5 Things I Wish I Knew Before I Started My Career in Urology
Most of this article will be centered on private practice urology. That has has been the world I have come to know for the last 7+ years.
If you are aspiring for academics, there should still be some good takeaways for you. This article centers on building a practice that not only is busy but also rewarding.
My personal goal as a resident was to work autonomously in private practice. I was not interested in research or a lengthy fellowship. Rather, I was simply ready to practice general urology full-time.
I will never forget a particular day I met with my chairman during my 4th year of training. I asked him for tips on how to find a job in the private world.
His answer was “I only know people in academia. You will have to find your own path”.
I wish I was able to read a post like this when I first started. My first few years (and first few jobs) were a bit of a struggle. Fortunately, I gained important experience and will do my best to pass this knowledge forward.
With that, here are five things I wish I knew before I went into practice as a urologist.
1. Perfect your approach to the common urology surgeries and get efficient.
Residency is a great time to hone your skills. The majority of your clinical practice when you leave will consist of what you see the most in your residency clinic.
In urology, that includes vasectomies, stone surgery, surgical benign prostatic hypertrophy (BPH) management, and incontinence.
Perfect these cases and learn from your complications. Once you have gained confidence, then focus on learning how to do things more efficiently.
Even a junior resident can do a transurethral resection of the prostate (TURP) that “gets the job done.” But, can you do the case with excellent results and minimal complications?
Can you minimize redundant steps and decrease intra-operative time to allow for more cases to be booked during your OR block time?
Can you maximize your patient’s understanding of the post-operative course? That’s important to minimize disruptive and unnecessary phone calls and post-op visits that can derail you and your staff’s productivity.
Like it or not, clinical practice is all about volume. The more you can take on in a day without compromising good patient care, the better your reimbursement.
2. Be confident, shake hands, kiss babies, and be visible.
It can be very intimidating your first few years in practice.
As a chief resident, you are used to being at the top of the food chain and having residents follow your example. When you start practice, this all changes.
Big city or small town urology
If you are in a competitive market (e.g. big city), the national shortage of urologists does not apply. You will have to work hard from day one to get referrals and build up a practice.
Most entry-level urology contracts have an income guarantee in the first few years. After that, if you do not have a high-volume practice, you will see your income drop significantly.
I remember my first day operating at my local hospital. When I looked up at the board, I saw five other urologists doing a total of 30+ cases that day.
The others viewed me as competition, and the welcome was far from warm. Cases were not just going to show up at my door in this type of environment. I needed to work hard, have great outcomes, and most importantly get my name out to the community.
Maybe you are in a smaller town or an area with a shortage of urologists. In that case, by all means you can relax as you will be busy from day one.
Succeeding in any size town
For those who want to live in highly desired areas, pay attention! Being visible in the community means sitting down with your hospital CEO and developing a rapport.
He or she may help market you if you can draw more patients to the hospital. An example of this is if you perform a unique type of procedure.
Get to know the nurses not only in the OR but on the floor, and be seen as professional but approachable.
Obtain a list of primary care providers (PCPs) in a 30-mile radius and go meet them all in person. Since you are not yet busy, you have time to do that.
Find a list of urgent care centers in your area and give them your personal cell phone number. They will appreciate you being able to see their patient quickly. They’ll refer more patients to you if patients don’t have to wait as long to see you compared to other urologists.
3. Use social media to your advantage in your urology practice
Use the extra time you have in your first few months to brand yourself.
Get the easy stuff out of the way.
- Create a website and register it on Google and Bing search
- Make sure your profiles are correct on WebMD, Vitals, RateMDs, HealthGrades and Yelp.
- Make a Facebook and Instagram page.
This is the minimum for your practice.
If you are part of a large hospital system, you may have restrictions on what you can post and how you can market yourself. Find these things out, and do as much as you can to accelerate your practice’s growth.
If you are not employed by a large hospital conglomerate, look to take things to the next level.
Most older, more established urologists do not understand the power of internet marketing and search engine optimization (SEO). Use this to your advantage!
I highly recommend making a personalized website with SEO optimization.
- Hire a reputable company to make the website.
- Run targeted ad campaigns
- Post content routinely on your blog
- Maximize your presence on sites like Facebook and Instagram.
Content is king, and the more informative content you have the better your visibility will be.
Most patients no longer simply go with the referral from their PCP. The majority of educated patients will “vet” their doctors online.
If you are not showing up, patients won’t know how to find you. If you have poor reviews, patients will not come.
New patient referrals are the key to a healthy practice. If you need good reviews to get started, just ask patients that have had a good experience to submit an online review. They will be your biggest advocates!
4. Take a coding and reimbursement course (specific to urology if possible)
My residency spent a total of ZERO hours teaching us how to bill and code. Do yourself a favor, invest in your financial future, and sign up for a coding course. It will be worth the several thousands of dollars it costs to register.
Is it boring? Yes. Is it important. Yes! Learning the rules of coding for services rendered in the clinic and operating room is critical! It’s vital for maximizing the income you deserve.
Most practices and hospital systems (for those employed) will have an in-house billing team. This doesn’t mean you should blindly trust them, however.
Take time monthly to sit down with your billers. Double check the codes they are submitting to payers. Also, keep an eye on what claims are being denied and why. I guarantee you will find errors.
Furthermore, many insurance companies simply do not pay certain claims because they know doctors are not paying attention.
Do not fall into the trap of assuming you are receiving full reimbursement for your hard work. For claims not paid, you should appeal or resubmit with the proper codes if you discover an error.
Good coding habits and an understanding of the ever-changing coding rules with private insurers and government programs is essential for all urologists. I wish I had taken my own advice years ago.
5. For a fulfilling longterm career in urology, mix things up
My last piece of advice centers on physician longevity.
It is understandable that at some point much of what we do can begin to feel mundane or algorithmic. There is nothing interesting in performing your 300th vasectomy of the year, believe me.
Most of the fulfilled physicians I know keep things interesting.
This could mean delving into clinical research and running a new clinical trial. Alternatively, most will dedicate time to learning a new procedure that is gaining traction.
You could even advocate for patients in the political realm. These new wrinkles to your career can keep work life enjoyable, keep you energized, and allow for a long and fruitful career.
About the author
Dr. R. Robert Dhir is a board-certified urological surgeon who sees patients in the Clear Lake area of Houston, TX. He earned his undergraduate and medical degrees from Georgetown University and was awarded honors in pre-medical studies, urology, orthopedics, and ophthalmology during tenure in Washington, DC.
Dr. Dhir served as chief resident during his urological surgical residency at University of Texas at Houston / MD Anderson Cancer Center, in addition to completing his internship in general surgery.
With over 10 years of clinical urological experience, Dr. Dhir’s expertise includes minimally-invasive treatments for enlarged prostate (Rezum, UroLift), kidney stone disease, surgical management of urological cancers, and men’s health (erectile dysfunction, low testosterone, and infertility).
He has multiple scientific publications in the field and remains an active member of the American Urological Association and Sexual Medicine Society of North America. Dr. Dhir was voted Top Doctor in Urology for 2018 and 2019, and Texas Monthly has named him to the 2019 Texas Super Doctors Rising Stars list.
If you’d like to hear more from Dr. Dhir, you can contact him at:
Dr. R. Robert Dhir
Founder, HTX Urology
600 N. Kobayashi Rd Suite 201
Houston, TX 77598
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Please leave a comment below. What questions do you have for Dr. Dhir? If you’re a urologist, what’s something you wish you knew before starting your career?