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GLOBAL STATE OF UROLOGY The State of Urology Training in the United States

By: Daniel A. Igel, MD, The University of Texas MD Anderson Cancer Center, Houston | Posted on: 15 Mar 2024

In 1915 Hugh Hampton Young started the first formal urology training program in the US at the Brady Urological Institute at Johns Hopkins University. Since that time, urologists have come to play a key role in the care of millions of Americans with fertility issues, stone disease, urinary tract stricture and obstruction, incontinence, prolapse, sexual dysfunction, genitourinary malignancies, and many other conditions.


Figure 1. Bryan Yager, Center for Management & Organizational Effectiveness, shares his expertise in the leadership industry.

Urology residency in its current form in the US typically includes an integrated 5 years of clinical and surgical urologic training, with about 6 months of general surgery training in the first year and about 4½ years of focused urologic training. Many programs also include an additional year of dedicated research, for a total of 6 years of training. Each year about 350 residents graduate from urology residency in the US.

After residency, many American residents choose to pursue an additional 1 to 2 years of fellowship training, although it is certainly not required, and many go out into community practice immediately following their training. Fellowships in the US come in many forms and include but are not limited to urologic oncology, pediatric urology, reconstructive urology, female pelvic medicine and reconstructive surgery, male infertility and andrology, and endourology. Many of these fellowships also consider international applicants and can be a great pathway for surgeons to learn skills and technologies in the US that may not yet be available in their home country.

While in the US we are fortunate to have access to much of the most cutting-edge surgical and medical technologies and treatments, there are other challenges that we face. Over the last few decades urologic practice has shifted significantly from largely urologist-owned private practice groups to hospital employment. Private equity has also made significant inroads into urology in the US, investing in many of the largest private practice urology groups in the country, bringing investment dollars to these groups but also concerns about physician autonomy. There is also a growing shortage of urologists in the US, with the median age of an American urologist being 54 and 28% of US urologists being over the age of 65 in the 2022 AUA Annual Census, in the context of a rapidly aging US population demographically. This has led to concerns about overwork and burnout in urologists, with many surveys showing urologists ranking near or at the top of these metrics.


Figure 2. Brantley Thrasher, MD, FACS, discussing his experiences in leadership.

While urologists around the world face a variety of different challenges, one thing that unites all urologists is the spirit of innovation and progress. Indeed, urologists around the world have demonstrated time and time again creativity and ingenuity that have driven forward not only urology, but surgery and medicine at large. As the world becomes increasingly interconnected, more and more of these advances in urology are the result of international and intercontinental collaborations, with diverse groups of urologists from around the world bringing different research and clinical strengths to the table.

The AUA Global Residents Leadership Retreat, along with many other AUA initiatives such as the exchange programs with Japan, Brazil, India, and Europe, was founded to help foster these increasingly important international collaborations and build leadership skills in young urologists from around the world.

This year I had the opportunity to participate in the inaugural AUA Global Residents Leadership Retreat. The curriculum of the program included focused exercises from experts in the leadership industry (Figure 1) as well as lessons from international leaders in urology (Figure 2). While there was much to be learned about leadership from these sessions, to me the most rewarding experience of the retreat was having the opportunity to share insights with urologic trainees from around the world, in my case including residents from Egypt, Chile, Japan, the UK, and Canada. I had the opportunity to learn about research, patient care, and residency training in a variety of countries, taking home new ideas and techniques to apply to my practice here in the US and made connections that I hope blossom into future collaborations and friendships (Figure 3).


Figure 3. US representatives to the AUA Global Residents Leadership Retreat: Andrew Fang, MD; Daniel Igel, MD; and Alexis Steinmetz, MD.

To any future participants in the program, I would offer the advice not only to make the most of the excellent leadership training offered, but also to really take the opportunity to network with the international cohort present, get their contact information, and form lasting connections for friendship and professional collaboration.