In this series, the Column editors will interview urologists charting unique paths outside the operating room. This project aims to highlight success stories and inspire future trainees. Up first is Dr Ruchika Talwar, Urologic Oncology Fellow at Vanderbilt University and the current AUA H. Logan Holtgrewe Legislative Fellow. Dr Talwar recently published “Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model” in The Journal of Urology^® and met with Mark Cuban to discuss the future of drug pricing in the United States.

Editors: Thanks for taking the time to sit down with us! So tell us about your current role with the AUA and what sort of work this involves.

Dr Talwar: I wear a few hats. First, I am the immediate past-chair of the Residents and Fellows Committee, where I worked to represent all trainees within the AUA. I am the current Holtgrewe Legislative Fellow. I’ve also been a part of the AUA’s delegation to the American Medical Association (AMA) since 2018. In both of these roles, I work to advance the policy and advocacy-related interests of organized urology.

Editors: When and how did you first become interested in advocacy?

Dr Talwar: I can track my interest all the way back to high school. Believe it or not, I thought I was going to be a politician. Despite eventually planning on a career in medicine, as an undergraduate, I pursued biology and legal studies.

My medical school [had] a very active AMA chapter, so I worked up to national leadership roles gradually. I honestly just showed up to the urology caucus one day and said, “Hey, this is me!” and that’s how I met some of the amazing leaders in the AUA’s Washington, DC, office.

Editors: Can you elaborate a bit more on how you identify and prioritize the issues you advocate for?

Dr Talwar: For me, it’s about identifying the problems that are most impactful for patient care and physician well-being. I direct my energy toward the things that frustrate me. Many of the problems physicians experience are [because] we’ve taken a back seat and let administrators without clinical experience take control; we tell ourselves we’re too busy to do anything outside of patient care. As physicians, our knowledge and expertise make us ideally positioned to identify the most pressing issues in health care and work toward meaningful change.

Editors: You bring up a really great point about how physicians have moved out of the administrative space, perhaps to their own detriment. The fact that you’re able to translate many of the challenges you see in daily practice to actionable items is impressive!

Dr Talwar: I’m just really stubborn [laughs]. It’s a lot of teamwork. You may see something that the AUA has advocated for attributed to one person, but really it’s a team effort led by our AUA policy staff and organization leaders.

Editors: To that point, we’re all so busy in medicine. How do you educate yourself to attain the baseline knowledge to make a difference?

Dr Talwar: It’s all about networking. I seek experts out, and I’m not afraid to say when I don’t know something. When I came to Vanderbilt for fellowship, I became interested in drug pricing. I saw this problem and this new company, Cost Plus Drugs. And I thought, there’s something here. My gut is telling me this is going to help a lot of patients. I met with experts like Dr Stacie Dusetzina. I had calls with her where I said, listen, this is what I’m thinking, but I don’t know a lot about this, can you educate me?

One thing I’ll say that helps people with limited time: Twitter! I put effort into curating who I follow on my timeline, and now I learn a ton from them. I’ve also signed up to get certain journals’ table of contents straight to my email. Although the published articles may not be directly related to urology, they highlight problems that are analogous in urology, or things that I have been interested in more broadly.

Editors: Can you tell us about your experience as the Holtgrewe Legislative Fellow?

Dr Talwar: Most of the work I’ve done in the fellowship has built upon the work I’ve done prior, but I couldn’t apply for the fellowship until this year because I didn’t have any protected time to work on the Hill. So what I’m most looking forward to is the time I’m going to spend on the Hill later this month!

I’ve traveled to DC every year, not just for the AUA Summit, but also to meet with Congress and represent the voice of urologists nationally. That’s something that I really enjoy doing.

Editors: It seems like a central theme is public communication. How do you communicate your ideas to laypeople in an empowering way?

Dr Talwar: That’s a great question. And that’s actually one of my major career goals—to bridge the gap between the amazing research that’s done in medicine and the policy that comes out of DC. We as physicians understand data. But the COVID pandemic underscored that the rest of the world doesn’t always think this way. It’s not enough to quote evidence.

I think what’s more impactful is sharing your stories. I use this method in congressional visits, and I encourage others to share their own patient stories. That’s what resonates with people. Although the numbers demonstrate the scope of the problem, we’re ultimately healers, and sometimes it does come down to a patient story. Stories help you tell people, “Look, all we’re trying to do is take care of patients.” I’m trying to cure this person’s prostate cancer, and I can’t because the medication that they need to live longer is going to bankrupt them. That’s going to be way more meaningful than me saying that x number of men are diagnosed with prostate cancer every year, and here’s the average out-of-pocket cost, etc.

Editors: We agree that stories are powerful! Any recommendations or advice for medical students like us who are interested in working in this kind of space?

Dr Talwar: Training can definitely get tough. When you’re in the trenches dealing with constant pages, seeing late night consults, and working through sleepless nights, it’s easy to lose sight of what motivates you. I’d encourage medical students and residents to stay true to your north star, which for me was health policy, and try to integrate it into your daily clinical life. This has helped me fight burnout and stay focused.

The other thing I’ll say is seek out mentorship. That’s been invaluable for me. Some of the most supportive people I have ever come across are in this department here at Vanderbilt. And even though they’re not directly in exactly what I want to do, they all move mountains to make sure that I have a chance to pursue this interest. My mentors in residency did the same. They didn’t fully understand what exactly my policy interest was, but they went out of their way to support me however they could.

Editors: So after fellowship, how do you see yourself working in this space as an independently practicing urologist?

Dr Talwar: I’ll actually be staying at Vanderbilt after I finish my fellowship—again going back to the importance of mentorship and finding people who believe in you! I’ll be 50% clinical, while the other half of my time will be spent working in the Office of Population Health with Dr C. J. Stimson, who’s also a urologist and has led the way in bundled payment programs for many different conditions.

I definitely got lucky that there was such an opportunity, [but also] it’s a lot easier to justify this interest because now I have a proven track record of work with the AUA and the AMA.

Editors: Lastly, what are your thoughts on the future of advocacy and health policy within urology? Are there any big issues which you see becoming increasingly important over the next decade?

Dr Talwar: We need to continue improving access to urological care for vulnerable populations. Along with that, it’s very important that we continue to encourage a diverse urology workforce. We talk about really personal issues with our patients, and it’s so important to have providers who look like patients so that our patients are comfortable. We also need to be vocal about issues like reproductive health care and transgender care since both of those domains are constantly under attack. It’s really easy to say, “Well, they’re not directly related to urology,” but they are. We need to continue to push our colleagues and our organization to lead on that front.

I’m interested to see how artificial intelligence will start to play a role in urological care. I think urology has always been at the forefront of technology, like with robotics, which was adopted by urologists earlier than in other fields. We’re going to have to make sure that we have policies in place that allow for ethical applications of these new artificial intelligence–related technologies.

Editors: We want to end by thanking you for sharing your story! It’s valuable for students to hear from urologists who have other professional interests and are able to integrate them back into their clinical practice for the benefit of patients. We appreciate you leading the way and setting that example for the next group of urologists!

Dr Talwar: Thank you! I’m grateful to be featured on this platform. I hope we can remind aspiring urologists: Don’t lose yourself. Everyone’s metrics for success are different. Don’t compare yourself to what other people are doing—just stay true to what drives you. For me, that’s health policy and advocacy.