When mechanical clocks were invented, pendulums measured time—moving right created a “tick” and returning left a “tock.” Today’s digital clocks and watches do not tick or tock, nor do we see or hear gears rotating forward and backward. Their movements and transitions are silent. And thus, from afar, as with other well-run organizations and companies, we watch our AUA run like the proverbial quiet well-oiled clock “to promote [its mission] of the highest standards of urological clinical care through education, research, and the formulation of health care policy.” Up close, however, these transitions are far from silent.

A group of 8 created the AUA over dinner in 1902, and the 1904 membership photo in Atlantic City shows 32; the AUA counted 22,000 members in 2022. Now the AUA is an umbrella for 3 legal entities: (1) AUA Inc, (2) AUA Education & Research Inc, and (3) the Urology Care Foundation, with a separate political action committee (AUAPAC). The AUA is a professional organization run by professionals; no longer a group of a few individuals interested in urology. As such, no member can attend their first annual AUA meeting and easily figure out the when and where, much less the how of the organization. As a urologist before our first solo operation, we’ve spent 10 or more years learning our specialty. Few of us urologists have studied, practiced, or performed the business and organization of anything or examined organizational leadership and transitions.

While the study and examination of leadership is as old as the beginnings of medicine, only during the last 20-50 years has it achieved status as an academic field of study. As the scope and size of organizations increase, it’s recognized that organizations have lives of their own. To be done well, preparation, education, and succession planning are parts of organizational management.

Those selected for the 10-year-old AUA Leadership Program are already leaders in their own spheres; during this program we are exposed to the AUA in a way that helps participants understand its mission, goals, and direction, and how these tasks are currently being accomplished—an investment into our specialty’s future. This opportunity reveals the AUA scale and role, and how it communicates as an organizational structure the best of urology, and nimbly manages the future and the unexpected.

During my practice of urology, some changes in the structural pillars of urology—education, training, and advocacy—could scarcely be foreseen. As an older member of our group, I can recall diseases in which we had few options and inefficient practices. In an ingenious way the Leadership Program via capstone projects is geared to recognize new and created issues of our specialty. It is my privilege to work with individuals who were trained with different knowledge of education, research, and advocacy, to investigate the future. I’m honored to watch and work with these urologists to help prepare the “tick” to be soon the “tock” of the AUA. The quiet swinging pendulum confirms the success of the program.