"I enjoy weekends, of course, but I really look forward to Monday. It’s my day in the operating room with the urology residents and physician assistants. Working side-by-side with them on surgical cases is insightful and rewarding. They work through clinical problems, ask questions during procedures, and take on new levels of responsibility. Their abilities and confidence develop exponentially over the five years we’re together, as they master urological and urogynecological skills.
I was attracted to urology by the prospect of change and innovation in the field and I have not been disappointed. Urologists have been able to improve patient outcomes and advance the scientific study of diseases, innovate procedures and use new technology in the operating room. The benefits of our efforts to improve how we treat our patients are obvious. When I started training, hand-assisted laparoscopy was the gold standard for nephrectomy. The da Vinci robot was at the R+D level. Additionally, there were no ureteral access sheaths, and the nitinol basket was new. Terrific current research assures me that we can look forward to new processes and procedures for our patients.
What has changed among urologists ourselves? I could easily say, “everything.” Importantly, from my perspective, the field is making significant efforts to become more diverse. Of the approximately 9,600 urologists in the United States, between 8 and 12 percent are women. That doesn’t sound like many, but when I started in urology in 1999, only 2 percent of urologists were female. Women in the profession are significantly underrepresented and continually face challenges because of gender. Female urological surgeons are still rare enough to continually be confused with our wonderful nurses and support staff. We have made some progress, but we certainly can continue to strive to make our surgical faculty reflect the populations we treat. We need to attract more people of color to our profession. Equitable pay across all the specialties is still a goal for female surgeons. But optimistically speaking, progress is being made.
If I were to give new residents some advice, I would say that for a successful career in urology, you must love it and to be willing to put in an amazing amount of hard work. Surgical disciplines are careers that take on a life of their own and are intricately bound to who you are. Urology is not a “punch the clock” job. Every surgical case requires detailed preparation preoperatively, intraoperatively, and postoperatively. You may go home to your family or take a vacation, but you seldom have your patients far from your mind. It is just the reality of a urological or surgical practice. We are very fortunate to have much more help at Yale New Haven Hospital than in the past, both in the office and in the hospital with our residents and advanced practitioners. But at the end of the day, the patient is truly yours, and many times, they remain your patient for their lifetimes. Such continuity is a responsibility and a truly gratifying part of urological clinical practice.
I am a strong believer in the power of mentorships. Some of the best mentors are not always obvious initially but are often serendipitously found. I have been fortunate to have benefitted from many individuals who inspired me in different ways. The physicians and surgeons I emulated most during my earliest training years were from diverse backgrounds, including vascular surgery and the female general surgery and breast surgeons in New Haven. The Department of Urology at Yale and in the community of New Haven were enormously influential in my career decisions. My most memorable surgical mentors stood out as having a unique balance of surgical skill, clinical acumen, a compassionate bedside manner and overall humanity and humility.
I think that for those just entering the field, they might want to be flexible about mentors. It’s quite possible (and may be advisable) to have one mentor for research, one for short- or long-term career goals, and one to speak to about juggling family and interpersonal issues. It is not always helpful, and perhaps even unwise, to have only one person advise you on all things. Multiple perspectives are often required to successfully facilitate navigating your career.
Professionally, my most compelling surgical interests lay in dealing with complicated mesh surgical revisions. I appreciate the challenge of caring for-and if necessary, operating on older male and female patients with prolapse and incontinence. My hospital administrative work centers around facilitating the operations of the Verdi 3 South surgical floor as the medical director, and facilitating the education and implementation of the ERAS protocol in our Urology division for the Yale New Haven Health System. I currently have an IRB-approved clinical research project. The thesis is to evaluate the non-inferiority of a native tissue sling with fascia lata versus the mesh sling and rectus fascial sling. The secondary endpoints are costs, decreased reliance on supply chain, and less need for hospitalization compared with the rectus fascial sling. I will be reviewing the outcomes and the role of native tissue use in primary or salvage surgical procedures for stress urinary incontinence.
When not at work, I enjoy playing tennis and spending time with my children and friends. My home away from work is Standard Beach in Westbrook."