Specialty Profiles

What it’s like to specialize in urology: Shadowing Dr. Sethi


As a medical student, do you ever wonder what it’s like to specialize in urology? Meet AMA member Amanjot Sethi, MD, a urologist and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in urology might be a good fit for you.

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Amanjot Sethi, MD
Amanjot Sethi, MD

“Shadowing” Dr. Sethi

Specialty: Urology.

Employment type: Medical group.

Years in practice: 13.

A typical day and week in my practice: The days I spend doing clinical work fall into one of two categories. A day in the clinic is filled with procedures, postoperative follow-up appointments and new patient appointments. When I am operating, I am either performing robotic-assisted minimally invasive surgery, including robotic radical prostatectomy, robotic partial nephrectomy or reconstructive procedures such as robotic pyeloplasty or general urologic operations such as endoscopic surgery for kidney stones, benign prostatic hyperplasia or bladder cancer. Both clinic and surgery days can be long, sometimes 10 hours or more. 

The most challenging and rewarding aspects of urology: Urologists must help patients navigate incredibly vulnerable moments in their lives and guide them through decisions that can greatly impact quality of life. These factors can make the job of a urologist challenging but also quite rewarding. As a urologist, patients often come to you in severe discomfort (complete urinary retention, kidney stone pain) or under significant stress (new cancer diagnosis). In these instances, I feel such gratitude to be able to use my surgical training to alleviate these conditions with relative swiftness.

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Urologists also routinely deal with an aging population. Much like any physician and surgeon, we have a strong desire to help people live their best quality of life, regardless of their age. However, there is a balance between having the ability and skills to perform procedures and operations on patients and knowing when doing so would do more harm than good.

A urologic surgeon and mentor once taught me that when it comes to performing operations, “Just because you can, does not always mean that you should.” This awareness can lead to challenging conversations and ethical dilemmas for urologists and our patients, especially when these patients or their families may have difficulty grasping the potential impact of treatment.

How life in urology has been affected by the global pandemic: One major impact—which is not unique to urology—is that many patients held off on attending to their urologic health, especially during the earlier parts of the pandemic. This hesitancy to seek evaluation resulted in some patients showing up with urologic issues, such as kidney stones and cancers, that were more advanced in severity. There has also been a shift to virtual care, which has its benefits and challenges. Other than that, not much changed for my practice as we continued to perform cancer operations and procedures throughout the pandemic.

The long-term impact the pandemic will have on urology: One beneficial impact will be that many urologists who were previously not as familiar with providing virtual care have now had the opportunity to become a lot more comfortable in conducting video visits for common urologic issues and related follow-up. While our specialty tends to require in-person visits for procedures, many of us are certainly more comfortable with the virtual platform and dealing with the issues that don’t require these in-person interactions. Currently, patients are also becoming more accustomed to this avenue of care, which will allow for more flexibility in our practices.

Three adjectives to describe the typical urologist:

  • Chardi kala: I borrow this from my native language, Punjabi, and my faith, Sikhism. Chardi kala can be defined as having a positive and joyful attitude towards life and the people around you, even when current circumstances are not ideal. Very early in my medical school exposure to urology, I saw that so many of the urologists I met had such an affable and optimistic attitude, even when dealing with difficult patients or situations. I very much connected with the chardi kala I saw in them. 
  • Humorous: This is so important!  Rare is a urologist without a good sense of humor and easygoing nature. 
  • Adaptable: The diverse nature of the field and the complexity of clinical presentation in both clinic and operating room warrant adaptability.

How my lifestyle matches, or differs from, what I had envisioned: One of the selling points of urology was the ability to be in a surgical subspecialty without experiencing as much stress inherent to treating acute emergencies seen in other specialties like general surgery or trauma surgery. While this does hold true, taking call as a urologist can still be quite busy and require significant time dedicated to emergency room and operating room care, attending to a number of acute issues that warrant urgent intervention.  This results in a practice that is busier than I originally imagined as a medical student.

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Skills every physician in training should have for urology but won’t be tested for on the board exam: Endurance and adaptability. The days can be long, and the diverse clinical scenarios and pathology also come with the need for adaptability. The ability to connect with—and relate to—patients is important. While most urologists will have exceptional surgical and clinical training, one of the most important skills is the ability to connect with patients, manage their expectations, and guide them through some of the most difficult and vulnerable times of their lives. This requires skill sets that are not often tested on board exams.

Another skill that is important to develop is the ability to have conversations about end-of-life issues and navigating surgeries and interventions in patients who are poor surgical candidates.

Mantra to describe life in urology: Always strive to stay in chardi kala! Otherwise, here is a classic—and cheesy—urology joke: What do you call a urologist with dry feet? Unemployed.