David Ginsberg: Great. Alan, thanks so much for having me here. Always fun to see you, though rather it be in person. So Dr. Wein asked me to talk a little bit about just fellowships in general. So I thought I'd just start by talking about the fact that there are both one- and two-year fellowships on the urology side of urogynecology, female urology, however you want to term it. For many of us that are older, that have some gray hair, we did one-year fellowships. That's all there were at the time. And I think for most of us that did one-year fellowships, we are able to provide outstanding care in the field of whatever you want to term it, whether it's female urology, which is what part of my fellowship was named when I did it with Dr. Raz, and then it became female pelvic medicine, now it's urogynecology with reconstructive pelvic surgery. And then there are those of us in this field that refer to our field also as functional urology.
So whatever term you want to use, be aware that there are both one- and two-year fellowships in this world. So what changed? Both American Board of Urology, American Board of Obstetrics and Gynecology agreed to collaborate and have a single co-sponsored specialty. Gynecology termed it as urogynecology. Urology termed it as female urology. This now became ACGME-accredited fellowship. For those of you that are urologists, you understand that through the American Board of Urology, there are a grand total of two ACGME-accredited fellowships, pediatric urology and initially was female pelvic FPMRS, female pelvic medicine and reconstructive surgery. So for example, our other fellowships in urology, whether it's oncology, SUO, GURS, reconstructive, stones, endourology, those aren't ACGME-accredited. Those are just different rules and regulations, think about it when you have an ACGME-accredited fellowship. So what changed? So ABOG positioned to change the name. So FPMRS became URPS, urogynecology and reconstructive pelvic surgery, and new certificates were administered in 2024. I didn't do anything differently. I didn't take a new test.
I didn't do any different training. I just have now changed from being an FPMRS provider to now being an URPS provider, urogynecology and reconstructive pelvic surgery. So what does this mean for urologists? What does this mean for me as a urologist? Well, here's an example of my certificate from the American Board of Urology, not the updated one, but the previous one. And as you can see, I am board certified. I'm board certified in urology, but also have a board certification in FPMRS, or URPS if I had my new certification now. So again, so I can label myself or you want to market yourself or however you want to term it. I'm a board certified urologist. I'm a board certified URPS provider, and say that I'm a urologist, a urogynecologist, I'm an FPMRS provider, however it is that you want to term it, providing care for all of these patients. So for my practice, sure, I am doing a lot of urogynecology on my daily basis, but like most people that are with that certificate, continuing to practice urology. So I still see men with LUTS and I'm still seeing patients with neurogenic bladder. Some of my colleagues, for example, with the certificate will still do stones. I have no interest, but they're still doing plenty of urology. And then I wanted just to talk a little about one-year fellowships. So there have always been one-year fellowships.
They're not ACGME-approved. They do have a SUFU certification. And I know at the end of my presidency at SUFU, the movement was to try and make this a more standardized process to say that you have a SUFU certification for a one-year fellowship, and that is being done the level of SUFU. But just to give a sense of the pros and cons. So what's the pros of a one-year fellowship from my perspective? Well, obviously it's only one year, so it's shorter. The goal is that SUFU will set some minimum standards. It should be easy for all these fellowships to obtain, and it'll be acknowledgement of that one-year program, and you will continue to have male procedures, actually, as part of your logs for those fellowships. Which obviously are not part of the urogynecology logs because the urogynecology logs, the URPS fellowships are urogynecology based. There are no male procedures involved with those logs. What are the cons of a one-year fellowship? So you're having a certificate.
It's not clear what that certificate is giving you, because this is not, again, an ACGME-approved fellowship, so you're not getting an ACGME certification. And there's always been this concern, well, there'll be practice restrictions if you don't have an ACGME urogynecology certification. And the reality is we really haven't seen this. So let's say that you do a one-year fellowship and you're comfortable doing slings, robotic sacrocolpopexy, anterior repair, posterior repair. Well, these are also things that the American Board of Urology would expect you to be very capable of doing. So the American Board of Urology would say, "Yes, you can do that whether you've done this fellowship or not. You've had this extra year of fellowship. So I don't foresee problem with practice restrictions." Depending upon where you are, it may be more challenging to get a certification to do vaginal hysterectomies, but otherwise I don't see a lot of providers having a lot of barriers to practice urogynecology, or at least a good portion of it, after a one-year fellowship. So that was what I wanted to start off with, and I'm happy to answer any questions that I have no doubt Dr. Wein is going to have for me.
Alan Wein: Oh, thanks. That was a great summary of basically the status quo. So for an individual in, let's say, urology residency who wants to get out and pay off some of their student debt, when faced with looking at, let's say, a fellowship in URPS, whether it's a one or two-year fellowship, what does the ACGME fellowship ... Which as you pointed out, it's only a two-year fellowship, you have it on paper, you have it on your wall. What does that actually get you that doing a one-year fellowship does not? And for that matter, according to residency review committee, what we should be teaching in our residencies should enable, let's say, a person who graduates to at least be able to do slings, simple pelvic organ prolapse repairs, and perhaps whatever your particular department at your particular school specializes in that you have a special knack doing.
David Ginsberg: Right. So think about what our residents can do when they leave USC as residents. I would feel very comfortable with, essentially, all of our residents doing slings, anterior repairs. Some posterior repairs, others may not be comfortable with that, but for certainly a sling and an anterior repair. And what you're going to get out of a two-year fellowship is, I think, a much greater understanding and comfort level with more advanced pelvic surgery. I think everyone is going to leave, at least in our fellowship, you're going to leave very comfortable doing a vaginal hysterectomy. And I don't know that's going to happen at every one-year spot. Some of the one-year spots are a little more male-focused than female-focused. So it depends on the location. You're going to be very comfortable in the field of functional urology. You may not be as comfortable in the field, the full gamut of urogynecology.
When you look at the history of what jobs people are getting, the majority of graduates from one-year spots are more likely to go into a private practice job. A much higher percentage of graduates from the two-year spots are going into academic medicine. So you talk about having debt. In my mind, I thought you were going to ask why do a fellowship at all? Because that's what we've seen in residency is that there are some graduates that are just deciding, I'm not going to do any fellowship at all because I can get paid pretty well by going right into practice and being a general urologist with maybe some focus based on what you are very comfortable with from your residency, whether it's robotic surgery, stones or female pelvic medicine, whatever it may be. So I thought that was going to be why you were going to ask the question. And I think that if you're leaning towards more of an academic practice, then certainly we've seen that those with an interest in urogynecology and academics are more likely to do a two-year fellowship.
Alan Wein: Now, I know that you or anyone coming out of your fellowship or probably your residency for that matter is going to be equally good at taking care of men with lower urinary tract dysfunction. And my understanding, and correct me if I'm wrong, is that the GYN-based URPS fellowships don't concentrate on that, nor do they concentrate on neurogenic bladder dysfunction as much as the urology-based fellowships do.
David Ginsberg: Right. I think that's probably fair. And again, I haven't spent time in a urogynecology-based fellowship. But based on what's emphasized on boards, what's emphasized on case logs, you're certainly going to get much more neurogenic bladder and dysfunctional voiding on the urology-based fellowships than most, I'm not going to say all because I think some do a good job with it, but a good number of the gynecology-based fellowships. But again, I'm not in those fellowships to know. But I think that knowing who is involved with most of the urology-based fellowships, I know, for example, how important urodynamics are to us and how often we're doing urodynamics. And I think we're all trying to ... It's that jigsaw puzzle of a patient that comes in that's seen multiple urologists in the past and you're just trying to figure out what is going on and what the next best of therapy is.
And that's where I think our urologic training is really going to help us, whether it's a male or a female patient, because those are the patients we're seeing a lot of. And I think you're probably going to see a good amount of those patients, whether you do a one-year spot or a two-year spot. And I always tell ... For example, I tell our fellows, I expect you to leave our fellowship as a urodynamic snob. And you know what good urodynamics are because sometimes when patients get referred to us, the urodynamics may not be optimal and they're going to appreciate what is not an optimal study and what a good study should look like. And I don't think our fellowship ... I hope our fellowship is not unique, in the other fellowships are doing the same thing and also producing urodynamic snobs.
Alan Wein: I mean, do you see urology at a big disadvantage because of the number of GYN-based programs versus the number of urology-based programs? And the number of GYN, I mean, I think that it's uncommon, not rare, but it's uncommon for a urologist to go into a GYN-based URPS fellowship. And so the discrepancy in the numbers of people who hold that certificate is getting bigger every year because they have more fellowships, they have therefore more GYN people going into those. I think there's still some GYN people that go into the urology-based fellowships because they figure it's probably a better training experience for their particular needs. But it looks like every year the number of people who hold that certificate increases more so in gynecology as a ratio than it does in urology. Is that going to hurt urology in the future?
David Ginsberg: I don't think that it's going to hurt urology. And just to clarify one thing, if a gynecologist ... So we have a dual program. We have a urology track and a gynecology track under one umbrella of USC urogynecology fellowship. But our urology side does two years and the urogynecology side does three years, and that how it is for all. If you're doing a gynecologist doing a fellowship, you have to do a three-year spot. If you're a urologist doing it, you have to do it minimum two-year spot. But if you match on a gynecology side, it may require you to do a three-year spot. It kind of depends on what that program's looking for. We're at a disadvantage because they are just more on the gynecology side, so there's more of the gynecology-based URPS providers to be referred to.
And then I guess the other disadvantage would be that a lot of those patients are theoretically controlled by gynecologists and they are going to more likely to refer to gynecologist. That being said, you make relationships. I have a good number of gynecologists that continue to refer to me. You're always going to be theoretically also the referral site for the urology side. And then depending upon the community you're in, I think you're still opportunity to be very busy. There will be more than on the gynecology-based side and urology-based side. So I think that the disadvantage we have is when decisions are made through ACG [inaudible 00:15:04], they have a larger voice. But I think that there is always going to be a role for urology-based URPS providers, and I don't see that going away.
Alan Wein: Well, as long as there are people like you in charge on the urology side, I think probably we're still okay. But listen, thanks so much for your time this evening. Thanks so much for your thoughts. And hopefully some people watching this will realize the advantages of the urology-based fellowships and also what, let's say you, collectively, meaning the people who run the urology-based fellowships, offer in terms of a different style of education, different concentration than the ones that are gynecology-based.
David Ginsberg: That's great. Thanks for having me, Alan. It's good to see you.
Alan Wein: Thank you. See you soon.