Dr. Mary McHugh is a urologist who’s been out in practice for a year and a half. She talks about her journey to urology, especially as a female, in a very male-dominated specialty.
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[01:21] Interest in Urology
Mary was exposed early on to urology when she was a second-year student during a six-week general urinary block that covered OB/Gyn and Urology. She saw how urologists were fairly entertaining who showed videos of the robot. From that moment on, she got introduced to the concept of the specialty that she had never even considered or known much about. But this sparked her interest in learning more about surgical fields.'I just never thought about urology - period... I had always thought women didn't become surgeons.'Click To Tweet
She always thought she’d do something that wasn’t procedure-based or medicine-based. That said, she didn’t really experience any gender bias when she took the course. In fact, there wasn’t any single female lecture in the course. Every single person that came and talked to them was a man. So it was interesting she ended up down this path.
What she really liked boiled down to medical management, procedures, and surgery. She likes the organ system, the anatomy, and that some of the problems had to deal with the quality of life. What she likes about it is that 100% of the issues people deal with is quality of life. And being able to make that impact and make it fairly quick, it leads to a lot of satisfaction to both patients and physicians.
[04:20] What is Quality of Life?
One of the biggest quality of life issues is overactive bladder urinary frequency. This would not be considered to be a life-threatening illness. However, it’s something that affects how they carry out their daily activities. And some people get so bothered by this. Fortunately, there are things they can do for that to be fixed but they never even realized until they stepped into a urologist’s office.
Another example is stress urinary incontinence. This is leakage, or anytime there is an increase in intraabdominal pressure. So when a woman or man coughs, laughs, or sneezes, they may leak urine. Again, not a life-threatening condition, but can be ostracizing and can interfere with things they like to do like running, dancing, horse-back riding, hiking. They have things urologists can do to help improve that.
[05:45] Traits that Lead to Becoming a Good Urologist
You have to be a good listener and a good communicator, especially that patients that come to you have very sensitive issues that deal with sensitive areas of the body. And they want to feel like they’ve been heard and understood. As a woman, you get a lot of male patients that are very shy when they come in. But you have to make them feel at ease and like they can open up to you and talk to you, so you can get to the root of the problem.'Anybody who is going to be counseling patients on procedures, you really have to be a good communicator.'Click To Tweet
That being said, you have to be able to set expectations and be very clear about what’s happening, what the potential risks, complications, side effects, etc. So patients really know what they’re getting into when they’re signing up for surgery.
Mary had other interests prior to urology such as dermatology to GI and then to peds, until eventually, she found urology after she took the course and went on her clerkships. She chose a clerkship path where surgery was second to rotation so she was able to make that decision right away.
[08:18] Types of Patients
Among her patients are those with overactive bladder, stress urinary incontinence, voiding symptoms in men due to enlarged prostate, erectile dysfunction, and recurrent infection (a big one she sees). She also sees a lot of chronic bladder pain syndrome or interstitial cystitis, stones, and hematuria workups.
Mary is in private practice in northern New Jersey and she says 70% of her patients where an OB/GYN will identify a problem and send the patients to her. Then she goes from there and does everything on her own. The other 30% are looking for another opinion or have things done or they’ve seen another urologist. So about 70% are common and the other 30% come with some things done.
[11:11] Choosing Private Practice over Community Setting
Mary’s husband came out of his training first and finished his fellowship. He wanted a specific job in a specific location so he moved while she was finishing her last year of residency. She has always envisioned herself going into private practice. She thinks it’s hard to provide training and mentorship to residents when you haven’t been out in practice or out in the world. She also likes the independence of private practice as she has always liked doing things herself and at her own pace.'It was the job market and my own style and personality that really influenced me to go into private practice.'Click To Tweet
During Mondays, Mary is in the office seeing patients. Wednesdays are full days in the office seeing patients. Fridays are procedures they do in the office such as cystoscopy, vasectomy, urodynamics, and other procedures. She also does prostate biopsies and ultrasound and injection of Botox to the bladder. Tuesdays and Thursdays are a bit more variable. As a new attending in their area where they’re saturated with physicians, it can be hard to get block time. So when she puts cases on her schedule, they get added to the hospitals she’s on staff at. The way you get block time is either to acquire somebody else’s block or to be employed by the hospital system.
A lot of the consultations she gets sent are a lot of non-operative patients. About 20-25% of all the patients she sees end up having a procedure whether it be in the office or having surgery. This can be a little disappointing for her considering she wants to do surgery.'You do the cases that you can and you have the best outcomes that you can and that's how you build your reputation.'Click To Tweet
She explains that one of the biggest things you have to realize coming out of training is that it takes time to build and it takes time to establish yourself and establish your reputation. Don’t believe everything you see on Instagram where everyone has 10,000 cases on their first day.
[17:55] Urology as a Male-Dominated Specialty
It’s just the perception of a lot of patients that only males will treat that part of the body or look at that part of the body. It has to do with traditionally, who was in the specialty looking back 20-40 years where even every specialty was even male-dominated.
That said, women are still a rarity in the field but a lot more women are being trained now which is great for both male and female patients.
[19:20] Taking Calls and Emergency Cases
Mary is in a large urology group and in her care center, there’s only two of them. Their call is going to be split by whoever is in your care center. So it’s every other night for her. ER calls are determined by hospitals. One of the hospitals assigns ER calls a month at a time. She doesn’t describe it as too bad. But based on politics, some hospitals keep a stronghold on the call and don’t want outsiders taking it which she considers as a blessing in disguise.
Some of the emergencies they see are necrotizing fasciitis of the genitals, testicular torsion, abscesses, the common ones they get consults for their scrotal abscesses, and septic stones. And retention – a common one they get consulted for all the time. Oftentimes, they call you and patients are super uncomfortable so you have to go take care of it.
[22:13] Work-Life Balance
Mary considers having enough family-work life balance. Her husband’s hours are pretty long as well. So they have that time when they go home at night where there’s a couple of hours and then the weekends. Whatever weekends he’s not working.
It’s a lot better than training she calls it. And there are things you can do to minimize your calls your make sure everybody’s questions are answered and everyone is tucked in. If you’re doing a procedure on a Friday, everything is taken cared of and you don’t have any worries about that when you go on call over the weekend. It’s a matter of letting people know that you’re available but also explaining to them what kinds of things they should be calling you for. When they’re not on call for the practice, it’s not as bad.
[23:35] Residency Path to Urology
Urology is its own training program. Most of the programs are five years, some are six years. Although a lot of them have gone down to five years. The first year is a general surgical internship and then usually for four or five years of urology. A lot of the programs that are six years have built-in research year.'If you're applying, know how long the program is going to be. But it's all one program you match into the whole thing.'Click To Tweet
The urology match precedes all the other matches, after the military. But urology matches in December. It’s not through the NRMP, but through the American Urologic Association. They give you a number and you do it through its own unique match.
The reason for this could be that it’s a self-regulation issue. When you’re in a specialty, you don’t want to have so many people. This is just Mary’s guess though.
Urology matching is pretty competitive. Check out urologymatch.com and find a more specific breakdown. There are not a lot of applicants but it’s a 60% match rate for those applicants and they break it down in general. You have to be really high performing as a student and have good Step scores. The process could be different now as well. Mary is a DO and a lot of the programs that were DO are now in the urology match accredited by the ACGME as a single graduate medical education system. And so it’s gotten a lot harder than when she matched since it was a separate match. She applied into the urology match and applied to as many programs as possible. But they’ve done away with programs that are just AOA accredited. Mostly, all are ACGME-accredited at this point.
[26:38] Negative Bias Against DO and Other Subspecialties
Having been on both sides of the interview trail and as an interviewer, she thinks there are biases. The Specialty Stories breaks down per specialty, MD vs DO, and Mary thinks the data speaks for itself. It can be done as a DO but that’s more of the exception than the rule.
There are a lot of subspecialties you can do after urology such as oncology (2-year and 1-year fellowships), female pelvic medicine and reconstruction (2-year and 1-year fellowships), pediatrics (2 years), reconstruction and trauma (1 year), andrology and male sexual health (1 year), and fertility. Those are the general subspecialties. Urology is its own subspecialty.
[29:30] Working with Primary Care and Other Specialties
Mary says there are a lot more technology and a lot more procedures to help patients. She commends those primary care doctors for starting people on medication and working up a lot of the urinary complaints. For instance, Botox is for patients with frequency and urgency, indicated if you’ve failed to two or more medications. Sometimes, patients think that there’s no solution or they’re stuck with the medications. And people are always so surprised when they learn about their options. So just getting them into the urologist sooner and not being afraid to send in a patient to see if there’s anything else they have to offer.'Sometimes, patients think there's no solution or they're stuck with the medications. And people are always so surprised when they learn about their options.'Click To Tweet
Other specialties they work the closest with are general surgeons, OB/GYNs, family practice and other mid-level providers like PAs, NPs, etc. Opportunities outside of clinical medicine for urologists include speaking engagements, expert witness, write books, consults, etc.
[32:15] What She Wished She Knew that She Knows Now
Mary believes that one of the hardest parts of being a surgeon is that you become extremely disappointed when something doesn’t go according to plan or someone has a complication. Dealing with that the most is one of the hardest parts of her job as it’s emotionally taxing. So you have to learn how to deal and cope with that.
When you go out, everyone is just so bright-eyed and bushy-tailed and ready to soar, but it takes time. It takes time to develop a rhythm. It takes time to develop finesse. So there should be patience and you should respect the process.'What you've done 10,000 times as a chief resident that you can do with your eyes closed suddenly becomes the hardest thing when you're an attending.'Click To Tweet
What Mary likes the most about being a urologist is her patients which she considers to be very awesome and this adds to her job satisfaction 100%. She comes from an urban area in her training and so now it’s different there. Now, she’s out in the community and the suburbs. Patients listen to her and they take their medication. They make her job very enjoyable.
The thing she likes the least is that sometimes you feel helpless in your ability to help people because you’re constrained by what insurances will cover. This is an issue because people are on a fixed income and they can’t afford these things.
If she had to do it all over again, Mary would still probably do it. Again, on social media, you see these people so happy after some procedures. But what it all comes down to is to think about what complaints or complications you’re going to deal with.
[37:30] Final Words of Wisdom
Stay interested. Read as much as you can, when you can. Getting exposure early is key. If you’re a medical student, it’s doing all the things you should do to match into a competitive specialty. Learn the people who are on the faculty at your institution. Get involved with research. Meet the residents and get that chairman’s letter if you have a department. Do as well as you can and you’ll succeed!