Urology Career Pros & Cons: Is It Right for You?

Are you considering a career as a urologist? With so many specialties to choose from, it’s one of the most challenging decisions medical students have to make.

This guide will cover the pros and cons of becoming a urologist, from the high compensation to the strong work-life balance to dick joke after dick joke.

There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in residency, whether or not you want to focus on procedures, the level of patient interaction you’ll have, the setting you’ll practice in, the people you’ll work with, your work-life balance, your compensation, and more.

This series takes a deep dive into the career of a urologist from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and explains why he ultimately chose not to pursue urology as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in urology.

For a completely objective and unbiased look at urology, including more details into the daily life of a urologist and the exact steps to take to become one, also check out our guide to How to Become a Urologist (So You Want to Be…)

Urology Pros — What I Liked

1 | Funny Personalities

One of my favorite parts of urology was the sense of humor.

Despite being in a surgical specialty, the urologists I met and worked with were funny and didn’t take themselves too seriously. This is, in part, due to the fact you’re dealing with penises day in and out. It felt strange to be super serious under those circumstances.

I loved the humor, which primarily consisted of dick jokes, and I appreciated the laid-back nature of the urologists I came across during my training.

In terms of personalities, I vibed the most with urologists, ENT, and neurosurgeons. Ortho was great, but a little too bro-y for me, and plastics was split into two groups, aesthetic-driven and reconstruction-driven, and I didn’t quite fit in as neatly in either.

2 | Operating vs Clinic Flexibility

Urology is unique among surgical subspecialties in that it offers more flexibility than average. You can be more procedural or clinical depending on your preference and your stage in life.

Earlier in a urologist’s career, they may focus more on complex surgeries, but it’s common for older urologists to phase out those surgeries and focus more on simpler procedures and spending more time in the clinic, as they may be less enthusiastic about standing in the operating room for hours at a time.

On the other hand, when you’re younger and want the excitement, challenge, and compensation boost, you can focus more heavily on procedures, especially the more complex and exciting ones.

Tying into this is the unique balance of urology, which offers a great mix of surgical and medical expertise. Ortho would be more surgical and less medical, whereas something like nephrology would be heavily medical.

3 | More Engaging Clinic

This is a first for me. I actually enjoyed the clinic aspect.

One of the upsides of the flexibility of urology is that you are destined to do more clinic than the average surgical subspecialist. If you prefer the OR over the clinic, this might seem like a drawback to you, but it’s actually still a good deal.

The cool thing about the urology clinic is that you’ll perform a higher number of small procedures, which makes it a faster-paced and more procedural environment, with quick procedures like cystoscopies and vasectomies.

I found urology clinic significantly less boring than most other specialties.

4 | Excellent Lifestyle and Compensation

Urology ranks tenth among the highest-paid medical specialties, with an average annual salary of $529,140.

It’s still a surgical subspecialty, so you’re working for that income, but it’s not the worst out of the surgical fields. A urologist’s work-life balance is much better than that of the average neurosurgeon, for example. After residency, you can expect 40 to 60-hour work weeks.

And again, due to the balance between the clinic and the OR, you have greater flexibility in controlling your lifestyle than in some other surgical subspecialties.

I also like that urologic emergencies, things like testicular torsion, infected kidney stones, gross hematuria with clot retention, and priapism, are relatively uncommon, so call generally isn’t as challenging as other surgical subspecialties with more common emergencies.

5 | Grateful Patients

If you fix a guy’s penis problem, he’ll love you for life. You’re now the best doctor in the world. You may as well have saved his life.

Your patients will love you because many of your interventions will have an immediate and positive effect on their quality of life. Urology patients tend to suffer from sensitive health issues for many years before they seek care, and they’re understandably incredibly grateful when you can help them maintain a robust sex life or even help them be continent throughout the day.

6 | Technology & Variety

Part of the fun of being a surgeon is experimenting with all the new, innovative tools and technologies that the surgical device industry continually develops.

Personally, I’ve come to realize that I need variety in my work—it excites and energizes me, and it’s one of the reasons I love plastics so much.

Urology is great in that there is a wide variety of cases. You may be breaking up kidney stones or vaporizing prostate cancers using lasers. Or you might use robots and laparoscopic procedures to remove kidney or bladder cancers. It’s not just minimally invasive; you can also get your open case fix, with kidney transplants or lymph node dissections.

If you want complex, life-or-death surgeries where you carefully dissect around the aorta and vena cava, removing lymph nodes and curing a patient of cancer, you can do that. Or maybe you want some quick, satisfying cases where you retrieve a large stone and relieve a patient of some of the worst pain of their life in less than 30 minutes.

You can be the cancer-slaying hero who saves the day or the quality-of-life captain who helps a man stay continent or anything in between.

Urology Cons — What I Didn’t Like

1 | Bread & Butter

There’s no getting around it—if you’re a urologist, you’re staring down the barrel of the one-eyed snake on the regular.

This actually doesn’t matter all that much because the “gross out” factor of any field, whether penises in urology or poo in gastroenterology, is largely lost as you continue to train and develop a tolerance for it.

When choosing a specialty, we often focus on the sexy zebras, but you need to ask yourself if you can tolerate the bread and butter—the things you’ll be seeing day in and day out.

In urology, you’re dealing with a lot of cancer, specifically prostate, bladder, testicular, renal, and adrenal. There are also kidney stones and benign prostatic hyperplasia (BPH).

For peds, there’s undescended testes, vesicoureteral reflex or VUR where urine goes back up to the kidney due to valve issues, and hypospasias, where the opening of the urethra isn’t at the tip of the penis.

There’s also infertility treatment, including varicocelectomy, vasectomy reversal, and microTESE, which stands for microdissection testicular sperm extraction. This procedure takes sperm directly from the testicular tissue using a microscope.

And of course, erectile dysfunction and neurogenic bladder.

Another helpful heuristic is to imagine the worst aspect of a specialty and see if you can tolerate doing that on a regular basis.

I would need more exposure to urology cases to speak definitively on this, but my sense is that it’s one of those specialties where I love the physiology and learning about it in the preclinical years, but the actual practice and surgery might be less exciting based on the subject matter.

I love the variety when I look at procedures like TURP, TURBT, implants and prostheses, cystoscopy, oculopexy, lithotripsy, and so on, but none of them quite excite me in the same way as facial reanimation or a free flap.

Some of the most intriguing reconstructive cases in urology also don’t always have the best outcomes.

Keep in mind that the stereotype of a specialty isn’t usually the truth. Many people think urology is just sticking your finger in butts and retracting foreskin all day, but it’s much more than that.

Many also think that urology is just about treating men, but urologists also treat women for urogenital tract cancers and issues with voiding. There are even subspecialties within urology that treat women almost exclusively, like Female Pelvic Medicine & Reconstructive Surgery (FPMRS).

2 | Separate Match

Urology doesn’t use the NRMP like most other specialties. It has its own match called the URMP, or Urology Residency Match Program.

This isn’t a huge deal, but it is a slight annoyance, and I’d love to know the reasons why specialties like urology have their own thing or why ophthalmology uses the SF Match.

Urology supposedly did this to give students time to interview and arrange their first two years of general surgery training, which can be done at a different institution. This would be prior to the categorical training that’s offered now.

At least with urology, you match before everyone else in January, so you have some extra time to relax in MS4.

3 | Lifestyle

While the lifestyle has its perks, it also has some downsides.

Some think that urology is a more relaxed surgical specialty, but the training is still a surgical residency, and you’re going to pay the price for that. Even after residency, it still has a surgical lifestyle.

When people mention it’s more laid-back, they mean that, on average, it’s not as malignant as some other surgical subspecialties. The old adage of “only do surgery if you love the OR and can’t see yourself doing anything else” definitely holds true.

Most attendings are operating, and they do some form of call. It’s not going to be as terrible as call during residency, but you’re doing something like one in four or five.

Being on call is fun the first few times you do it, and then it grows old. And the older you get, the more it grinds on you.

Urology offers high compensation of over $500,000 a year, but to achieve that, you must be willing to put in the work, which requires many hours.

You may say, “Hold on, I’ll just work less and make less, and I’ll be fine,” but it’s easier said than done to say no to an additional $100,000 by working a little bit harder. Some people can say, “No, I have hard boundaries on my time,” but most of us, myself included, would likely play some mental gymnastics to justify it.

Should You Choose Urology?

So, is urology right for you?

If you want to be primarily surgical with optionality to fall back on a more clinic-heavy practice as you get older, with good work-life balance and cutting edge new technology—along with the perk of making dick jokes every day—urology might be a good fit.

Honestly, in preparing this, I feel like I would have loved urology. However, the one big question mark I had was how much I would enjoy the bread and butter and the day-to-day. I can’t comment on this definitively because I didn’t have the proper exposure. There aren’t many downsides, as long as you’re set on a surgical subspecialty and you know what sacrifices you have to make in that field.

A wise surgeon once told me surgery is like sex. Watching it is fine, but doing it is way better. And if you’re willing to make that sacrifice, urology is a solid choice.

Medical school moves quickly, and there isn’t much time for experimentation and exploration, so I prioritized plastics, orthopedics, and neurosurgery over urology and never had proper exposure to it. If I did, who knows, I might have loved it.

Overall, if you want to work with your hands, enjoy the pathophysiology of medicine, like building long-lasting relationships, love the operating room, and are prone to making dick jokes, then urology may be a good fit for you.

But it’s up to you to determine whether the pros outweigh the cons.

If you want to learn more about ophthalmology, check out So You Want to Be a Urologist.