Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

Special Report

Virtual Tumor Board

Insights

Medcast

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

Clinical Forums Recaps

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Live Events

Interactive Tools

Job Board

Partners

Treatment Landscape Evolutions

Subscribe

Articles

“Five years after telehealth suddenly became a routine part of care for most Americans, we show that it has not led to runaway utilization or spending. This kind of in-depth analysis can inform its future," says Chad Ellimoottil, MD, MS. 

Data refute concerns about telehealth as Congress weighs legislation 

The detection rate ranged from 44% to 58% on day 0 and 58% to 80% on day 1.

64Cu-SAR-bisPSMA shows efficacy in detection of biochemically recurrent prostate cancer 

“What we hope overall is that this is a biological study that might inform therapeutic development for this disease,” says David A. Braun, MD, PhD.

Identifying unique therapeutic targets for chromophobe kidney cancer

The safety review committee recommended that the phase 2 portion proceed with the 8 GBq dose.

Trial of 64Cu/67Cu-SAR-bisPSMA in mCRPC progresses to dose expansion phase 

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

LinkedIn

Spotlight

Peers and Perspectives

Clinical

1rem

, discuss key topics in health policy for urology and recap the American Urological Association’s (AUA) recent Annual Urology Advocacy Summit, which took place from February 26-28 in Washington DC. Rhee is the chief of urology for Kaiser Permanente Southern California, the president-elect of the AUA Western section, and the chair of the AUA public policy council. Galansky is a PGY-4 urology resident at Johns Hopkins University Brady Urological Institute in Baltimore, Maryland as well as the 2024 AUA Holtgrewe Legislative Fellow.

This discussion originally took place during a live X (formerly Twitter) Spaces event held by Urology Times. To begin their discussion, Rhee and Galansky highlighted the 3 legislative priorities of this year’s AUA Advocacy Summit: Medicare reform, the workforce shortage, and telehealth. They also discussed the meaning of the theme for this year’s meeting, which was “resilience.”

During the event, Rhee also reflected on how the AUA Advocacy Summit has grown since it first began, given that this year’s meeting was the final Summit under his tenure as Chair of the Public Policy Council. Galansky also provided insight on her experience becoming involved with the AUA, and shared how other young urologists in the field can get involved with advocacy.

Rhee and Galansky ended their discussion with hopes of future positive legislative change for the field of urology.

, or anywhere that podcasts are available.

In this episode of Speaking of Urology®, Eugene Rhee, MD, MBA, and Logan Galansky, MD, discuss key topics in health policy and recap the AUA's recent Annual Urology Advocacy Summit. 

Health policy in urology: 2024 AUA Advocacy Summit recap

 highlights the role that advanced practice providers (APPs) can play in filling the gaps created by the growing work force shortages in urology. Bunce is a physician assistant at Advanced Urology Institute in Naples, Florida.

Specifically, Bunce outlines the help that APPs may offer in the treatment of patients with benign prostatic hyperplasia (BPH), which she highlighted during a session at the most recent American Urological Association (AUA) Annual Meeting titled, “Choices That Matter: Optimizing BPH Care for Urologists, APPs and Patients.”

Bunce comments, “This is something that's going to help prolong physician longevity, which will also extend and help with the physician shortage. The amount of effort and energy that a physician can pour into their APP will have a return on investment greater than you could imagine.

Don’t forget to subscribe to Speaking of Urology® on 

In this episode, Janelle Bunce, PA-C, highlights the role that advanced practice providers can play in filling the gaps created by the growing workforce shortages in urology. 

How APPs can bridge the gap in urologist shortages

Every year, young urologists start their long-awaited exciting careers after going through a few challenging years in residency. Dr. Bristol Whiles, who recently graduated from her residency in urology, talks about her trajectory in these hard times and brings us some interesting thoughts on how to overcome the difficulties that inherently residency brings us, but at the same time be productive and competent in what is expected of a great resident. Although it is common sense that a resident works incessantly, it does not mean that they cannot dedicate some time for their families and hobbies. The one-million-dollar question is: “how can they do that?”, and she talked us through some game-changer ideas, useful not only to residents, but generalizable to every profession. Brilliant in every way, she managed to excel not only in the triviality of the everyday assignments of a good urology resident but also showed above-average engagement in cutting-edge research at the university, which was a determining factor for her choice to engage in a minimally invasive surgery fellowship program. Finally, she gives some insights to younger residents that aspire to stand out and excel in their future careers.

On this podcast, Bristol Whiles, MD, discusses her urology residency experience at the Kansas University School of Medicine Department of Urology.

Dr. Bristol Whiles discusses her experience as a urology resident

® Assistant Editor Janelle Hart spoke with 

. She discusses why and how mentorship can be valuable at any point in a urologist’s career. Suskind is an associate professor of urology and obstetrics, gynecology, and reproductive sciences, and a chief of neurourology and female pelvic medicine and reconstructive surgery at the University of California, San Francisco.

“Open your mind to being both [a mentee and mentor,] no matter where you are,” says Anne M. Suskind, MD, MS, FACS, FPMRS.

The “reciprocal relationship” of mentorship in urology

 She discusses how and why urologists are succumbing to burnout and depression and suggests ways in which they can improve their mental health in their everyday practice. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California.

“We cannot give if our cup is empty,” says Diana Londoño, MD.

Consequences of burnout and depression in urology

. He discusses why it is so important as a physician to be educated on the tips and protocols associated with identity theft. Moyad is the director of preventative/complementary and alternative medicine in the department of urology at the University of Michigan Medical Center in Ann Arbor, Michigan.

“I thought identity theft was simple. You fix this 1 little thing. Today, what physicians and health care professionals need to be on the lookout for is [that] it's much different,” says Mark A. Moyad, MD, MPH, on the latest Speaking of Urology podcast episode. 

Dr. Moyad discusses the reality of identity theft as a physician

 discusses findings from the study, “Failure to Attend Urology Appointments: A Retrospective Analysis of a Single Urban Academic Practice,” which was published in 

. White is a urology resident at Maine Medical Center, Portland.

“I think one of the most surprising things to us as we started to look at the data is that we had a very low rate of no shows amongst telemedicine visits,” says Randie White, MD.

Urologist Dr. Randie White discusses appointment no-shows

study, “Impact of urology trainee debt levels on future practice choices and expectations,” for which he served as a study author. Harris is an assistant professor of urology at the University of Kentucky, Lexington.

“We really found it surprising the sheer amount of debt that our urology trainees are carrying,” Harris said.

Dr. Andrew Harris discusses debt levels in urology trainees

discusses the recent Urology Practice study, The impact of stricter guidelines on post-interview contact, restricted interview topics and differences by gender in the urology match, for which she served as senior author. Kielb is chief of reconstruction and neurourology and professor of urology, medical education, and obstetrics and gynecology at Northwestern University Feinberg School of Medicine, Chicago.

“I think the take home message is that when you're interviewing applicants in your program, take a step back and think about the questions you want to ask,” says Stephanie J. Kielb, MD.

Dr. Stephanie Kielb on curbing restricted questions in the urology match process

 discusses findings from a recent study published in Urology titled, Gender differences in authorship in urology: a five-year review of publications in five high-impact journals, for which she served as senior author. Kieran is an associate professor of urology at the University of Washington, Seattle.

Kathleen Kieran, MD, MSc, MME, discusses findings from a recent paper published in Urology.

Study evaluates authorship for women in urology

"For telephone-only (audio only) visits, Medicare has officially stated that such a visit would be considered the same as an in-person visit, with a few qualifications," write Jonathan Rubenstein, MD, and Mark Painter.

How to bill for telephone-only urology visits

"With the requirements for an E/M code as noted above, we agree with you that the supporting documentation, if appropriately documented, would support a level 3 outpatient visit for a visit regarding counseling for contraception or family planning," write Jonathan Rubenstein, MD, and Mark Painter.

Level of service for vasectomy prompts coding confusion

Arpeet Shah, MD, highlights the shift toward precision medicine, ongoing work force challenges, the integration of AI, and more. 

Trends in urology: Arpeet Shah, MD, on challenges and opportunities in 2025

Overall, 403 medical students and other applicants were matched across 148 urology residency programs nationwide.

Hundreds of future urologists celebrate Urology Match Day 2025

"As we all know, Medicare rules do not always follow CPT directives. The same is true in this case," write Jonathan Rubenstein, MD, and Mark Painter.

Urology Coding Q&A: CPT 50080 and 50081

Timothy D. Lyon, MD, discusses the Urology Practice paper “Initial Experience With Inpatient Hospital Care at Home for Urologic Disease.” 

Expert discusses feasibility of at-home inpatient urologic care

paper “Initial Experience With Inpatient Hospital Care at Home for Urologic Disease.” He was speaking at the 2025 Desai Sethi Urology Institute Urology on the Beach meeting. Lyon is an associate professor of urology and Urology Residency Program Director at Mayo Clinic in Jacksonville, Florida.

Please provide an overview of this study and its notable findings.

In this paper, we looked at urologic patients who were admitted to Mayo Clinic's Advanced Care at Home program. This is a hospital-at-home program where we provide care for hospitalized inpatients in their home. It's done with several services. We have a technology bundle that's brought to the patient's house that provides secure internet access, provides an iPad-like device where they can have daily video rounds with their physicians, as well as as-needed contact with their health care team. And we provide an array of services through home care nurses, things like phlebotomy, IV infusion therapy, skilled nursing, and we can do basic radiography, things like X rays and ultrasounds. To date, we've cared for more than 3000 patients in this program across our site since it started in 2020, but the majority of them have been people with medical diagnoses. So the objective of this paper was to look at, who have we treated with urological problems? What do they look like, and are there any opportunities to expand what we offer in the program in the future? So when we looked at our experience, we identified 54 patients in the Advanced Care at Home program with urological diagnoses. They ranged in age from late 40s all the way up to 92. The vast majority of patients, 95%, had GU infections, things like pyelonephritis, requiring IV antibiotics. The other 5% had other problems after urological surgery; for instance, diverticulitis, congestive heart failure, needing a few days of diuresis. Average length of stay in the program was 3 days. Overall, we saved 216 brick-and-mortar hospital days by caring for these patients at home, and the rate of readmission within 30 days was 16%, so we concluded that it appears very feasible to treat patients with genitourinary infections in this program. It's perfect for the patient that gets admitted with pyelonephritis, say, after cystectomy or a kidney stone procedure, doesn't need any surgical intervention in terms of a drain or stent and just otherwise would be in the hospital for 2 or 3 days on IV antibiotics, waiting for their cultures to result. So this allows them to go home in a place that they're more comfortable. But it really remains to be seen whether we can expand this to care for other types of urological inpatients. We do have the capability to offer nasogastric suction. And so our next step is to think about, are there other types of patients who we could identify who may be able to go home, say, a day or 2 early than they otherwise normally would, and continue to convalesce in the program before hospital discharge?

This transcription was AI generated and edited by human editors for clarity.

Videos

"It really remains to be seen whether we can expand this to care for other types of urological inpatients," says Timothy D. Lyon, MD.

Tania Solomon, PA-C, MSc, highlights the Advanced Practice Provider (APP) Fellowship at Emory Urology.

Tania Soloman, PA-C, highlights APP fellowship in urology

, highlights the Advanced Practice Provider (APP) Fellowship at Emory Urology in Atlanta, Georgia. Solomon is a physician assistant, the APP lead, and the director of the APP fellowship program at Emory.

In describing the program, Solomon also noted, “Our APP fellows receive competitive compensation—about 75% of the salary of a new graduate hire. [Also, our] APP fellows are eligible for all benefits at Emory, and they are able to bill for patient care (unlike residents).”

Could you highlight the APP fellowship at Emory?

We started that back in was probably about 2011. I was working late 1 night, and Chad Ritenour came into my office and said, "I'd like you to start an APP fellowship in urology." So, after my work hours, I started on the curriculum, started on application materials, doing the research, and we had our first APP resident in 2013. We continue to work on developing the program. We're working with other fellowship programs at Emory. We're hoping to get all of our fellowships under 1 umbrella at Emory, instead of just being silos, [and] eventually work towards getting accreditation. We've so far only had physician assistants, but we're going to open up the applications to acute care or acute care certified nurse practitioners as well.

It's a 12-month program. A lot of people will ask, "why would an APP want to take on 12 more months of education for less money when they can just go find a job and get full pay and get training on the job?" I think as good as the NP and the PA programs are, you just can't get as detailed in a lot of the specialties, especially a surgical subspecialty. I think the APPs come out, and they're a little hesitant. They want to work in urology, but they don't feel like they have the knowledge base, and they're just seeking more formal education. I think some employers are a little hesitant to hire new graduates in specialty areas, and it's a growing trend. There's lots of post graduate programs in many areas.

Could you expand on what the fellowship curriculum entails?

We want to train them in broad-based urology—men's health, female urology, oncology, general urology—so that they have that broad base. When you hire somebody, typically, you're going to have maybe a 6, maybe a 12-week onboarding and orientation, and then you put them in their position, in their area, in this small portion that they're going to work in, and you get pigeonholed, if you will. Some people might love [that]. I didn't do a fellowship, so my area of expertise is more oncology and stones, but don't ask me about female urology and some of those other areas. So, we can offer broad-based education.

They're going to be in the OR. They're going to learn to surgical assist. They're going to be outpatient. They're going to be inpatient. They're going to be doing consults on the hospital floor, in the ER. We want them to be comfortable in all areas. They come out of the fellowship competent and competitive in the field to any urology position that they're interested in. We hope that they like us, and we like them, and that we're able to hire them at the end of their fellowship. At Emory, we've grown and expanded since I've started. I've been in urology for 20 years here at Emory. When I started, I was the third APP to be hired ever in the department, and the goal was to have 4. We were just 1 location right here on Clifton, and now we're 4 locations. We've got an APP team of 15, [with] another position posted. We're probably going to add 2, 3 more APP positions. We're the largest surgical subspecialty within surgical services here at Emory. Build it, they will come.

This transcript was AI generated and edited by human editors for clarity.

“They come out of the fellowship competent and competitive in the field to any urology position that they're interested in,” says Tania Solomon, PA-C, MSc. 

Tania Solomon, PA-C, highlights APP fellowship in urology

Amy M. Pearlman, MD, interviews Gia Ching of GCC Consulting regarding the benefits of a consultant for health care professionals

The benefits of working with a consultant when starting a private urology practice

 of GCC Consulting regarding the benefits of a consultant for health care professionals. Pearlman is a urologist and co-founder of the Prime Institute in Coral Gables, Florida.

Are there any last messages that you want to give to people viewing who maybe are still in training, trying to figure out what they want to do with the rest of their lives, or once they're done with training for people who are early, mid, late career, who are thinking, what am I going to do in this next portion of my life and my career?

I think that wherever you are in your career, there are always benefits to working with a consultant. I think that, wherever your timeline may be, it never really hurts to have a discovery call with a consultant to just see and get some ideas and just give you some possibilities. It doesn't have to be done today or tomorrow, but it's always nice to know what your trajectory looks like for the next 3, 5, 10 years, and working with someone like that, at least they can give you the guidance and help you avoid a lot of the common things that we've seen when providers are looking at potentially building a private practice. I think that everyone's path is different, and the time to get there is obviously different for so many providers, but I think that one thing I can definitely attest to is that once the clients take the plunge and either do their own thing or join someone, they're always so much happier when they are in their own practice, whatever the model may be. So I think that if you feel ready to do it, fresh out of fellowship, or fresh out of residency, or maybe you're just getting burned out and you want to do your own thing, I think it's always nice to have all your ducks in a row, like Amy said, and at least get someone who can give you that perspective on, "This is what your strong suit is. This is what you love to do. These are your passions. This is what I would recommend you create a practice focusing on." And just having someone with another set of eyes I think is always helpful and gives you a lot of inspiration as well as a lot of encouragement on exactly what you need to do next.

You can find this online, Instagram or social media, as well as our website, gccconsultinggroup.com, and you know also you can contact Amy and she can refer.

Awesome. Thank you so much for hanging out with us today. I just want to emphasize, everything that I've worked on with my sister and with Gia over the past few years additionally, starting with our starting with our educational site and then our own practice, we were never taught in training, and I don't know that we're ever going to be taught it in training. So oftentimes, we need to go outside of our medical circles and reach out to people who can really provide us real-time guidance and set those timelines. And I'm not saying that everyone should leave their current practices and start their own practice. I'm just saying, we talk about burnout all the time, and we talk about the issues that are involved in big health care systems and with insurance, and so for people who are just curious, who just want to think about some potential other opportunities, I think a really good first place to start is discussing with a consultant who's done this before.

And I think for your practice, there are so many new things. It's not just building it. Now we're at phase 2, where we're adding on new services, we're adding on different things to the practice. It's almost like it never stops growing. It never stops evolving. That's the fun part as well. Dr Amy, you're 3 years in, but the sky's the limit. There are a lot of exciting things coming out for Prime in 2025 so I think, like I said, there's never really a right or wrong time to bring on a consultant. I think it's just a matter of wherever you are with your journey, wherever you are with your practice, it never hurts to have someone come in and just look at what's under the hood, give some professional advice on some growth strategies, or some operational streamlining strategies that can ultimately benefit you and grow your practice.

"Just having someone with another set of eyes I think is always helpful and gives you a lot of inspiration as well as a lot of encouragement on exactly what you need to do next," says Gia Ching.

Edney specifically considers 3 principles to improve job satisfaction in the context of integrating APPs into urologic practice

Mark Edney, MD, on 3 key principles that improve job satisfaction

, highlights the 3 key principles that improve job satisfaction according to Daniel H. Pink, who authored the book “Drive: The Surprising Truth About What Motivates Us”. Edney specifically considers these principles in the context of integrating advanced practice providers (APPs) into urologic practice. Edney is a urologist with Chesapeake Urology in Salisbury, Maryland.

With respect to integrating these APPs in a way that increases their job satisfaction—helps you the most clinically with your clinical burden, but maintains their job satisfaction. One of my favorite leadership books, and I mentioned this during the during the talk, Daniel Pink wrote a book called "Drive". This is probably now 15 years old, but the principles remain. He was the first one to put together the notion of what creates job satisfaction. If you go back to the 60s and 70s, people thought it was money. If you pay people more, they'd be happier on the job. It's actually not the case. What creates job satisfaction are 3 principles: mastery, autonomy, and a sense of purpose.

Mastery. Give them the ability to become good at something on their own. Again, the example in our group is Joy doing his advanced prostate cancer clinic. He's become the local master of advanced prostate cancer, and that creates tremendous job satisfaction. He loves being the go-to guy when we have questions. "Hey, Joy, this drug vs that drug? What would you suggest?" "Well, I would suggest this drug, because this study said this, and this is the literature." He can do that, and that mastery is really good for him.

Autonomy. We've got to be available for them, we've got to train them up, but you also need to let them go. Let them practice urology without hovering and being a smothering oversight. You need to provide appropriate oversight. Arms length, talk to me when you need to talk to me. If I see something that I need to reach out to you about, I'm going to do it. But let them practice urology so that sense of autonomy, like I have my own practice, I can make my own decisions, is really critical.

The final point that Pink makes in that book is a sense of purpose. The sense of my job actually has a critical role in the organization I'm working in, and I can see where my role relates to the whole. They need to not feel like they're an island out there on their own, without any kind of connection to the mothership. We are all on this team together. Your role is critical, and this is how what you do makes it easier for me to do what I do. This is how this all comes together to provide community urology care.

As long as they understand their purpose, they have a sense of mastery of something and give them some autonomy. Those 3 elements combined absolutely elevate job satisfaction and make them happy. It makes them stick around. Once you train up an APP and you get them some experience, you don't want to go somewhere else, because they can. They can easily. They'll leave. They'll go somewhere else. You want them to feel like they've got a place here that they value. They value being part of your team. They've been allowed to develop a certain amount of autonomy and mastery of the subject, and they feel well supported. They feel like a colleague with their docs. They don't feel like an employee. They feel like a medical colleague. I think if you do those things, you're going to be extremely successful at integrating APPs.

“What creates job satisfaction are 3 principles: mastery, autonomy, and a sense of purpose,” says Mark T. Edney, MD. 

Amy M. Pearlman, MD, interviews Gia Ching of GCC Consulting regarding building a personal brand

Amy Pearlman, MD, and Gia Ching on building a personal brand in urology

 of GCC Consulting regarding building a personal brand. Pearlman is a urologist and co-founder of the Prime Institute in Coral Gables, Florida.

What would you say for a doctor who's interested but is unsure, what would you say is one of those very first steps they should take toward starting their own practice?

I think the first thing you need to identify is, do you have a following, or do you have a niche that you know that you're not currently able to fill with your current role? So wherever you are, if you're a part of a larger practice, if you're a part of a hospital organization, or even in academics, do you foresee that the market you're trying to be in has a need, and what are you going to be bringing to the table? So that's aside from hiring us, but you would want to start at least identifying your own market and really being able to identify, Okay, if I were to go on my own, what would be the bulk of my practice? What would I be doing? Would I be operating? Would I be doing non surgical? Would I be doing second opinions? Because there's a niche for everything, but we just want to make sure that it's viable in your area.

From there, I would say you want to start working on your personal brand. Before you ever decide to open your practice, you at least want to have some type of digital presence as well as be active in associations and just be putting out the network. From there, obviously you can come to a consultant like myself or someone else and give them your ideal timeline, and they can go ahead and evaluate and give you a roadmap of everything that they would recommend you do from the time you're starting until the time where you're looking to actually open your practice. Most consultants are going to ask for a minimum of a 6- to 12-month runway, and that's being conservative. That's not factoring in a custom build-out. So you definitely want to make sure that your timeline aligns and you start working with the right team that can build you out on social media and digital platforms, so that when you're ready to open the door, you're not starting at ground zero, hoping patients walk by; you're already cultivating that initial layer, that it's going to come see you right when doors open.

I definitely echo those sentiments. I recently gave a talk at the Sexual Medicine Society of North America meeting. It was within the session of how to build a thriving men's health practice, and one of my colleagues spoke about how to do that in academics, and another colleague spoke about how to do that at the VA. I was speaking about how to do that in a concierge private practice. I finished that talk, and I had a couple people come up to me afterwards who are still in training, and they said, "I bring up a similar idea to a lot of my mentors, a lot of people that I speak with, and they all tell me it's a really dumb idea, and there's no way that that I should pursue this opportunity." And so they were like, "I'm so glad to hear this that you're doing it, because this really is my dream." And what I tell them is, obviously I'm very encouraging, because I've never been able to provide such personalized, compassionate care in all of my life, in what I'm doing, in my current practice, but I tell them, you have to start somewhere first, it's rare that for anyone, their first job out of training is their dream job. Number 1, you have to build your expertise and your reputation somewhere, because otherwise, how are you going to expect people to just knock on your door and expect to pay some of those concierge fees. They're paying for expertise. And so I encourage people, where do you want to spend the first 3 to 5 years of your career really learning how to be really good at what you do, and then think about what those next 5, 10 years are going to look like?

That's great advice, and that's exactly my philosophy as well. Start now, even if you're in residency, even if you're a fellow. Start now at some capacity. You're going be so much happier that you did it than starting at ground zero, 2 to 3 years into working in academics or working at a hospital, and then having to start from scratch. I think that if you have even a couple extra hours a week to put something on the internet, a YouTube video, a social post, it's really going to compound over time, and you're going to be set up for success.

"I think the first thing you need to identify is, do you have a following, or do you have a niche that you know that you're not currently able to fill with your current role?" says Gia Ching.

Chad W. M. Ritenour, MD, FACS, highlights the work being done by the Office of Well-Being at Emory Urology to mitigate burnout amongst physicians. 

Chad Ritenour, MD, on efforts to promote physician well-being at Emory Urology  

, highlights the work being done by the Office of Well-Being at Emory Urology to mitigate burnout amongst physicians. Ritenour is the Chief Medical Officer at Emory University Hospital and a professor of urology at Emory University in Atlanta, Georgia.

We know that physician burnout has increased over the last few years, and burnout increases your risk of patient safety issues, of quality concerns, and people just not being able to focus or be at their best with work. About 3 years ago, we started talking of establishing the Office of Well-Being at Emory. I was really privileged to be 1 of 2 people who was tasked with that job. We now have a very large office that supports 35,000 people, including those in the department of urology.

One of the things we work on is how do we make the work easier? I like to say what takes 23 steps that should only take 3, and how do we get closer to those 3 steps? We have digital partners that have brought in ambient listening technologies for us to be able to see patients in clinics in a much more efficient way, for us not to have to do our notes late at night, every night after seeing patients, because the processes are better. How do we create the culture that prioritizes people taking care of themselves? How do we look at people that have children and the ability to have time off and still come back to work in a productive way? How do we create social communities that enable people to actually spend time together, to go out to dinner together, and actually get to know each other, so that we are better at taking care of the patients when we are in clinic and we are better in being able to push Emory to the next level. I think all of us are here because we want to make a difference, and one of the ways we make the most difference for our patients is we take care of the people who are taking care of them.

“One of the ways we make the most difference for our patients is we take care of the people who are taking care of them,” says Chad Ritenour, MD.

Chad Ritenour, MD, on efforts to promote physician well-being at Emory Urology 

Mark T. Edney, MD, discusses how to foster a collaborative environment between urologists and advanced practice providers.

Mark Edney, MD, on creating a collaborative culture with APPs in urology 

, discusses how to foster a collaborative environment between urologists and advanced practice providers (APPs). Edney is a urologist with Chesapeake Urology in Salisbury, Maryland.

It starts by treating them as true colleagues. They're not less than. At that roundtable that Dr. Sklar and I did, I heard from a lot of colleagues in the platform, some have an attitude of, "They're just APPs. They can only do so much." It's a less than attitude. You have to get rid of that. They're trained medical professionals. Yes, they're trained at a much lower level than we are. Fine. But they're trained, and they have capabilities. You have to switch your thinking to learn, how do I harness those capabilities? How do I increase their training in urology? And how do I provide the proper oversight so they can start doing a lot of things that I don't need to be doing? It frees up time for me to do the things I'm actually trained and needed to do, given the volume.

Number 1 is treat them like trained professional colleagues. That's how we treat our APPs. They're not less than. They're not the folks handling the stuff that I just don't care about. They're colleagues. They come to us with questions.

One of our APPs runs the advanced prostate cancer clinic. It's been a tremendous boon to his practice, his job satisfaction, in fact, because he's been able to wrap his mind around a clinical area. He knows the literature better than almost anyone in our practice, because it's a defined amount of literature with respect to managing, staggering these drugs for advanced prostate cancer. He's the local expert in it. There are times where I will go to him, and say, "Hey, would you start this drug or that drug? And he'll say, "I'd go with this for these reasons," and he'll give the reasons. They can develop that level of expertise in a particular niche in our practice. You have to let them go. You've got to support them to do that. That's the culture in our practice. No one's better than anybody else. We all, we all sort of have a certain level of training. We have licenses, and we all ought to be working at the top of those.

And the APPs depend on us, and that's the other thing. You have to be open, as an attending in your practice, to any question, anytime, from the APPs. There's never a bad question, and there's never a bad time. If you're seeing a patient and you don't know what to do, come talk to me. I don't care if I'm busy. Sometimes I am busy and sometimes I'm the middle of something. Take 2 seconds. "What's your question? Let me help you." Everybody's harried, everybody's got too many patients on their schedule, and everybody's in a rush. It's hard, because sometimes you've got 3 things going on. The last thing you want to do is take 2 minutes to field a question from an APP. You have to do it. You have to find that inner strength and peace to say, this is critical. This is how our practice runs. I don't have time right now, but I'm going to make 2 minutes for you. "What's your question? How can I help you?" You have to do your best to do that.

As long as APPs are properly supported, they will take off and they will change your practice. That's the culture in our practice. I hear it back from them that they really appreciate that we are also available and willing to help really at any time. We have 2 satellite offices that are remote locations, half an hour away. I'll be in the middle of my clinic, and one of our APPs will call from the Seaford office. They're up there alone, seeing patients, which they're able to do. She'll call, and I'm in the middle of something. She'll call, "Do you have 2 seconds to talk?" "Of course I do." I'll drop what I'm doing. "I've got this patient. X, Y and Z is going on. I'm trying to decide between A and B." I'll say, "It's a great question, and I think you should do this." We do that fairly frequently. The more you do that, the more they get comfortable making those decisions on their own.

It's all about clinical experience. We get experience. We get so much in training, but practicing good urology is really about your experience and your time. You know your time and practice, how many patients you've seen with different types of issues. You get better and better as you gain clinical experience. We as urologists, sometimes we make a decision that we wish had gone a different way because you had an outcome you didn't like. Well, you learn from that. Same thing with them. They have a question, you answer it, and then the next time that question presents, "I remember that conversation I had. I think I'm going to go this way instead." That's how they evolve. You have to help them evolve. If you create that culture in your practice where we're all in this together, we're all trying to handle the urologic load in our area, and we're working together, they feel an integrated part of the team. And it takes off, and they have tremendous job satisfaction when they feel like they actually have a place on the team.

“As long as APPs are properly supported, they will take off and they will change your practice,” says Mark T. Edney, MD. 

Practice Management

Latest News