Urology is the medical and surgical specialty involving disorders of the genitourinary tract and the adrenal glands. Specialists in this discipline must demonstrate knowledge, skill, and understanding of the basic medical sciences relevant to the genitourinary tract and the adrenal glands.
Residency education in this specialty is designed to educate physicians in the clinical aspects of diagnosis, medical and surgical therapy, and the prevention and reconstruction of urologic diseases, neoplasms, deformities, disorders, and injuries.
Five years of postgraduate education are required. As found in the American Board of Urology’s (ABU) Information for Applicants and Candidates handbook for certification, an applicant for certification by the ABU must:
The ABU mandates a minimum of five clinical years of postgraduate medical training. The training must include:
- 48 months in an ACGME-approved urology program
- Three months of general surgery in an ACGME-approved surgical program
- Three months of core surgical training (e.g., intensive care unit, trauma, vascular surgery, cardiac surgery, etc.) in an ACGME-approved surgical program
- Six months of other rotations, not including dedicated research time, in an ACGME- or RCPS(C)-approved core surgery program
All rotations listed above that are not part of the core urology training must have been approved by the candidate’s program director. As part of the core urology training, the candidate must have completed at least 12 months as a chief resident in urology with the appropriate clinical responsibility and under supervision in institutions that are part of an ACGME-approved program.
The final 12 months of the urology educational program must be spent as a chief resident with appropriate clinical responsibility under supervision in institutions that are an approved part of the program.
For more information, visit the American Board of Urology and the American Urological Association.
The description of this surgical specialty was adapted from a description set forth by the American Board of Medical Specialties (ABMS).
Urology as a Career
Urology is a surgical specialty with a wide spectrum of opportunities, ranging from office practice to minimally invasive endoscopies to major open surgical procedures. This variety is a particularly attractive feature for practicing urologists. Urologists are the prime caretakers of the male genitourinary tract and the female urinary tract and operate on the kidneys, ureters, bladder, prostate, urethra, testes, etc. Furthermore, for many patients with prostate disease, kidney stones (nephrolithiasis), and incontinence, urologists are the primary physicians. Most urologists in private practice will see between 50 and 100 patients weekly and perform additional cystoscopies, prostate biopsies, vasectomies, and other minor office procedures. They will also perform a range of major surgical procedures including nephrectomy and transurethral resection of prostate (TURP) in the hospital. A urology practice may be primarily surgical with three to four days a week spent in the operating room, but most urologists operate only about one to two days a week.
Although most urologists in private practice are generalists and see a spectrum of diseases ranging from benign prostatic enlargement (BPH), stones, incontinence, and cancer, there are recognized areas of subspecialization within urology, especially at the academic centers and in large group practices. These include urologic oncology, pediatric urology, stone disease, infertility, impotence, female urology and incontinence, and laparoscopy. There are clinical fellowships in these fields that are from one- to three-years long. A fellowship appointment requires completion of an accredited residency program. Residencies in urology include one or two years of general surgery followed by three or four years of urology with a total length of five to six years. Many programs also include six months to a year of research time, and there are well-established basic science research fellowships through the National Institutes of Health and through the American Foundation for Urologic Disease (AFUD).
For many students, their initial exposure to urology is on their third-year rotations in surgery. Unfortunately, at many institutions, most students are never exposed to urology and never get a chance to consider it as a career choice. Those students who become interested in urology generally take an elective fourth-year urology rotation for four to six weeks to gain a better understanding of the specialty and to get letters of recommendation to apply for a residency position. As a surgical specialty, urology is quite competitive and continues to attract some of the best and brightest medical students. There are a total of about 90 programs and 220 residency positions in urology filled through the match each year.
Urology is interesting and exciting in that one can adapt the field to his or her own talents and circumstances. If performing major surgical procedures is a priority, it is possible to construct such a practice; if performing endoscopies and office practice are priorities, that can also be accommodated. As an example, a young surgeon may elect to perform major oncologic, pediatric, or reconstructive procedures while the same surgeon 20 years later may elect to perform minor surgical procedures or even have primarily an office practice. Urologists are generally friendly and have wide-ranging interests outside of medicine. With the aging population and the continued rise in the number of patients with BPH, prostate cancer, incontinence, impotence, and infertility, urologists expect to stay quite busy in the coming years.
Anurag K. Das, MD, FACS