The Role Of A Urologist
Urologists are surgeons who treat problems involving the female urinary system and the male genitourinary tract. Although urology is a surgical speciality, a substantial amount of urologists’ work involves the medical management of conditions without surgery. Urology patients range from babies to the elderly.
Urologists manage conditions involving the kidneys, ureters, bladder, prostate and male reproductive organs. Common conditions in the bladder include stones, tumours, incontinence and erectile dysfunction in men. They also manage impotence, sterilisation and male infertility.
10% of GP consultations and 20% of acute hospitals referrals are related to urological conditions (1). Most urological surgery is elective with emergencies being rare. Common procedures include:
A urologists job involves working with colleagues including other surgeons, anaesthetists, theatre nurses and medical students in theatre. Outside the theatre, they work with physiotherapists, nurses, administrative staff, and therapeutic radiographers. Once at a consultant level, urologists lead and manage their teams.
The working week involves theatre time, ward rounds with medical staff, as well as outpatient clinics where diagnostic tests are carried out. Operations can range from simple procedures to highly complex procedures carried out with surgeons from other specialities. Administrative work is to be expected and varies from writing GP letters to attending MDT meetings.
25% of current trainees are women (1). This is higher comparatively to other surgical specialties, but it must be noted that surgical specialties have less females than males. In the UK, male to female surgical consultant ratio is 8:1 (2).
Compared to other surgical specialties, urology also has the highest numbers of Less than Full Time (LTFT) trainees. On-call demand is not as high compared to other surgical specialities.
Qualities imperative to urologists include manual dexterity, visuo-spatial awareness, good organisational skills, communication and leadership skills.
Minimally invasive surgery and robot-assisted surgery is the future in urology considering it was the first speciality to adopt these techniques.
A Typical Week
A standard contract for full time consultants is divided into 7.5 Programmed Activities (PAs) and 2.5 Supporting Professional Activities (SPAs). New consultant appointments have been seeing a reduction in SPA time.
PAs include outpatient activities, theatre sessions, pre-op and post-op care, emergency duties as well as multi-disciplinary team meetings. SPAs are tailored to each doctor’s interest and may include formal teaching, research, clinical management and appraisals.
Due to increasing pressures in a 7-day working week, trusts may request that urologists provide Saturday working hours. To those already at consultant level, this must be done following mutual agreement however, new consultants may have this specified at appointment.
Some 20-25% of acute surgical hospital admissions are urological emergencies (3). Emergency work is either predictable (takes place at predictable times such as following a weekend ward round) or unpredictable (arises from on-call duties). The British Association of Urological Surgeons (BAUS) supports the withdrawal of over 60s from on-call rotas or those with extenuating circumstances
Below is an example of a day in the life of a urologist:
The Route To Becoming A Urologist
Entry to urology is possible after completion of two-year foundation training and core surgical training. During core training, it is the trainee’s choice to take up general posts or ones more focussed on urology. Six months of urology experience during core training is needed to progress into specialist urology training.
Membership of the Royal College of Surgeons (MRCS) exam has to be taken during the first two years of core training.
Urology speciality training (ST3) takes five years but the duration can vary amongst individuals. At the end of training, trainees must pass the Intercollegiate Speciality Examination (FRCS) and will subsequently receive a Certificate of Completion of Training (CCT).
Specialist urology training is competitive with 2018 having 125 applications for 47 ST3 posts (5). To enhance their applications, candidates can complete courses such as Advanced Trauma Life Support (ATLS) and Basic Surgical Skills and Care of the Critically Ill Surgical Patient (CCrISP) (1). Academia and research are desired by selection panels, especially those relevant to urology.
Due to the competitive nature of urology, it is important to develop knowledge and skills in urology as early as possible. This can start at the medical student level by joining the university’s urological society, becoming involved with the undergraduate curriculum by the British Association of Urological Surgeons and attending surgical conferences.
Foundation trainees can offer to help urologists with audits and research projects as well as attending courses offered by the likes of the Royal College of Surgeons.
Core and Specialist trainees can undertake a research project, work on getting their work published, become involved in teaching junior colleagues and participate in Journal Club (1).
Alexandra Hospital in Redditch is one of the West Midlands’ leading urological centres for junior doctors training. The Urology department in Cambridge University Hospital was named one of the best by the American Urology Association Conference in May 2014.
The Bristol Urological Institute (BUI) is an established research unit that is recognised for its extensive publishing in all areas of urology and receipt of national and international grants.
There has been increasing specialisation within urology. The main sub-specialities are:
Endo-urology: (small internal endoscopes are used to visualise the urinary tract to perform surgery using key-hole techniques).
Urological oncology: (prostate, bladder, kidney, testicular and penile cancer).
Functional urology: (investigation and treatment of bladder symptoms such as incontinence. Also involves dealing with neurological conditions that affect the bladder such as multiple sclerosis and spinal injury).
Andrology: (male fertility and sexual health)
Reconstructive urology: (repair and reconstruction of the lower urinary tract).
Paediatric urology can also be considered as a subspecialty. (1)
Those interested in research and academic surgery should secure a senior lecturer position with the possibility of a promotion to chair. (6).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
As with any speciality, there is potential to increase NHS earnings via private practice. JRSM reported in 2008 that the total income for urologists was £125,664 with NHS income making up £79,901 and private income making up £45,763 making the ratio 0.57.
This sits at the same threshold as cardiothoracic surgery (0.50) and general surgery (0.62) and is superseded by plastic surgery (1.90) and trauma/orthopaedic surgery (1.40). (7)
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The British Association of Urological Surgeons (BAUS)- publishes two journals: the British Journal of Urology International (BJUI) and the Journal of Clinical Urology (JCU). BJUI aims to constantly deliver new research of the highest standard. JCU is divided into the five urology subspecialties and has articles clinically relevant to everyday practice
The European Association of Urology (EAU) supports urology trainees and specialists by providing access to educational material, scholarships and clinical visits. Members are also automatically enrolled into the EU-ACME Programme which allows for educational activity tracking irrespective of which country members are practicing in.
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(1) Urology [Internet]. Health Careers. 2020 [cited 1 June 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/urology
(2) Women in Surgery — Royal College of Surgeons [Internet]. Royal College of Surgeons. 2020 [cited 1 June 2020]. Available from: https://www.rcseng.ac.uk/careers-in- surgery/women-in-surgery/
(3) A Guide to Job Planning for Consultant Urologists [Internet]. British Association of Urological Surgeons; 2016 [cited 1 June 2020]. Available from: https://www.baus.org.uk/_userfiles/pages/files/Publications/2016%20Job%20Planning%20for %20Consultants.pdf
(4) Urology curriculum [Internet]. Gmc-uk.org. 2020 [cited 1 June 2020]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/urology- curriculum
(5) 2018 Competition Ratios [Internet]. 2018 [cited 1 June 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Content/Resource%20Bank/Competition%20Rat io%27s/Competition%20Ratios%202018.pdf
(6) The Intercollegiate Surgical Curriculum [Internet]. 2016 [cited 1 June 2020]. Available from: https://www.gmc-uk.org/-/media/documents/urology-master_pdf-76167756.pdf
(7) Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants' NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine [Internet]. 2008 [cited 1 June 2020];101(7):372-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/