← Rod Squad: The Urology Podcast for Students
Rod Squad: The Urology Podcast for Students
Episode 63: Episode 63: Women In Urology: A Discussion with Morgan Sturgis
00:53:09
In this episode, Megan and I discuss the importance of women in urology. This is a topic that is ...
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- [00:00]
A
Hello, and welcome to Rod Squad, the urology podcast for students. I'm Parker Adams, and I'm doing urology. This is episode 63, an introduction to a series about women in urology. I'm going to be interviewing a fourth year from Rush University in Chicago, Morgan Sturgess. She reached out to me a little bit ago and wanted to start this series for my podcast about women in urology, the good and the bad, the things that are challenging for women and how, what they go through as they're going into a field that's predominantly men. So we're going to start this off just by talking about women in urology with Morgan, and then it's going to develop, hopefully, into something more in the future. So welcome, Morgan, to the podcast. I'm glad to have you here.
- [00:46]
B
Yeah, thanks so much, Parker. It's great to be here. As an avid Rod Squad listener, it's definitely joining this side of things.
- [00:53]
A
Yeah. She dusted off the cobwebs for me. I haven't made an episode in so long, and we were just talking about that dusting off the cobwebs and getting back on the horse a little bit as I struggled through the first couple months of intern year. So I'm happy to be here. So I also just wanted to add, she did a one gap year in pediatric ophthalmology and crushing it even before medical school. So that's awesome. Why don't you tell us a little bit about how everything's going, how your fourth year is going, what your plans are.
- [01:25]
B
Yeah, great. Thanks for asking. So fourth year definitely looks a little bit different than we had originally anticipated, just in the setting of COVID Actually, even more robustly impacted was my third year. I only had five days of urology as a third year medical student, and clearly five days was enough to hook me for five to six years, depending where I end up. But I definitely had quite limited experience before my fourth year. So since starting, I have taken step two. I'm happy to have that behind me. And. And I had a month of a urology sub I at my home university, Rush in Chicago. That absolutely solidified my interest in urology. And I finished off the rest of my mandatory requirements for my school with emergency medicine. So now I'm just on some fun electives before my away rotation at Duke University in September.
- [02:14]
A
Gotcha. So it's probably on me. I haven't done a lot of research into this application cycle. I've heard whisperings from other medical students about the different limitations that they're Putting on it. Do you mind briefly kind of overviewing for my sake about the kind of limitations they're putting on away rotations and how you're dealing with that or any other unique parts of this application cycle?
- [02:38]
B
Yeah, absolutely. I mean, it's definitely an ever evolving situation. But I think some high yield takeaways are like, per the Society of Academic Urologists, we are only allowed one away rotation this year unless your home university does not have a urology program, in which case there may be exceptions here or there. There are also a few schools that are offering virtual aways. I know my school is, which has been really nice to kind of meet people virtually through grand rounds and whatnot. The other big difference is everything will be virtual this year. Urology was one of the first fields to come out and say that all interviews will be virtual yet again. And two other really unique things that urology is doing. There is one day at the end of October where we find out all of our interview offers on the same day, which is really unique. That's on a Friday in October. I believe it's the 22nd. We have the weekend to think about it and then we accept on Monday. So there will be a little bit of movement then. And the only other big change which is new again to urology this year is the signaling process. So from September 6th until September 17th, all applicants are given the opportunity to use five quote unquote signals. Signals. It's entirely optional for applicants, but all programs are automatically opted in with the opportunity to opt out. And essentially what this allows us to do is send five, like flirtatious messages with our top schools that we're interested in in hopes that it may show some real interest just in the setting of more and more urology applicants each year to potentially open up interview opportunities. So I think those are the really big changes this year.
- [04:19]
A
That's really interesting. I've heard through the application cycle that I went through last year, there was talk about doing like a coin system where you'd be given a certain amount of coins that you could give. Like you. I don't know, if you got five coins, you could give all five coins to one program and they would know, wow, they used all five coins for me, you know. And that would signal that you're really interested in them. Or you could split it up like one coin, one coin, one coin, or whatever else, you know. So it sounds like that's to some degree what it is, is you can kind of send out these messages that you have a limited number and If a program gets one from you, then they know how serious you are about that program.
- [04:58]
B
Yeah, exactly. I think I had also heard whispers of that last year, and I think the biggest changes they've since made to that is you typically, I believe, you cannot send more than one signal to each place. You also cannot send them to your home university or wherever you do an away rotation because those are inferred signs. Significant interest. Yeah. Kind of nice in that regard. I know that ENT did this signaling process last year, so that's where a lot of the research has come from. And it seemed to have been a really well received process from both the applicant and the program side of things. So who's to say if it'll stick around even after this, this Covid era?
- [05:40]
A
Yeah, yeah, I mean, I definitely agree that. I mean, we've been kind of forced into this situation where we just have to apply like everywhere. And I don't think it's our fault that we're doing that because, you know, don't hate the players, hate the game kind of thing. We're put in this situation where we have to apply broadly. And it's nice to kind of have a utility where we can really show emphasis on certain programs and have other people be limited by the emphasis that they can provide to a number of programs as well. So it's kind of nice being able to do that without limiting the number of applications. It's. It'll be interesting to see how it works out.
- [06:16]
B
Yeah, definitely. I was actually really lucky to present a Grand Rounds at my home university. And I chose to study up on Covid's impact on urology residency, both training for current residents, but also recruitment efforts for those in my shoes. And it was really interesting. Last year, the AUA match data showed that there was almost a 10% increase in applicants even in the setting of COVID despite urology being one of the fields most impacted by Covid in terms of student exposure. Just because many of us as med students either don't see urology at all in the formal curriculum or during third and fourth year have such limited exposure unless you really seek it out. And because of COVID obviously everyone has been impacted in different ways. So the prediction had been maybe there will be less applicants, but we actually saw quite the uptick, which was quite interesting. So I think that this will kind of help at least begin to ameliorate and the overflowing of applicants for each program and show some real interest from those of us that are sending emails.
- [07:14]
A
Yeah, yeah. I mean, that's an interesting insight. I don't really know what caused that. I was thinking about it when I was going through the application cycle and it's like you had so much time. It was so easy to apply to places like you're just doing virtual interviews and stuff. So I wonder if some people were like, well, I might as well shoot my shot and apply urology. I can do a backup and if it doesn't work out, it doesn't work out. Whereas other years that might be more impactful on your schedule or something like that. So I'm not sure really what caused that. I guess the situation that were provided. But it is interesting and kind of going off your comment on exposure to urology, I have had that conversation with someone else too where it's like, you don't learn a lot of urology at all during medical school. I mean, even in your first two didactic years, like you learn a significant amount of like microbiology. You know, if you went on infectious disease rotation, you might know. I mean, you're still a medical student, so you don't know a lot, but you might know. Maybe I don't know 5, 10% of everything there is to know to be an infectious disease doc, but going out onto your urology rotation, you know, like 0.01%, you know, like, you might have heard the word priapism before, but maybe that's about it.
- [08:24]
B
Exactly, exactly.
- [08:26]
A
So it is very challenging.
- [08:28]
B
Absolutely.
- [08:30]
A
So again, before we get into the women in urology, I'm curious, so you spent five days on urology, so tell me what that was like. What did you experience in those five days that really spiked your interest? I mean, that's not a long time. So I'm kind of curious to see how those five days went.
- [08:47]
B
Absolutely. This is a story that I love telling and I get to tell it quite a bit because people are often surprised when I say I'm going into urology. Um, I think I honestly kind of have to backtrack just to contextualize it for you. I did work, as you mentioned before, I took one gap year before starting at Rush and I worked in pediatric ophthalmology. And I really, really loved it. It was everything I wanted in terms of longitudinal patient care in the clinical setting. I was absolutely in love with the or. I love the people I was working with. And I really did feel like the work we were doing had an immense impact on patients quality of life. I came into medical school really open minded and I had the blessing and the curse of loving Almost everything, to be honest. But I thought that maybe a surgical subspecialty might be where I end up. As much as I loved ophthalmology, I can't put contacts in my own eyes. I don't even like eyedrops. So I definitely knew I wouldn't be doing that for the rest of my life. So I looked into ent, I looked into ob and I really enjoyed both of those as well. I ultimately ended up choosing to do a week of urology. It was optional my third year because I had been previously working in urogyne and really, really enjoying it. I found during those five days of urology that it checked all of my boxes and then quite a few more. I had really, really missed working with a diverse patient population, especially in terms of working with men, women and kids in ob. So I loved that opportunity. I still loved that I could use my hands and communication skills to improve that patient quality of life aspect. And to be honest, I found third year that the peer personality match was so crucial to my day to day happiness. And I definitely found a home within the urology workroom. The residents were just absolutely incredible and are still some of my best friends.
- [10:37]
A
Yeah, if we have one thing, I feel like we have a specialty that's made up of some really, really impressive people. You know, they're funny, they're caring, they're patient. And I've really enjoyed a lot of the attendings, residents that I've worked with in this field at my program, at other programs, like it's, it's a rarity to run into someone where you're like, wow, we did not get along.
- [11:01]
B
And that's pretty special. I think that that's one big, like, misnomer coming into med school. I think you have the idea of falling in love with a patient population of physiology or pathophysiology. And that is definitely true to an extent. I mean, I knew I absolutely loved the pelvis and anatomy lab. But you also spend quite a few hours each week with your peers in the workroom. So finding the people that you both want to work alongside in the hospital but also grab a drink with after work is something really special that I am lucky to have found in urology.
- [11:34]
A
Yeah. And kind of building off this point of this just like lack of knowledge and exposure about urology. I mean, there's people that have been practicing in medicine for a while that still don't really understand what urologists do. And I was asked by an attending anesthesiologist the other day and he's like, oh, so you're doing urology? And I was like, yep, yep. He's like, so are you going to be a clinical urologist or a surgical urologist? I was like, I'm going to be both. I'm going to be both. What are you talking about? Yeah. And I was like, talking to another med student and they were like, oh, so like, are you. Do you. Is it. Do you do any surgery? And I was like, yeah, no, we operate a ton. Like, I don't. People don't understand that, you know, like 90% of your of your training is going to be in the or. So there's a lot of misconceptions. So maybe that's another goal of this podcast, is to just kind of shine a light on the details of urology.
- [12:35]
B
Absolutely. I know. Even when I told my parents that I was going to be applying urology, half of my family I was applying neurology, and the other half were just like, what on earth? You're just going to be a penis surgeon? So there's quite a few misnomers. Especially as a female in urology, I definitely get some raised eyebrows. But I am really, really excited about being a woman going into this field.
- [13:00]
A
I'm excited too. I am so excited too. So my favorite residents I work with are women. My co resident is a woman, Gabby. She's absolutely incredible. So that was a wonderful segue into a little bit more of what we're going to be talking about today. I was looking over your overview for this podcast and you have some wonderful statistics to help kind of detail why this is such an important topic for us in urology. And why don't you give us a brief overview of why it is so important and some of the statistics that go along with it.
- [13:33]
B
Sure, I would love to. So I think one thing, just a very basic overview, is that excluding ob gyn, urology has had the greatest annual percentage increase in female trainees compared to all all other surgical subspecialties. This is per 2016 that came out of Harvard. I thought that was super interesting. And since my interest in urology started, I've been following the AUA State of Urology Workforce census that comes out every year. From the most recent 2020 edition, it shows that there was a significant increase in the number of women in the urology workforce. Shockingly, in 2014 we had 897 female providers. And in 2020, just six years later, that number was up to 1,375. So that equates an annual growth of almost 9% per year. That's relative to our male counterparts with an annual growth rate of 1.8%. So really a significant jump in female providers year to year, which is pretty crazy. And I love this fact that in 2020, for the first time in history, women urologists surpassed 10% of the workforce, which I think is incredible.
- [14:41]
A
Yeah, that is absolutely awesome. And their acceptance rate into urology is also increasing. I don't remember the specific data on it, but it was like in 2013 or something, their acceptance rate was like, I don't know, like 60%, 55% or something like that. And now most recently it's up to like 70s or it might even be up to 80 now as far as women going into urology, which is also awesome.
- [15:11]
B
Yeah, definitely. And I certainly can say from a current applicant standpoint, as I've been looking at programs, it's definitely something that, that we look for that it's really interesting chatting with. I have, there are four others in my class applying urology and one other female and the other three are males. And just what we're looking for in a program differs. I mean, I definitely look at the program and I like to see other female residents to know that that culture exists. And then it's also really important to take the next step and look at the faculty of the program and see do they have women in their faculty and leadership positions as well. And it'll definitely take some time for that to catch up, but I think we're headed in the right direction.
- [15:52]
A
Yeah, I completely agree. And I'm like, looking, you have this wonderful graph about kind of the, you know, the percentage of women in urology is not consistent across age groups. The younger population in urology has a much higher concentration of women than the older about to retire population. So hopefully it's kind of predicting the future where this field becomes a lot more gender balanced as far as providers.
- [16:20]
B
Yeah, absolutely. And I think that, I mean, it's really important in general just to see women in urology. I think a very common misnomer is that we only have male patients, while our male patients, we love them and they are a huge portion of the day to day care we provide. As you know, we have female patients, we have pediatric patients. It's really important to have the representation on the provider side as well. As those numbers start to uptick in terms of the interest in urology and thus the applicants in urology and then furthermore, the trainees in urology, I think we'll definitely start to see that workforce Balance out during our careers.
- [16:58]
A
Yeah, I mean, simply put, I think diversity is power. And just like having a diverse, you know, provider population just provides better care for patients. You know, different people, whether they're, you know, different races, different genders, different upbringing, whatever it is, can bring something special to the patient encounter that maybe you wouldn't have thought of. So wherever that diversity comes from, I think is an improvement. And like you said, a lot of people don't understand about how many females we treat. I mean, post pregnancy leakage is a huge issue and we deal with it day to day. You know, like that's a huge patient population that we manage. You know, kidney stones happen in men and women, you know, and this isn't even tapping into like the sexual aspect of female medicine. And um, I've had a couple of lectures on this in the last month and it's, it's really atrocious. That kind of care that we give for women or like female sexual dysfunction, it is like not even on the radar of most urologists and it's what we're supposed to be treating. So, you know, to have a larger population of women in the field of urology, hopefully would, you know, that that might be something they'd be able to bring to the table is to be more conscious sexual health for women.
- [18:18]
B
Exactly. No, I totally agree. We actually, we have an amazing female urologist in leadership at Rush, and she just gave a grand rounds talk too on female sexual dysfunction and dissatisfaction. And it's one of those things that it starts with conversation and starting with that conversation can hopefully lead to interest and interest can lead to research that can hopefully start to provide some options for women. Because it is our job as urologists to be advocating for our patients and to be having these conversations that can be uncomfortable and to make our patients more comfortable. But in order to do that, we have to be comfortable with the content. I think that's definitely something that as a woman going into urology, I will strive to do is to start the conversation via means like this.
- [19:02]
A
Yeah, exactly. And I think what's unfortunate is that urologists, we're a lot more comfortable talking to men about it. You know, how's your erection out of 10, you know, 10 being hard as a rock, zero being nothing at all. You know, we ask that question all the time. You know, are you, you know, are you able to maintain a erection during sexual intercourse? Like, we ask these questions all the time and it's just, you know, it's old news. It's a common conversation, but you Know, we don't ask women, like, are you able to have sex until you orgasm? You know, like, we're not able to, like, ask those kind of questions. You know, do you have any pain with sexual intercourse? Do you have any interest to have sex? How's your libido? And all those things are in these lectures that I've had. They're very treatable. There's medications for female libido. There's vaginal estrogen for vaginal atrophy after menopause, and all these different things. And we don't even ask the questions about something that we could really improve in this patient's life. In one of the lectures that we got, I thought it was such a good example of the emphasis that we put on male sexual health versus females in office, because they were saying it was talking about vaginal atrophy. You know, after you go through menopause, a significant amount of women will have vaginal atrophy that leads to, you know, pain with intercourse and all these other, you know, problems. And they were talking about it. They were like, if males penises at the age of 55 started to shrivel up and shrink, we would have, like, thousands of treatments for this.
- [20:39]
B
Oh, my goodness.
- [20:41]
A
But no, it happens to a woman. We don't even talk about it. But no.
- [20:45]
B
Oh, my goodness. That is a great example. That is absolutely perfect.
- [20:50]
A
Yeah. I'm like, it's so true. I mean, if a guy's penis shriveled up and shrunk down at the age of 55, there would be an uproar.
- [20:57]
B
Exactly. And we, as parents, providers, would absolutely be jumping on it to get to the bottom of it. But patients would also come in with a million and ten questions. And it's one of those things where even as a woman, like, as a patient, it's not something that I am keen to ask a doctor about. And as providers, we don't ask those questions. So it's definitely about educating ourselves in order to do that and in order to be better providers and make this more comfortable for our patients.
- [21:24]
A
Yeah, and I think you brought up another great point. It's not just the provider's unwillingness to get into the nitty gritty details of, you know, the sexual function of a female. But it's also like, society, which kind of, you know, makes it almost the expectation for females that, oh, this is just kind of what you go through. And it's unfortunate because they don't realize that. No, like, communicate this stuff because there's treatments for it, you know, this isn't just. Oh, it's just what happens after menopause.
- [21:54]
B
Right.
- [21:55]
A
There's stuff you can do. Whenever I'm talking to a young, like a younger female, premenopausal female about postmenopausal changes, I always tell them, I'm like, I feel like every single female after they go through menopause should just be put on vaginal estrogen.
- [22:12]
B
Truly.
- [22:13]
A
Yeah, I kind of stand by that.
- [22:16]
B
Not a bad idea.
- [22:19]
A
So do you mind talking a little bit about your exposure to urology so far? I know it's fairly limited, and just talk about some of the. I mean, you touched on a little bit about the opinions of family members as you presented your choices, specialty to them, but is there anything else that you've experienced that was kind of specific to you being a female going into this specialty?
- [22:42]
B
Sure. Yeah. So I was really lucky, I think, again, my five days on urology as an M3, I was really fortunate at Rush to be exposed to multiple different subspecialties. I had a bunch of days in the or, and I absolutely loved catching kidney stones and then being in an open nephrectomy the next day. But I also really loved in clinic. I was in a men's health clinic one day, a female pelvic reconstructive clinic one day, and a pediatric urology clinic one day. So that made up my five days total as an M3.
- [23:12]
A
That's a pretty good five days, right?
- [23:14]
B
I mean, it was simply the best, clearly enough to hook me. And I think that just really speaks to the diversity within urology in terms of all the possibilities. As a provider, there are obviously so many options in terms of what patients you want to treat, what surgeries you want to do, what conversations you want to have. And that's definitely appealing to me as a future trainee. So I loved. The female pelvic reconstructive surgery clinic was, again, run by one of my greatest mentors at Rush, who's a female urologist. And I thought that she just did such a great job in terms of making these patients feel at home. And all of these patients had opted to come to a urology clinic. And so many of them always giggled and said, I didn't even know this existed. I thought it was only for men. I thought I could only go to my ob. And I was really drawn to the role that my provider had in terms of her collaborative relationship with OB gynes, with colorectal surgeons, with the other urologists in the department. So I absolutely loved that. I was nervous I remember so vividly for my day of men's health clinic. Just wondering, oh goodness, am I going to get kicked out of the room in the same way? A lot of my guy friends got asked to leave during OB visits and in my entire time in urology now, which again is not robust, but I've had about five weeks total now. I've only been asked two times either to one not do an exam or one time to leave the room. And I think that that's a pretty good ratio so far. I entirely want to make my patients as comfortable as possible. And I understand as a 26 year old female, a 26 year old male is not keen to talk to me about his erections. And that is totally okay because the number one goal is to provide the best patient centered care. With that said, I will say the providers that I've had the chance to work with have been really, really great at advocating for not only me as a female urologist, but also just all of our like student trainees in terms of making patients comfortable and having that autonomy, but also advocating for us and saying, either Morgan's going into urology or Morgan's with us. I think this would really benefit her learning. So I've definitely appreciated that from the provider side as well.
- [25:31]
A
Yeah, I'm glad that you've had a really good experience with it. I think both being a female and a male in medicine, there are times where it can be difficult and understandably, you know, I've talked about this maybe on the podcast, but at least to other people about on my urogynecology rotation, you know, it's, it's tough. You know, you get young women in there and it's completely understandable that they do not want me in the room for their exam. So it's something challenging to go through and even out in medicine. You know, like my sister's an ER physician and you know, she has to deal with everything under the sun and she had to do a digital rectal exam on a teenage or like young twenties guy. And her strategy, because no guy wants to have a female do a digital rectal exam. But her strategy, and maybe you can use this later in your practice, was she brought the biggest nurse that was in the ER with her. It was this huge like 6 foot 3 guy. And she brought him in the room with her and she was like, all right, we got to give you a digital rectal exam. He's like, no, I don't want, I don't want a girl doing that digital rectal exam. Or whatever. And she's like, well, you have two options. Either I can do it with these nice small hands, or he can do it.
- [26:51]
B
Which should he choose?
- [26:53]
A
He chose my sister.
- [26:56]
B
It's true. It's absolutely true. Had a patient comment on that before, too. That's quite funny.
- [27:02]
A
Yeah. Yeah. So there are tools that you could use as a woman to help calm patients down about it, I guess.
- [27:09]
B
Absolutely. I will say I've been quite pleasantly surprised in terms of patients being open. And I think a lot of that is just due to the environment that the attending physicians and the residents, at least in my home university, encompass for each patient in terms of making them as comfortable as possible. And in terms of giving me the time to really build a rapport with them, I think has definitely allowed me to get more exposure to urology. So I've actually had a really great experience in terms of the clinical side of things. And to speak to your other question before about what do people think when I say urology? I always get such a kick out of it. I think it surprises quite a few people. And then some people who know me so well say that, you know what? That makes perfect sense. Sense in terms of what I want to do as a provider, in terms of wanting to help heal, lead and learn, and be able to really have an impact on a patient's quality of life. I think urology really affords the opportunity to do so many of those things and with men, women, and kids, which is ultimately what I really wanted. So my family has now learned it is urology, not neurology. And now they, loud and proud, share it with everyone.
- [28:20]
A
It's just gonna get worse from here on out. The passion just builds. Yeah, I mean, I still get that question as a guy, you know, like. And I can only imagine that that question comes with more undertones than that question comes when it's directed at me. You know, like when somebody's asking a female why you chose urology, that comes with different connotations than when somebody asked a guy why they chose urology. Just because the sensitivity of the field. But I still get that question, you know, all the time. And it's a hard question to answer in the sense that it's a long answer. And I usually just tell people because it's the best specialty. And if they ask more questions, then I answer them. But, you know, if urology is one thing, it's balanced. You know, you get the best of so many worlds. You know, you get to be in the or, and in the or, you get A great diversity of types of surgeries. Big, small, complicated, easy, all these different types of things. And then the clinic, you know, you get different patient populations and the things that you're treating, you know, largely are affecting these patients lives. You know, kidney stones are said to be one of the most painful things in the world and you get to treat it, you know, and you know, sensitive matters like erectile dysfunction or sexual dysfunction in a female, those things are sensitive. And patients don't talk about that to just anybody, but they talk about it to their urologists. So it's pretty special that we get to treat all that stuff. And yeah, you can answer that question without talking about genitalia at all.
- [29:55]
B
I think that a lot of people, especially outside of the medical field, don't know that it's much more than just a penis surgeon. And I think even in our career trajectory, urology continues to be one of the most rapidly advancing fields. I mean, our technology has just blown me away and is really headed in quite a future looking direction. And I think we'll see a lot more of the gender affirmation branches of urology come into play, which will be a really, really unique role to serve as a provider and a really cool landscape to get to train in.
- [30:27]
A
Yeah, yeah, I completely agree. And you know, there's just things that just. People don't understand. They don't understand that urology encompasses the bladder. They don't understand it encompasses. Is the kidney or the adrenal glands. They don't understand any of that. And yeah, it's. They don't understand that the robot, the surgical, the surgical robot that's used was created for urologists. It was, first surgeries it was used on was. I think actually it might have started with heart, but then they completely aborted it because they were like, well, this doesn't work. And then they tried it with urology for prostatectomies and that was kind of the first surgery that it was really like mass massively used on.
- [31:07]
B
Right. And I think it's pretty cool that we can say we are both clinicians and surgeons and we can use our hands, but we can also use robots and lasers. And that sounds pretty cool too.
- [31:18]
A
And we don't have to use a stethoscope. I was, I always joke that my stethoscope's been sitting at my house gathering dust for the last year. I know, I'm like, do I hold it up to the penis? Like, what am I supposed to be listening for here? Let me preface that with everybody should be doing Complete physical exams and listening to the heart with the stethoscope. You should be doing that exams.
- [31:49]
B
Oh, that's great.
- [31:51]
A
Well, I am so excited that you decided on urology. I was curious. I mean, it's something from a guy's perspective. I don't get a lot of like talk back from patients as far as like my gender in the field that I'm choosing. I mean, I'll get some guy patients that are like, why did you choose to look at dicks all day? Or something like that. And you know, I just say I wanted to turn a hobby into a career and
- [32:19]
B
you're cracking me up.
- [32:21]
A
That's usually, that usually quiets them down. But I was curious if you, you know, come across that any like pushback from patients as far as like, you know, why are you choosing to kind of be in this field kind of in a derogatory way? You know, unfortunately it happens. And if you've come across that already or if you've discussed it with other providers about how they handle those types of situations.
- [32:47]
B
Yeah, no, definitely a great question and certainly something that I was nervous about when both first exploring urology and then ultimately deciding on it. I really am quite lucky. I haven't had too much pushback from our male patients at all other than those the one or two clinic patients that just didn't want me in the room or to do an exam. It's totally valid. I also look like I'm about 16 years old. So again, I'm a young looking female, so I entirely get it and ultimately want to promote patient comfort. At the end of the day, I will say I get a lot of comments from our female patients and they're all so supportive but way more than males comment. The females will just be like, what on earth are you doing in here? Or it's so in here. And I think that's really special and I think it's great for them to be able to see females in this role too. They're so used to having just, just a frat party of these rock stars coming down. And I think it's been really refreshing for especially a lot of our longer term urology patients that are females to see more of us. And I think that it's a really, really cool shift that we'll continue to see. But surprisingly, not too many, not too many harsh comments from the males and lots of cheerleaders from our female side.
- [33:58]
A
That's good, that's glad to hear. And I've had a couple unfortunate experiences. I think this is My third year, this wasn't in urology and I really want to become a physician that emulates how the physician handled the situation. But it was, I think it was in a family medicine clinic and one of the mas who was a female was going in and getting the patient ready, taking vital signs or whatever else. And you know, the patient was just being super derogatory, like trying to get the like female ma, like out on a date or something or like all this just inappropriate stuff for the, you know, for the clinic or professional environment. And I was really proud of the physician because the MA came out and was kind of rolling your eyes and didn't take it too seriously. It was like, oh, this guy's kind of being creepy towards me. Whatever, whatever. And the physician went in and advocated for his MA and was like, hey, this is really inappropriate. This isn't, you know, behavior that we tolerate at this clinic. And you know, this is kind of your last warning. If you, if you talk like that to our staff again, we're not gonna, you know, you're gonna have to find another place to go. Which I think it's unfortunate that happens. But it does happen. And I think when it does, as providers and the leader of the team, I think we need to be able to stand up and advocate for our other providers and as well as I like support, you know, employees or like support staff. So I don't know if that's something that you've experienced so far in your, you know, medical exposure or if you've seen it kind of at a periphery. But unfortunately I don't know if it's going to happen more in the setting of urology for females. If that's something that comes up more frequently. I hope it doesn't, but if it does, you know, how do you see yourself kind of handling that situation?
- [35:47]
B
Yeah, no, I definitely don't think it's an impossible situation to present itself. I think ultimately it would just be for me as the person in that situation about maintaining the most professional demeanor as possible and just trying to understand where the patient is coming from, being sure to like ask them open ended questions to make sure that it's not something I said or did. But if they would prefer to have a male provider, that's, that's absolutely something that they have a right to have. But at the end of the day I will be as professional as possible and obviously hopefully a male counterpart would be willing to see them. I have definitely had and will always appreciate attendings and other male residents advocate for me and Say, Morgan is with us. She is a urology trainee. She will be doing the surgery or in the. Or with us, things like that. And just like the story you alluded to, I think that that's really important and something that I hope males continue to take on. And I think that collaborative relationship of you guys advocating and us maintaining a professional demeanor and composure, showing that we are competent and we deserve to be here, and we have the same skills and knowledge base to treat patients as best we can. And that's our only job at the end of the day. As long as we do those things, it's up to the patient and obviously respecting their autonomy.
- [37:02]
A
Yeah.
- [37:03]
B
It will hopefully continue to only get better and better as more females are seen in the field. I think right now we do kind of still stick out quite a bit, but eventually, hopefully, that will trend downward.
- [37:15]
A
Yeah, hopefully it'll become more normalized. As, you know, people will, you know, possibly just expect to have a female urologist. Maybe you guys will dominate the field in a few years. I mean, isn't that what happened with OB? OB was like, all men, like, 30 years ago, and now it's like, all women, like, totally pendulum. Yeah.
- [37:35]
B
I've actually talked to quite A few male OBs, too, just about the same thing. And being like, how has it been for you in this situation? And I think that they have a lot or share a lot of the same sentiments that we have already chatted about today. Just in terms of being like, this is what I'm passionate about. And it's truly an honor to be able to treat these patients and the different chief complaints that they come in with. And the surgeries are fascinating and do have a really robust impact on their life. So. So this is what drives me and motivates me. And if patients are open to that and they're open to my personality, it's a really, really great relationship. And for those that it isn't exactly their forte or their interest or perhaps they've had a poor experience in the past, then obviously I respect that, and we have the resources to refer them out to a female OB kind of thing. So I think that's definitely a position that I will be lucky to be in someday. Right. To be able to say this. This field is something I'm so passionate about, and I love being in, and I hope to become the best clinician and surgeon I can be, and I hope that that emulates my patients. But if it does not, that is totally okay because I know hopefully I'll always have another provider that is male or meets their preferences, to give them the care that they need is the end goal. Right. So lucky to have that.
- [38:53]
A
Yeah. And I hate to bring up another, like, I want the purpose of this to be able to discuss women in urology and the things that come with that, the good and the bad. And unfortunately, on my interview trail, you know, there's unfortunate gender prejudice against females in urology, even from, you know, high ups at these academic institutions. And one of the questions that I would have, I had like a list of questions as I was going through interviews, and they're kind of discussion questions. And there are questions I would present to the person interviewing me when they. When they, I don't know, when I saw an opportunity for them to be asked. And one of those questions was regarding women in urology. I wanted to hear, you know, the perspective of these people interviewing me about their view on women in urology and kind of what their opinion is going forward, you know, and how welcome they were to women entering the field. And I'm not going to name names, but I asked. It was a program director. I asked him this women in urology question. I can't remember exactly how the question was worded. And he basically went on this rant about, you know, he just doesn't understand why a male would go into ob and he doesn't understand why a female would go into urology. He thinks it's crazy. And I, like, I don't know, I think a lot of times we are just like, yeah, you know, my family will think that sometimes or like, other people that I tell I'm going into urology will think that, but we don't really think that a program director is going to have that prejudice. But unfortunately, it's still a thing. And I think the utility of this podcast is to bring up these unfortunate occurrences and to make people aware of them, that there's still people out there at these programs that, you know, will look down on you for being a woman going into urology. And it's unfortunate, but all I can say is that I'm proud that you're here and I am excited for you to be in our field.
- [40:46]
B
Thank you. No, I think you bring up such a great point. And even though I'm lucky to be at an institution that really does value and promote and wants to continue to really advance the female presence, I think that it would be silly to ignore the fact that that is still an issue. And I've definitely heard of some programs that are female friendly, which I love, and Programs that really stick out, that definitely have a really great female presence in residency, in faculty and just in terms of mentorship and social life. But there's even, I mean, there's even published literature. There's a book about choosing your medical specialty. It's from the early 2000s, but there's a whole section in the urology chapter about women in urology and how it's hard and how you're in residency during childbearing years and being a small field with sometimes only one or two co residents, how it's really a disservice to. I quote your co residents in your cv and it literally ends with saying female urology residents or surgical residents in general are like staying single longer and longer because it's so demasculinizing to males if you're assuming a heterosexual audience. And I remember reading that and being quite shaken by it and being like, this is just crazy. But it is the truth and the reality for many programs. But for me and for my energy and my excitement about this field, it really just makes me even more motivated and inspired to talk about women in urology and to make sure that we are exposing medical students to this area. Males, females and everything in between. It's so important. It's a disservice to our female patients to not have more women in urology. And I think we honestly bring such. It just really makes the culture and the collaboration, whether casually in the workroom or seriously in the or so much more fruitful. As you originally said, just having a diverse staff. So that definitely does still exist and is something that I'm sure I will deal with on this interview track and would be happy to provide updates. But for the programs that do exist out there that have a female friendly environment and are more open to diversity in terms of gender specifically, I am quite looking forward to learning more about them and then working with them in the future, even beyond residency.
- [43:06]
A
Yeah, I think that's very well said. I think it's unfortunate that there's still some high up prejudice about women going into urology, but hopefully we're moving in the right direction and it'll be a thing of the past and you know, a few years and we won't have to worry about it. So. And I think you brought up something else that's interesting to me. I mean, women going into a surgical specialty I think has always come with a little bit of judgment from people because it's a long residency, you know, it's grueling and you know, people always think like, oh, you can't get pregnant or whatever, or you're gonna set your career off path. And as much as surgical residencies are hard for males as well, I think they're very challenging for females, and people think that they're near impossible, which I think is crazy. But then adding on top of that the, you know, like, specific aspects of urology that even make that more nuanced, you know, now you're not just going into a surgical specialty which comes with its own challenges, but you're going into a specialty where sometimes, you know, people don't welcome women with open arms, which is crazy. So, yeah, it definitely comes with its challenges, but kind of going off this. Debbie Downer, parts of women in urology. I want to hear what your advice is to other females that are considering this field and kind of what advice you have for them as they're looking into it.
- [44:33]
B
And. Yeah, yeah, absolutely. No, I think this is great in terms of addressing the good and the bad, as our original goal was in terms of advice for others. I think a huge thing that's lacking even in formal curricula currently is just exposure to urology. Even pre clinical years, it's so tricky to get urology integrated into curriculums. So I would say if you're interested in urology, look into it more and reach out. I think it's easy to say that we have some of the most friendly providers out there, so definitely get in touch with residents and attendings in the field. Go shadow for a day or five like me, and I promise you won't be disappointed. I think third year, I know not every school requires urology, but I think no matter what field you go into, it benefits you to learn how to place fully. I know that that is something we consulted on all the time, and as silly as it sounds, it's one of those things that you'll see for the rest of your life. So I think clinical exposure to urology is really, really neat. And whether you're interested in primary care or trauma surgery, urology really does cover such a robust spectrum of medicine. So I think that almost anyone could enjoy a week in it, to be honest.
- [45:47]
A
And then I completely agree.
- [45:48]
B
Right. And then for prospective applicants or people that are seriously considering urology, it is competitive. So I would say start doing research. And the research possibilities are endless. I know I got involved as a third year and have been so grateful for all the projects that have come from it, from kidney stones to gender affirmation and cost effectiveness and analyses. And now Covid's impact on urology training and recruitment. And I think that there's so many fascinating areas in urology. Again, I can't imagine that someone couldn't find something they love within it. So I think getting involved with research will help your application and then for women specifically. I know I am someone who really craves mentorship, and it is not something I need, but when I have it, it's definitely so fulfilling. So I definitely sought out female mentors in the field. And again, I'm so fortunate to have a really great female mentor at my home university. But there's also the Society of Women in Urology that I've been able to network with, even just casually reaching out via email. I've made some amazing friends that I look forward to being colleagues with someday. And we are actually working on a project to hopefully open up a medical student branch of the Society of Women in Urology as a little personal project I'm doing on the side. So I'm hoping that that will be an even better collaborative networking opportunity for med students that are considering urology as well.
- [47:09]
A
Yeah, that's great advice, and I think that's a good segue into kind of the possible future for this series. On this podcast, you have some connections with the Society of Women in Urology and other, you know, prominent females in the field, and it'd be great to have them on with you. And we can discuss some of these issues and discuss with people that have had, you know, a longer time in the field and their experiences and what they would like to do about some of these problems. Do you mind talking a little bit about your connections? And, you know, you were. You kind of headed off this whole idea of doing this series, so thank you for that. But. But that also means that you have a much better knowledge about your connections. I have some female connections in urology, but it sounds like you have a more intimate connection with all these people. So do you mind outlining a little bit about what you see as the future of this series?
- [48:04]
B
Yeah, absolutely. I think the series could definitely go a few different ways, kind of in line with your overall idea when you originally pitched the podcast. So I am certainly happy to speak to my personal challenges and rewards, especially during this unique interview season. But I also do think that the interview series aspect is really special and unique, and I'm quite fortunate to have connections to residents at my home university of Rush. We have three amazing female residents that I would love to get on the show. I also have a few connections at Cleveland Clinic. I'll be at Duke in September and then a UCLA resident who's currently the young urologist branch contact for the Society of Women in Urology, who I'm hoping to get on here as well. Truly, I think we can have almost coast to coast covered. I think it would be great to hear from current trainees, but I also think it's equally as important to hear from some of our attending physicians that are in this older and more experienced age group whereby they've been in the field to hear about their experience as well. So we'll certainly talk to my attendings at Rush and network with a few others to see if they would be willing to share their experiences and the challenges and reward of being a female in urology. And then I think we could even also do just some content review of some common female chief complaints, some areas in female urology that are important to kind of educate our listeners and just talk about how we can better treat our female patients as well.
- [49:32]
A
Yeah, I think that is a great plan. I just had those couple lectures on female sexual medicine, so I am happy to cover those. Anytime it boils down to you can fix issues, there's medications for it, especially vaginal topical estrogen for everyone. We should hand them out like candy in the office. So yeah, I think that's. That'd be great. And you know, this podcast, I've. Since starting residency, I've thought a little bit about what this podcast is going to turn into with the challenges of. Of availability as well as the challenges of being a part of a residency program. And for the good and the bad, I am a representative of that program because I'm attending that program. So it does present a few different challenges making episodes. And I need to thread the needle between how much can I actually talk about my experience at my program and how much content can I go over without, you know, talking about anecdotes of patients and stuff like that. So I'm still working on finding the time and finding kind of the method of doing this podcast during residency, but I think this series is a great way to start.
- [50:52]
B
Well, very much looking forward to it. And thanks for taking this on. I think it's such an important area to be talking about in urology, and I'm happy to house it here.
- [51:01]
A
Yeah. Yeah. And my co resident's a woman too. Gabby. She's freaking incredible. We got to get her on here as well sometime on one of these episodes. She would be great.
- [51:11]
B
Absolutely love it.
- [51:14]
A
So, yeah, so I don't know if you have like an email that you want to give out for people to contact you. Or they could also like go through me if they're specifically interested and I can put them in touch with you after you say it's okay. But at least for my contact information, you can reach out to me@rodsquadpod.com which is my website. Or you can email me@rodsquadpodmail.com or you can go to my Twitter Instagram, which I'm struggling to post on, but I'm gonna get better eventually. And it's Odd Squad Pod for both of those. So if you have any that you'd like to hand out, that's totally fine. But I completely understand if you don't want those things out in the world.
- [51:56]
B
I would be more than happy to. If there are any listeners that are tuning in and want to connect, I would absolutely love to hear your ideas or honestly just meet you. My name is Morgan Sturges and the best email is morganush.edu and that's M O r G A N r S T U r G I s@rushrush.edu. i would be more than happy to chat.
- [52:22]
A
Awesome. Well, it was so fun chatting with you, Morgan, and for all the listeners, I hope you found this useful. Just kind of this table discussion about the importance of women in urology and the importance of discussing some of the good and the unfortunate persistent prejudices that are out there against women in urology and making people aware of it so that hopefully in the future we can improve the setting of women in urology. So thank you for listening. I hope everyone is doing well and staying safe and take care. Sam.