Most urology residents cannot wait for the final days of residency. People approach this professional milestone with a combination of anticipation, relief, and a sense of accomplishment. But many young urologists also experience an undercurrent of dread. Although training programs prepare us to be qualified urologists, they don’t always teach us how to be successful in practice after residency. Over the years I have been in a solo practice, a single-specialty urology practice, a hospital-employed practice, and finally in an independent multispecialty practice. I have learned a few things along the way, and I would like to share my Top 5 Things I Wish I Knew Before Starting Practicing.

The first thing that I wish I knew prior to starting in practice was how to code properly. Generally, Evaluation and Management coding is not covered well in residency. Understanding how you get compensated for the work that you do and learning how to assign a code that matches the time and effort that you put into a patient visit is vital for survival in any type of practice setting. This should be a major focus prior to starting your first job. It is important to realize that there are legal ramifications for improper coding. Urology-specific coding classes are available through the AUA or through PRS Network. If possible, try to work with the office coder prior to your first day of clinic. You can always visit the CMS.gov website, which can be helpful but a bit overwhelming.

The second thing that I wish I knew was how to understand and negotiate a contract. It is important to do your own research before evaluating a contract. You need to know what you are worth by looking at national salary data and local salary data. When assessing a contract, you also need to see what benefits are offered. Examples include health insurance, disability insurance, vacation time, educational stipends, and maternity/paternity leave. Online resources such as MedScape, Doximity, and MGMA may be helpful. It is critical to find a qualified lawyer to explain the legal jargon and help you understand the specifics of your contract. This will be money well spent. Remember to get it in writing or it doesn’t exist. It’s okay to ask for things during a contract negotiation—all they can do is say no.

The third thing to understand is “how the money works.” You must understand your compensation model to figure out how you are paid. Are you compensated via a straight salary model or is your compensation based on a productivity model or some combination of the two. If you perform well, is there a bonus? If your performance does not meet a particular threshold, is there a penalty? How does your compensation change over time? Understand how overhead is allocated in the practice. What portion is your responsibility and how will this affect your bottom line? Read the monthly financial reports and, if possible, talk to the accountant. Understand where the money goes in the practice. Ask questions up front to avoid disappointment later.

The fourth thing to learn is how to deal with hospitals. This is more complex than it sounds. Each of you will have a unique relationship with the hospitals that you cover. What does the hospital expect from you? What is your emergency room call requirement? What happens if you must take time off? What can you expect from the hospital? Will you have an advanced practice provider? Is there a hospitalist group? How do you get block time in the operating room (OR)? What type of equipment do they have in the OR? It helps to get to know the people in the office of medical staff affairs and the staff in the OR. To really understand the system, try to serve on a hospital committee.

The final thing to understand before starting practice is that the work life balance is a myth. This is the hardest part of the job. A stable work life balance is virtually impossible to achieve, and imbalance is the norm. Set your individual priorities and try not to compromise. Create healthy coping mechanisms to help with the inevitable imbalance. Above all, truly value your spouse, partner, friends, or family. You will need their support when your life is wildly out of control.

Although urology residency is full of struggle and sacrifice, the real work is just beginning. Developing an understanding of at least 1 of my Top 5 things will be a great benefit in the long run. The practice of urology is rewarding and complex. Remember to pace yourself for a long career and enjoy the experience.