Starting practice after fellowship, whether in an academic or community setting, can be daunting. However, fellows completing a urologic oncology clinical, research, or combined fellowship have a unique set of skills to aid in this transition (see Figure). In general, during a urologic oncology fellowship, a fellow spends 1 year conducting research and 1 year furthering their clinical and operative oncology skills prior to completing training. Fellows arrive at their practices with a fund of clinical knowledge, research experience, and surgical expertise, but putting these skills into action and building a practice takes refinement, mentorship, and networking.

Figure. Fellowship learnings essential for practice. Created with BioRender.com.

New attendings should have a vision of their ideal practice. What subspecialties of oncology do they wish to practice? What are their research goals? Discussing these goals early with your department or practice helps to establish your referral base and your schedule. Furthermore, this helps with refinement of your operative and research skills as you are focusing on the diagnoses, cases, and projects that interest you.

Mentorship throughout your career is important but is especially helpful during transitions. During residency and fellowship, new attendings have already gathered many mentors who have helped shape their careers. Maintaining and continuing to grow those connections will prove very fruitful early in practice to discuss cases, complications, and research ideas, as well as successes and challenges in life. Furthermore, seek out new mentors. These will be urologists within your practice as well as physicians and colleagues in other departments. Being available, introducing yourself, attending meetings, and joining in on combination specialty cases will be helpful to establish these relationships.

Building networks may look different in academic and community practice settings. In academic centers there are already established connections and often weekly meetings between departments such as urology, medical oncology, radiation oncology, and other surgical subspecialities. Therefore, collaborative cases and discussions about patients are often easier than in community practice initially. It is still important, however, to be available for colleagues and collaborative to build your connections and mentors during the early transition into practice. These mentors will be critical as you refine your clinical and surgical skills, establish your lab or clinical research efforts, and build your practice. Establishing yourself in a community practice initially can be difficult given nonurologist colleagues are not housed under one roof. Therefore, it is important to start meeting your medical oncology, radiation oncology, and medical or surgical colleagues early. Regardless of your practice setting, it is also important to seek networks outside of your institution. Local, national, and international networks help you to stay current and forward thinking for new innovations and treatments to challenge the current standard of care.

Lastly, as parting words of advice to fellows transitioning into practice: (1) pick a practice or institution that will allow you to achieve your career goals; (2) have confidence in your operative and research training and know that surgeons are constantly refining their skills; (3) be a forward thinker and not complacent with the status quo of the current standard of care; (4) proactively seek out mentors early and often throughout your career; and (5) establish local, national, and international networks.