything other than surgery do that yeah they say that a lot and I don't think that's true either um because I think I could be happy in some of the medical Fields like I loved hemonc was also really interesting to me and like again something like GI or Interventional Cardiology you can do procedures and other things um but I'm also really happy in surgery how much on the scale of like medicine to being in the or do you think Urology is you like for like I think if for example a cardiothoracic surgeon or something like that and I think it's skewed like way you're in the hour all the time but then you of course have Clinic days and stuff like that is it the same as most other surgical Specialties we have clinicans or is it more CL you know what I mean yeah I think it's a little skewed of how people think of it I think people assume if you're in surgery you're like always operating I thought that um and it is a lot of clinic and in residency like our fourth and fifth year are purely operative here at Jefferson so like I will be in the or every day that I'm at work um for these two years um but in practice that's not the reality um so I would say most of our attendance probably are in the clinic three days and in the or2 approximately sometimes that switches where they might have a week they're in the or three days and Clinic two days but usually one of the clinic days is procedures as well where you're doing um cystoscopies to evaluate like blood in the urine or pull a stent that was placed um and you can do like vasectomies and Clinic prostate biopsies so usually I would say it's like two days of Clinic one Clinic day of procedures and two days of or is probably the average got it got it and then the first year of residency at least here you do six months of general like surgery and then you go after six months you go into Urology it's kind of however the schedule works out like I actually started on Urology um because they'll usually have one intern on Urology and the other two here are on their gen surge rotations I see okay okay and then the second what's the second year like the second year here um you rotate at Jefferson for four months at Methodist for four months and which is like a smaller Community Hospital in South Philly and we also rotate down at Nemours in Wilmington Delaware as our pediatric hospital and you're doing like procedures there or yeah I would say it's mostly or as a two and you're kind of just starting to learn a lot of the endoscopic skills how to Sisto how to treat Stones bladder tumors that kind of stuff you do have some Clinic when you're at Jefferson with Dr huboski Who's one of our Stone experts he's one of our like really Advanced Endo urologists who's phenomenal to work with um and then in at Dupont or I guess called Nemours now um they we do clinic in and all are there got it so so first year is like you're kind of doing some general surgery a little bit Urology second and third year you're doing mostly or with the occasional Clinic third year is our most Clinic third years are most Clinic okay so we're at Jefferson the entire year and we have like three different services that kind of mesh together when you're in the hospital but for the purposes of like kind of splitting up attendings and who their point person is we split them up so our a service is three attendants who do mainly oncology B service is a lot of endo Urology and some robotic stuff like minimally invasive and sea service is our like reconstructive um kind of men's health kind of stuff female pelvic reconstructive surgery so you do the third years are kind of with the attendings of their respective services and they are either in clinic or the or so some Services you're in the clinic three days a week another ones on like two got it got it how's the workload like as your Urology resident a lot I mean it's a surgical residency for sure I think people think about Urology as you're going to have like an easier life than a general surgeon and like it'll be a lot more chill and that might be true in practice but in residency it's still a surgical residency so you have the same hours you have a big workload um at Jefferson we're lucky to get a lot of autonomy um but that also translates into maybe a little more work outside of the hospital as like a Tit for Tat kind of thing what are the hours like um it depends on the year okay so let's see I would say third year is one of our busiest years as a service resident um so usually we are going through the list in the morning with everyone around 6 30 most days some days it's like 6 or 5 45 if we have conference and stuff um but you have to round on whoever you're expected to travel on before that so however much time it takes you depending on how big the list is I would say I usually got in around 5 30 and probably left the hospital 6 30 to 7ish most days unless the or went long for some reason um but just because you leave the hospital doesn't mean you're done working you forgot your writing notes and stuff like that when you get home or yeah not so much notes necessarily um third year we pre-op a lot of patients so you're responsible for making sure that patients have if they had a urine culture collected you make sure it's treated before they go to the operating room make sure they have cardiac clearance and you're kind of just like double checking everything so there's multiple sets of eyes making sure that patient's safe for surgery and ready to go and they don't need any further work up before they're going under anesthesia so first case is like 7 A.M first case starts at 7 30. got it um and then on Thursdays we start at 8 30 because we have conference in the morning and then weekends do you have do you have a lot of golden weekends is it like one gold one black and then two I forget the other colors yeah we ours is a little more simple than that I think um we have Night flow which is really nice I see okay so Sunday night through Friday night there's a junior in-house overnight got it and they are just working night shift they go home during the day so you've come back for a night and there's a chief on backup call so the Juniors in-house is the main like contact person they'll see the consults they'll do anything that comes in and if they need help with something where they like can't scope a catheter in on the floor or if somebody needs to go to the operating room or someone's getting like admitted or discharged they'll call the chief but otherwise they take care of everything in-house and the chief only has to come in if it's something um bigger that they have to help with um on the weekends there's a junior in-house as well so we do like kind of power weekends where you start Saturday morning and you are on until Sunday at 6 pm so it's home call you can go home it tends to be pretty busy on the weekends but again there's a chief on backup call so your Junior's in-house either a two or a three and they the chief comes in to like round in the morning kind of see all the patients make sure everything's okay and then if anything has to go to the or they come in and different things what are the big I just out of curiosity what is the most common like emergencies you see in urology I would say the most common one is like a septic Stone okay or any sort of like urinary tract infection and the kidneys aren't draining well so if you because they can get sick really fast so if you have a urinary tract infection and a stone that's obstructing that urine can't drain down to the bladder and you get something called pilovina's backflow where all that urine with the bacteria kind of gets pushed back into the venous system and become back to remake and sick like very quickly so those are the people we take to the or like immediately even if they might be stable a lot of times we act pretty quickly to stunt them because they can go downhill quick they're really sick especially if they don't have Reserve got it um even if I guess even no matter because it's like one ureter as opposed to the other year it doesn't matter that the other kid is just in the blood you're getting bacteria so it's Bad News Bears yeah so we always say if someone's obstructed the reasons to stencil on is uh any obstruction with a UTI unilateral obstruction in a solitary kidney that's like your only kidney that's making your own or bilateral obstruction wow sometimes their creatinine is like through the roof yeah bilateral obstruction they might not be infected yeah so they're not like having fevers but if their kidney creating is going up got it then yeah so let's fast forward a year and a bit and say you're starting as an attending um and say I let you practice this in attending for three years okay after that three years I give you a hundred million dollars and I say hey you're welcome and I say you now you have the option I'm gonna say you have I've given you 100 million dollars you can either continue working full-time as an attending you can work part-time as an attending you can switch careers or you can go live on a beach what do you think you would do it's hard because it's five years in the future-ish yeah I feel you be too young to just like quit everything out together I think I'd go crazy yeah but I might work part-time at least for a while finally that's great does everybody say they would just keep working well most people are like I work full time it's my passion forever well some people are like uh for example the the Dr loss was he was saying you know I maybe spend some more time with my kid but he never said that so yeah I think I would too yeah that would work part-time 100 100 so thank you yeah I do think it would be tricky at the beginning because you would have to have like a smaller patient census and then it's it's difficult for patients to follow up with you if you're only part-time because you're like only there certain days you can't be like a Moonlighting you're a consultant urologist right or anything like that I think you technically can but it's not common it's not common because that way you don't I mean you don't really need patient continuity right there's like being in the hospital occasionally when they need you and stuff like that via Urologic hospitalist yeah yeah all right people that could be I think we could create that yeah that's awesome so what is the best thing about being a neurologist the best thing about being a urologist I think the people are one of the best things I love everybody that I work with and it seems like kind of across the board like on the interview Trail different programs are either rotated at or interviewed at just people are great so they're fun to work with I think there's a lot of Ingenuity in urology we're advancing the field really quickly even from like when I started as an intern there's a lot of like new um new tools and things that we use like we're using the single port robot for some stuff now instead of a multi-port robot what does that mean you only need to put one kind of so so our classic multi-port robotic surgeries you usually have five or six ports in um the single port it's a little bigger incision but we usually make one of the incisions bigger at the end to take out whatever we were taking out anyway either a kidney prostate bladder or whatever um so it's a single port in all of the arms go through that Port oh that's cool yeah so it's interesting I don't know how much utility it's going to have yeah I'm wondering if you have worse I mean I I know very little about this but I'm think I'm just thinking generally for if you have five ports right for example you can get things at a different angle but if you're just coming right here and if something's behind some you know what I mean I guess yeah it's hard because all of your arms are in view yeah when we use the multi-port like one arm can be out of View kind of retracting something for us so it's taking some getting used to I haven't personally operated on anything I've ever seen the same like the you're in the same kind of hood and stuff like that same user interface yes the the oh man what are they called The Da Vinci thing yeah like the console that you're sitting at is all the same but the robot itself is different um so that's something newer that we're like starting to look at um we use a lot of like disposable ureteroscopes now that have like digital cameras that have a beautiful picture compared to our reusable Scopes um we just started trying out this like vacuum device where when we go up into the kidney you laser stones and then you have to pluck out all the pieces um and sometimes the pieces are just like dust and it's hard to like actually grasp them and for most people that'll all wash out normally for some like spinal cord injury patients or patients who are bed bound it doesn't wash out as easily I see um and for years we've all said like we just need like a vacuum to just like suck out the kidney and they finally have something that's yeah that's a good invent I feel like that's a great mist I don't know I feel like it's cool to know about these little things because if I was a urologist I'd be like I want to jump on the next thing yeah if you invent it if you invented at Jefferson under Jefferson they get everything right so you have to um I'm not sure exactly you're thinking selfishly and wanting to make tons and tons of money because I'm trying to think because I know there was an anesthesiologist at Jefferson who invented a better spirometer during surgery or something like that and he he did very very well very very well this is completely off the point okay the counter question to what is the best thing about being urologist is what is the worst thing about being neurologist oh man I think one of them is that most people have no idea what urologists do yeah I think even other Physicians don't know I don't think we learn a lot about it in medical school so I think it's fair that people don't know but it can be annoying to get like consults for things that are not necessarily A Urologic problem um or just like family and other people like really don't know what you do for a living I kind of think you're just a penis doctor do you want to tell us you want to give us what is a urologist tell us well oh man that's a hard question I know I know you know um I think people just don't know the scope of it a lot of people don't know that it's a surgical field so they don't know that we operate um we're dealing a lot with oncologic problems kidney cancer prostate bladder testicular cancer um we do pelvic organ prolapse for females we do pediatric urologies a lot of congenital problems people with spinal cord injuries Ms Parkinson's have a lot of issues with function of their bladder from all of the neurologic connections being damaged or not working for some reason um we do Men's Health erectile dysfunction there's a whole scope of things that we do I know you guys do with electronics that's interesting I guess especially if they did procedures or something like that you'd need to to step in that's for what if it's for example if they're is it is it just like if someone comes up and they say I have erectile dysfunction they'd come talk to you or is this is it a second point after you know what I mean like yeah the primary care physician be like you have to go see urologist because I think because I because I get confused because there's like we're definitely going down a little rabbit hole here but there's such like sexual health doctors right and stuff like that and I don't know it's just I would say Urology kind of takes the Forefront in a lot of that at least for Men's Health yeah um and so like primary care physicians will prescribe like Viagra and different medical therapies but if that's not working take the next step then they usually come see us or some people will just come see us at the beginning a lot of times two our procedures can cause erectile dysfunction so if we take out someone's prostate I was thinking that makes more sense to me yeah yeah so there's medical therapy you can do injection therapy into the Corporal to call directions that works a lot for spinal cord injury patients um and then there's also implants like penile prosthesis that we we do surgery for so as incoming Internal Medicine resident can you tell me what's a good consult and what's a bad consult oh man well I think I think it's never necessarily bad to call and ask if you don't know got it okay there are a lot of things that we can just kind of curbside yeah tell people about yeah um which is totally fine if you don't know something I don't think it's bad to call someone else to like ask a question um there's a lot of Foley problems that we get called about that are not necessarily A heartful like you can't put the Foley in yeah like nursing tried to straight cath it didn't work so we have to put it in now I think that every physician can put in a catheter um that being said I realized that like someone who's been like a hospitalist for 10 years has probably not put in a catheter in like five years so like should we expect them to do it probably not um but I think learning how to use a Cuda a catheter is something what is that I don't even know what that is it's like a it looks like a catheter except there's like a tiny like Bend at the tip okay so it helps get past a big prostate I see and truthfully they are like so much easier to place than a lot of catheters if it's for someone who's like an older guy with a big prostate and that's the reason you're having difficulty and nursing can place them there's a lot of nurses that do but then there's others that like hear a word that they don't know and they're like I don't know how to do that I'm not doing it what's the difference the only difference in training I guess you just when you first go in it's at more of an angle yeah that's it you just have to make sure the angle's up yeah and if it's not it doesn't hurt anything it just doesn't go it doesn't do its form it's perfect but it's purpose what is the uh the most common myth you think so from the lay public about what a urologist is it does or is is I think most people think it's not surgical uh-huh I think a lot of people know that it's like prostate related yeah so be like oh women have to get their prostate checked I go to a urologist and I think it kind of ends at that um like there's a lot of women who have stress incontinence that maybe don't realize that they can go see a urologists and there are therapies we can do for that or like overactive bladder we see um so I think people maybe don't realize the extent of what we can help with yeah no that that definitely makes sense so the next question I have is and again these are tough questions you might not have answers I know it's it's putting you on the spot here do you have any memorable experiences with like patience or even with other residents or or just procedures in general anything that pops out to you that says you know this Urology thing's pretty cool or this patient experience was pretty cool like I wouldn't go in I know you came in with a very open mind but maybe this was you know not necessarily going the down ways but saying like oh this is actually really really cool I think not necessarily like one specific patient but just in general I think a lot of the stuff we do is quality of life based which is really nice our patients tend to be very appreciative so like if you come in with a ton of pain from a kidney stone they can be like very painful and we admit you putting a stent bypass so your urine's draining okay your pain is gone immediately so people are so appreciative with that and I think a lot of people like people take for granted just like being able to pee normally and so if we can help someone who is having issues start peeing normally or divert their urine a different way it just really improves their quality of life which is a really great aspect of it and a lot of the cancers we deal with too some of them are bad but a lot of them have really great survival rates like prostate cancer Even If you're diagnosed with metastatic prostate cancer you can live for 10 years with the therapies we have um so I think it's a little different than something like pancreatic cancer where you know off the bat that they're like um their lifespan is probably not going to be great regardless of what you do I think we can really help people if we detect things early and intervene right away with like bladder cancer prostate kidney cancer a lot of times we just do a partial nephrectomy and we keep doing scans every year to follow them but that's Curative for a lot of people are there any screening procedures that is should be done on kind of most people by your you know what I mean um I'm just trying to think so most of the screening usually starts with their PCP so PSA tests for men usually I think it's when they're 50 or 55 is the recommendation right now a little earlier if you have a family history um and if the PSA is elevated they would come see us to see if they need any further Imaging or a biopsy um if you have microscopic hematuria on like a urinalysis then you would come if you have it like multiple times and you have like a smoking history or anything usually they would come see a urologist we would take a look in their bladder to see if there's anything going on and get some Imaging um but yeah usually a lot of the the screening stuff is done by a primary care physician and we get referred or in the Ed or something so if I'm a third year medical student and I'm not I hear about Urology but I like you I didn't have any experience in it and stuff like that but I think I might be interested in it how could I go about learning more about Urology and maybe getting some practice possibly in it yeah so I think reaching out to honestly any of the residents or a lot of the faculty um to say like hey can I just come Shadow one day see someone in clinic see someone in the OR kind of see the differences um if you're really gung-ho about it there's some great lecture series online so during covid um University of California San Francisco did a whole like coveted lecture series um that were all online and they're archived and it's basically like a bunch of like big topics in urology from a lot of the leaders in the field that would just do like a zoom lecture and that's all out there for free for anybody who wants to watch to see like if you if there's one topic that speaks your interest then you can watch the lecture on it from someone who's like one of the major leading people in the field yeah so now the other side so you're at the beginning now the other side said like beginning of fourth year maybe when you're a week away from submitting your applications and you're not sure you say I like Urology but maybe I also like general surgery or I like maybe even medicine or something like that is there anything you would tell to these students how to kind of finalize your decision and figure out for sure even though nothing in this life is for sure right but for now to make the decision of Urology or not hmm I mean I think you have to be okay with working in a surgical field where you're I mean anything in medicine your hours are going to be a little up in the air like if you're inpatient for medicine you you might not get out at the same time every day too um but I think it's a little more up in the air for surgery like you might be there till midnight operating if the case is taking longer than expected um we have add-on cases all the time that we try to call for at different times and sometimes so we don't have or staff till 9 pm so that's when we call for the case if it's something that needs to go overnight um the hours are long during residency but you can really tailor your practice after so I think if you want to be in like a procedural field the neurology is great that's good make sure you want to do procedures right yeah exactly and I mean it makes a lot of sense yeah like my fourth and fifth year I'm only in the or yeah and you're looking forward to that yes um so you have to be okay with that too there's also other people who are in urology who already know they don't want to do the big huge procedures where people are getting admitted for five days after and the complication rate is higher because it's a major surgery they know they want to do more like general urology be in the clinic a lot do some um more like General Urologic procedures and that's totally that's going to be their practice and they'll do amazing but you have to do the bigger stuff interesting yeah yeah I know that makes sense now Urology is a competitive field how did you attack maybe specifically your application or what are your suggestions to people that are interested in my neurology to making themselves more competitive and this could span anywhere this could span you know when you first go into Medical School say for some reason some reason you know I want to do Urology how can students make themselves more competitive because it is a harder match for sure than some of the other Specialties when they're applying for residency yeah I think it's changing a little bit because I think step one was a big kind of weed out score for a lot of programs and now that step one has changed to pass fail unfortunately I feel like it's going to make step two a bigger deal yeah um and your grades on your clinical rotations I think I've always been a big thing yeah um so I think keep an open mind going into third year and try hard on all your rotations they don't want to see that you just did well on your surgical rotations and that you blew off psych and medicine and all these other things like they want to see that someone's going to work hard and anything they go into um you're having good relationships with people always helps for any field um once I decided that I liked Urology I jumped on a bunch of research projects and kind of reached out to different residents and you work hard and then try to get stuff at least going before your application's due I don't think it has to be in urology but it helps but if you have research in anything and you can prove that you can take a project from like conception of the idea to publication I think that's all they're really looking for is someone who's going to work hard and follow through on something so again it helps if it's a neurology because it's something to talk about during an interview but I don't think it needs to be on it and then anything else that you're passionate about is always helpful like if you do like study abroad trips or you like were in Engineering in a bunch of cool stuff with that especially in urology there's a huge aspect of medical device stuff so and honestly anything else you're passionate about if you can like prove that you've spent a lot of time on something and have something to show for it and can talk about it like volunteering and stuff like that okay yeah for sure because I remember when I was just applying to med school it was like you know you got to get your volunteering research and all this stuff yeah doesn't need to be Urology that's an interesting statement it's just showing that you're kind of passionate about research and you can take a project from beginning to end yeah because I think a lot of people know that a lot of people don't encounter Urology until later in medical school unless you have like a parent or someone you know who's a urologist or you happen upon it earlier um I think it's not uncommon for people to discover it in their third year so to expect everybody to be like oh I've been working on my Urology application for the past 10 years it's insane and maybe that would be a down thing yeah who knows who knows so you're sorry fourth year I keep saying you're a third year that's okay uh but you're a fourth year now like me that's how I can remember it like there you go yeah um have you ever been burnt out or felt burnt out or felt like things were so hard that you want to quit I haven't been to the point where I like want to quit because like I can always kind of see the light at the end at the top like I know this is a temporary thing but I've definitely like been very fatigued and tired at different points of residency intern year there's a lot of long hours where you're you're on the floor a lot you're not in the or you see all the other people doing all the cool stuff and you're kind of running around doing this gut work which is just the nature of anything really in every residency you're gonna do that as an intern um but it's a steep learning curve so you're putting in a lot of long hours you're getting a lot of things wrong you're there for a long time so it takes a lot um I think for any field you have to be someone who takes constructive criticism well um because it'll only help you even if someone comes off as you think someone's being mean just take what they're saying and change what they want you to change and just move forward from that because that's truthfully all anybody's asking you to do some people just aren't as it's kind of a same thing so I've seen some things I feel like it's better than back in the back in the day right um but yeah yeah I've seen these things did you use any strategies you said you're looking you would look towards that you knew this you saw the light at the end of the tunnel did you do things like I don't know did you go to yoga classes or take weekends away or was there something for you that you found that worked when you were feeling kind of down or kind of like there was a lot going on yeah I think you have to try to keep some semblance of a life outside of work there are like weeks where it's just like not possible yeah but then when you do have time like take time to hang out with friends like I was friends with a lot of the general surgery residents and the other Urology residents who are going through the same thing as you are so you can kind of pick their brain about what they're doing and um talk about what you're all going through together which helps um so take time to like see your friends outside of medicine too like I have some friends up in Brooklyn who are not in medicine so it's always a nice like weekend getaway if I could go hang out with them and kind of just like escape the medical world for a while um if you can find time to exercise that's I always feel a lot better when I I can at least do something it doesn't need to be insane like just go for like a 20 minute run or something and kind of clear your head it helps that's great and then we're going to step out more generally now not necessarily Urology but thinking about lifestyle thinking about having a successful long-term career and this doesn't necessarily need to be in Wellness it could be in finance in the actual field you're going into or anything do you have any kind of advice or things you've been thinking about because you're kind of at the beginning right because you're being attending in a year yeah going forward um in terms of what it could be anything it could be like Finance it could be uh lifestyle it could be what did someone someone for example the the Dr lousy was mentioning you know I wish maybe necessarily I didn't wait so long to start a family and stuff like that because he feels like he's getting a little bit older now and he feels like maybe I want to be around for my kids as long as possible and and I'm a little bit older they're a bit a little bit younger and so on and stuff like that but it could be any uh what was another uh another Dr okasani who's a cardiothoracic surgeon said in his training what he would do every single day is he'd have a little notebook and he'd have a little notebook that when he would go through a procedure or something like that he'd write down the steps of the procedure and then he'd also write down uh he seems like insanely focused he's like he's a really he's wonderful he gave us a lecture one morning and I love he seems awesome but he says you know he'd also write down the attending preferences and then he'd also when he went home at night he'd read for at least an hour or two every single night on whatever was going I was like you are really set in the bar up yeah that's a lot that's a lot I will say especially in a surgical field and probably anything you're the attending you're working with is going to give you a longer leash if you know what they like I see so if you're we have multiple surgeons who do robotic prostatectomies and there are certain steps that each of them do a little differently and if you are doing the steps that they like to do as you're going they let you keep going because you know what they do you know what their steps are and what they're doing next so they trust you to keep going the way that they would want it to happen so I do think that's an important part of kind of like knowing who you're working with um and after you graduate you can do it however you want like you can set up your own way of doing things um but it's good to know like who you're working with how they like things done and kind of cater to that because they're going to give you a lot more autonomy if you show that you've been paying attention when you're working with them so pay attention to what the attending specific preferences and stuff so that makes sense yeah and not to say that you can never like question something that's happening but if they have like a very specific way of doing a procedure if you try to change it up they're probably just going to take it away from you give me the reins yeah exactly um so that's definitely important in terms of after residency a lot of people do fellowships versus just going into practice or there's academics and private practice so it's all stuff that I'm still trying to figure out right now yeah do you have any leanings on any way yeah my plan is to apply for a robotics Fellowship okay so there's like the Endo Urology Society where they have there's kind of a mix of fellowships within that some of them are very robotics focused some of them are Endo focused like stone treatment upper track disease um and some are like a mix of both so I'll probably apply to that with the goal of something that's a little more robotics focused and then I don't know if I'll end up doing academics or private now we're going to step back even further if you could speak to 18 year old Haley going into the field of medicine undergrad for going into her first higher education would you give her any advice would you tell her anything before she and Ventures down this this long honestly long road I think just go into everything with an open mind I think every year you feel like you have like no time and it's the hardest year yet and you're getting crushed in them the next year you're like oh I actually had a lot of time last year so just like take advantage of the time that you have um and use your time wisely and don't forget to that there's more to life than just medicine there's other things to do other than just be medicine easier said than done have you seen um it's a two-part question are there attendings that you have seen make mistakes and they're not not necessarily procedural mistakes I mean like career mistakes like for example lifestyle decisions or it could be mistakes in the in the orb would say maybe it was a not a technical mistake I mean like an attitude thing or something mistake that you want to make sure you lean away from um I think there's definitely people who have are a little more impatient I see in the operating room and I don't think that it necessarily helps situations so I definitely want to strive to be someone who doesn't have like an immediate like reaction like I think you have time to like step back and think about things even when things are tense in the operating room I think you can handle it well even if something's like serious I think there's a way you can talk to people that's more helpful um so definitely that's going to be part of my goal yeah that's great so we'll see we'll see yeah who knows maybe as soon as you get the kids and attending things happen and you're just you know throwing things no no I wouldn't think anyone yeah because I think the better relationship you have with people of any level like the nurses the custodians in the hospital anybody can help you if you are on good terms with people like they can't it can only be better yeah no that's a really good point make sure to because they're also you know they're humans too right so yeah they're humans and they're doing a lot of work in their own right too it's just different work and then selfishly it'll pay off in the end yeah that's true if you're nice to these people they'll help you out right exactly and it'll make your life easier and you know in the end that could mean also better outcomes for patients right so yeah it's a whole it's a whole thing okay so mistake you've seen attendings that maybe make mistakes on the other side are there attendings you admire and are there certain aspects or qualities of them that you aspire to be like yeah definitely um try to think of specifics I mean I think you can tell when a an Italian like truly cares about their patients and spends the time to talk with them through everything and doesn't just blow things off um I think there's also people who if they're like more specialized they think that some things are beneath them like if someone walks into their Clinic that's not like their exact specialty um it feels like they don't care as much maybe about that patient when that patient's just coming in to like get help about their problem yeah so if it's something you don't know I think it's totally fine to just tell the patient like hey this isn't what I deal with every day I'm not exactly sure here's who you should go see um but I think just like the people who like care for their patients you can tell they're a little more invested in like talking to the families after and like making sure everything's set up pre-op and talking to the patients that's great and and now this is kind of a weird question but do you have any book recommendations around medicine do you if you have a book that someone should read before going into men a lot of people mention Atul gawande's book you know or when breath becomes air is there very common when people mention I love that but I thought it was just really interesting to read what else do people meant the house of God is mentioned a lot uh kind of maybe on the other side of saying you know it's not So Glamorous yeah there are things that aren't the glamor to it is there anything and it doesn't have to be medical right it could be something someone what did someone mentioned someone mentioned uh Atomic habits the other day they thought developing their habits and getting uh in the way that they should especially as their lives become busier and busier and busier and busier establishing their habits now and they're kind of how they live their life now was really helpful when they just their life got busier so they knew kind of what to do yeah books what it could be anything it could be a fun book too um I don't know that I've read any that I necessarily would be like you have to read this before you start a residency um I know the Emperor of all melodies is like a big Medical Group that a lot of formalities yeah I know that it necessarily like helps you in residency but it's kind of the history of cancer treatment wow and like how kind of aggressive and almost barbaric things were at the very beginning where it was just like they talk about a lot about breast cancer so like radical mastectomies where it was like a very like yeah High morbidity surgeries they were doing for patients and then they moved to like lumpectomies and radiation and different things so it's it's an interesting Journey on the like history of cancer treatments and where we started and where we've come to yeah no that's great that's right I haven't heard that one yeah that's interesting awesome so I think we're coming near the end here do you have any closing words for people students specifically maybe a third year or an early fourth year who's interested in urology anything you think they should think about or any just closing remarks in general for people that are thinking about Urology as a specialty yeah I mean in terms of like in medical school I think keep an open mind to everything you're going through if you have an off afternoon it's really easy to just like do nothing with it um but go shadow in different fields there's a lot you don't have time to see every field so like like I never saw ENT or IR or anything maybe I would have loved those um anything you think you might be interested in Just Go Shadow keep an open mind um work hard and everything even if you know it's a field you're absolutely not going to go into you're probably only on that rotation for like what four weeks yeah like just put an effort to learn everything you can from it because it might be the last time you ever like see that specialty yeah um and then yeah I work hard get into contact with people do some research in something yeah that's fantastic because it's because you may have never got into Urology right I just I'm stuck with this initial story yeah because I sometimes think a lot of this you know life random and stuff like that but it seems kind of happenstance doctor and Sonia I was talking to him he said he had an amazing experience with a cardiothoracic surgeon who helped him and guided him and said you know what you're gonna you could be a great surgeon in this and it was like wait a second this is what I can you know what I mean this is what I can do so I almost think like what if maybe I just never had an experience with an ENT doctor yeah or an IR doctor so it's I think that's a really good tip to kind of dip your toes and everything and find your people too I think is a good thing that people say a lot and I think that that makes sense to me as well because these are the people you're you're going to be around them probably a lot of the time more than your family or friends and stuff like that you're you're with your cool residents yeah a lot in residences so yeah find the people you get along with yeah yeah actually for my like story of how I got into it I actually applied for a weight rotations in urology before I had a specific rotation wow so sometimes you just have to like make it work with how your schedule is lined up I think a lot of people have a lot of stress with like the order of their rotations yeah you can make it work oh yeah they kept on telling us that in third year I mean they kept on I remember like don't worry it's gonna work out people are like hardcore surgeons and they got it as their fourth rotation yeah their first rotation they were freak but it it does it all works out you can if you know if you think you want to do something and your rotation's not until June of your third year reach out to people earlier go Shadow you can get to know people without a formal rotation yeah well perfect Haley thank you so much for coming this was really really helpful yeah thanks for having me it was fun thank you and we're hell and we're done and we're closed

Channel: The Zach Highley Show

Views: 8,353

Keywords: the Zach Highley show, zach highley, podcast, Zach Highley podcast, medicine, med school, studying, growth, personal growth, doctors, medical school, study tips, study, personal development, self improvement, self-improvement, the Zach Highley podcast, fda, drug approval, billion dollar drugs, lexapro, depression, money, urology, urology competetivenss, residency

Id: CIWcgirwty0

Length: 53min 24sec (3204 seconds)

Published: Mon Jul 03 2023