Coping Strategies After Residency

Rural / community medicine urologists often do not have many urologist colleagues around to consult while in the OR, and some practices have minimal or no robotic surgery systems. Dr. Luskin and Dr. Silva emphasize that when the decision between whether to perform a procedure themselves or refer the patient to a bigger hospital system needs to be made, they must always think about factors other than surgery too. For example, the OR staff may not be adequately trained to assist in a certain procedure, and patients may need additional resources for supportive care after surgery that are not possible to obtain at a smaller practice. Additionally, having minimal to no RNs or advanced practice providers means that community urologists need to deal with every small issue that patients have. Dr. Luskin sees these responsibilities as an opportunity to learn about the road to post-operative recovery for his patients.

Next, Dr. Luskin emphasizes the importance of always being up to date and learning new surgical techniques. When he transitioned to doing robotic prostatectomies, he kept in touch with his Georgetown residency attendings. He also uses Twitter to find recent scientific literature about different urologic fields.

The doctors speak about OR mentality next. Dr. Luskin recommends avoiding doing more than one long case everyday, because it is mentally challenging to approach the second case with a good mindset if the first case was not ideal. He is self-aware of his mindset and has even canceled surgeries because he felt like he was not going to operate at his best. Dr. Silva also speaks about how to deal with frustration with OR staff, as turnover rates are high in community medicine. They both agree reframing can help overcome negative mindset. Dr. Luskin adds that teaching staff who are unfamiliar with a procedure can lead to more comfort and enjoyment for both parties next time the same procedure is done. Finally, Dr. Luskin encourages community urologists to pick and choose their procedures carefully by always balancing the costs and rewards.