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Why Urology?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Milhouse chose the field of Urology and why Urology is a great field for all.

Urology is the surgical and medical care of diseases that affect the urinary tract and male sexual/reproductive organs.

It was the first week of medical school and it seemed like everyone but me already knew what kind of doctor they wanted to be. I really hadn’t thought that far yet. I was just happy to be there. A classmate said he wanted to be a UROLOGIST. I didn’t have a clue what a urologist even was at that time. When I googled it, I immediately thought “I have no business in urology” and crossed it off my list. Urologists were the “male gynecologists”, men went into urology not women. And I definitely did not think I could be a surgeon.

My career path would forever be changed when we were given a 15-minute Urology lecture during my 2nd year of medical school. As I was packing my bag, ready to skip out on the lecture, in walks the speaker- a tall, young-appearing, BLACK WOMAN. THIS was the urologist. I sat back down and listened in amazement. It was at that moment, that I saw myself in her and thought I could be a urologist too.

Urologists made urology appealing to me. Urologists that I shadowed with were approachable and eager to teach students. Unfortunately, I had come to associate surgery with intimidation, anxiety, and unhappiness. But urologists completely changed that and turned me on to a love of surgery. They made the operating room feel like an exciting place to learn and transform lives. Urologists also do a lot of non-operative management of diseases and may follow patients for years. This appealed to me as an extrovert. I wanted to form long-term relationships with my future patients. When I discovered that urologists weren’t just “male gynecologists” and could even sub-specialize in female pelvic floor issues aka “female urology”, I was completely sold. I knew I wanted to do focus in women’s health and I realized that was possible as a urologist

What does Urology training look like for women?

Urology is a surgical specialty and requires 5-6 years of residency. If one chooses after residency, there are several sub-specialty fellowships available that typically range from 1-2 years. Urology is also a small specialty with only 357 spots every year in the entire country. Because of this smallness, you work closely with a small group of co-residents during training. We became a family during my time at the University of Chicago. I had a great training experience and left my residency forming long-lasting friendships. My attendings have become my mentors and colleagues that I call on for guidance to this day. I was fortunate to train at a program that sought out diversity in their residents. However, no program is free of microaggressions. As a black resident, I learned instantly that no one would even expect you to be the doctor. As a woman, I knew that I was not expected to be “the urology resident”. I especially knew that I couldn’t wear my emotions on my sleeve. If I had rough day, I cried in the car and not in the hospital. I had to navigate these assumptions and biases from other physicians, nurses, hospital staff, and patients by coming to work confident every day. Since urology is still heavily male-dominated and medicine is predominately white; I was surrounded by male residents who were more assertive than me by nature. I was the black girl in a huge BOYS CLUB, so it was very intimidating to me by nature. My white, male co-residents were certain of their abilities and here I was completely underestimating mine. One day, I had an epiphany. Even though I felt like an imposter, I would carry myself with the confidence they had. My internal motto became “fake it until you make it”. What that meant was that even if I got it wrong, I was going to be more assertive. I would not be reckless or misrepresent myself, but I would also not underestimate my abilities. I carried myself like I deserved to be there, even though I was battling an internal sense of inferiority constantly.

During the last two years of residency, I got married and became a mother. I was unapologetic about getting pregnant during residency. Fortunately, I received complete support from my attendings and co-residents during my pregnancy. Medicine and the United States in general still have a very long way to go in the way of postpartum leave and support. I only had 4 weeks of maternity leave. I came back to work with the increased responsibilities as a senior resident and my new job as a mother. One day I excused myself from the operating room for 10 minutes to pump breastmilk. It was during a part of the case designed for the junior resident to assist the attending, so my absence wouldn’t disrupt the surgery. The attending made an unintentional but damaging comment that he wished they made discrete breast pumps that would allow me pump without leaving the operating room. It wasn’t said in any negative tone and I know he didn’t mean to suggest I stop pumping; nonetheless, I felt that I was letting down my boss. Shortly after that comment, I stopped pumping altogether.

After residency, I went on to complete a one-year fellowship in Female Pelvic Medicine and Reconstructive Surgery. Fellowship gave me opportunity to focus on my passion of women’s health and prepare myself for operating entirely on my own. Now, 7 years out of training, I am the “go-to” female, pelvic floor urology specialist in a very large, multi-specialty private practice group. I have been able to design my practice the way I want, with a focus in female urology but still able to treat a host of general urology conditions. I work 5 days per week: 2 operating or surgery days and 3 office visit or clinic days. Unless I am on call, I have weekends off. Urologists take home call, which means we do not have physically be in the hospital when we are on-call. We only come in to hospital when urgently necessary. So even when I’m on call during the weekend, I can be at home majority of time. I have 14 other urology partners that I share call with and can go to for assistance and advice. I get to discuss deeply personal issues with my patients. I love talking about sex, genitals, and urine- the stuff people normally don’t discuss. I love that I have the opportunity to change the quality of my patients’ lives drastically. I love what I do as a urologist. I can’t believe that I almost didn’t become one all those years ago, because I thought urology was just for men by men.

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