1. DETERMINING WHAT KIND OF PRACTICE TO ENTER

Academia? Large group? Small group? Hospitalbased? Decide what fits best for you. Practice types are generally divided into four broad categories – hospital-based, private practice, academia and military practice. Read more about each below. NOTE: Three young urologists share their personal perspective on practice type and more in Appendix E.

WATCH: AUA2019: Choosing a Practice Model that Works for You in a Constantly Changing Environment

WATCH: AUA2019: How to Pick the Right Practice and Be Successful

LISTEN: Eugene Rhee, MD, MBA discusses sketching life after training on an episode of the AUA Inside Tract Podcast.

1.1 Hospital-Based

Salaried employment as a hospital-based physician can be seen as a way to escape the increasing administrative burdens of the profession and/or achieve a more satisfactory lifestyle – especially in a health care environment that is in flux. Advantages: • Guaranteed salary (typically with an incentivized plan) • Built-in retirement plans • In-house management of administrative affairs (e.g., human resources oversight, billing and collecting, rent and overhead, daily operations management, etc.) Challenges: • Not being in charge • Patient population defined by the needs of the hospital system • Possibility of compensation changing and/or being evaluated on pre-determined metrics (e.g., quality and patient satisfaction measures) as part of your overall compensation plan Unique opportunities in this practice type include the ability to climb the career ladder to manage multiple practices or become a leader within the organization. Hospitals may be a stand-alone entity or part of a hospital network such as Kaiser Permanente, Mayo Clinic, Cleveland Clinic, Veterans Affairs, an HCA (Hospital Corporation of America) affiliate, etc. If considering employment at a hospital, become familiar with the satisfaction level of the physicians employed there. Consider reaching out to current contracted physicians at the hospital for a better understanding of their satisfaction level with their contracts. Reaching out can also provide you with an opportunity to ask questions and seek advice that may help in negotiations.

1.2 Private Practice

Private practices can be organized as a corporate model (where physicians are shareholders) or where one or more physicians owns the practice and employs other physicians or providers. Physicianpractices are often incorporated for tax benefits as well as to protect owners from liability. Owners generally take a salary draw, split any receipts after all expenses are paid, and typically distribute receipts monthly or quarterly; it is often an “eat what you kill” model. This practice type can include solo practices, small or large single-specialty groups or a multi-specialty group. Advantages: • Often provides more control over how one individually practices, including the physical set up, management of the electronic health record (EHR)/health informatics system(s), employee selection and what type of patients are seen and how they are treated • Generally allows for decisions to be based on the interests of the owners/stakeholders versus those of an entire health care system • Partial ownership in the corporation can provide financial incentives separate from those received when caring for patients in the clinic, hospital, or operating room Challenges: • Compromising with the interests of partners that may differ from yours

• Nurturing referral sources and partnering with hospitals for mutually beneficial outcomes • Partial ownership usually requires an initial investment of time and/or capital to “buy in” to the corporation. This requires the new urologist to acquire a certain amount of fiscal risk

WATCH: Damara Kaplan, MD, discusses private practice employment as part of the AUA2019 Young Urologists Forum program.

LISTEN: Aaron Weinberg, MD, discusses private practice employment for an episode of the AUA Inside Tract Podcast.

1.3 Academic Practice

Academic urologic practice typically entails being hired by a medical school, cancer center, or large hospital system as part of an academic department or division of urology (often the primary site of a sponsoring residency program). One will generally have a rank position within a university or academic structure (clinical instructor, assistant professor, associate professor, professor, etc.) with responsibilities of (and resources for) research, education and administration. Academic practices still rely on clinical productivity in order to provide salary and benefits unless grant funding subsidizes a portion of your salary (depending on the budget approved in the grant). While most academic practices are administered by the division or department of urology within a medical school or cancer center, they can also exist as employed positions within large tertiary care medical centers with an academic affiliation (perhaps a secondary rotation site of a residency program). Working in a county hospital or VA medical center may also be part of an academic career, as these faculties often participate in the academic affairs of the sponsoring university. Hybrid academic positions also exist at private practice groups that service academic medical centers. While opportunities outside of an academic medical center to educate trainees and conduct research are certainly available, academic medical centers typically offer the ability to provide specialized tertiary urologic care in an environment where research and education are prioritized. A hybrid position may be advertised as being able to provide an “academic appointment and academic career,” but unless the setup supports attending conferences, conducting and presenting research, and plays an integral role in the education of medical students, residents, and/or fellows, those critical academic functions may be sacrificed for clinical productivity as required by the practice. In addition to a busy clinical practice, most academic urologists have the ability to shape the future of urology through research and/or teaching the next generation of urologists. For most (but not all) academic positions, fellowship training and sub-specialty practice is becoming the norm. It is important to look for programs that have a need for your specific area of expertise and interest. More about this practice type can be found in Appendix B. In addition, more about research as a job function (including funding, clinical trials and more) can be found in Appendix C.

LISTEN: Kyle A. Richards. MD, FACS, discusses academic practice for an episode of the AUA Inside Tract Podcast. 1.4 Military Practice

Practicing urology while serving your country offers a breadth of rewarding practice opportunities, as well as chances to go places and do things you would not otherwise have had the opportunity to do within civilian medicine. Military urology positions can range from single-urologist practices at smaller military hospitals in the U.S. and abroad to academic tertiary care hospitals associated with large military installations. Many of these positions are filled by individuals who attended medical school on a military scholarship program and/or completed residency training at a Military Treatment Facility (MTF), although direct accession into the active or reserve military force is possible. Interested individuals should contact a recruiting office (Army, Navy, Air Force) and ask to speak specifically with a recruiter well-versed in physician recruitment as well as one or several military urologists. Residents and fellows preparing for a military medical career should become familiar with their service branch’s strategic needs related to fellowship opportunities and practice locations available after training. Military urology leaders differ for each branch of service (Navy Specialty Leader; Army and Air Force Consultant to the Surgeons General).