I am still between these two specialties and would like to know a few things to make the decision clearer:
1. Which is better suited for private practice and why?
2. What procedures do private practice urologists do? (A urologist said he can count on one hand the number of procedures he does in PP i.e. very little)
3. How much of urology is inpatient in PP?
4. Exactly how "resource-intensive" is urology in the sense of needing OR time, other personnel...etc
5. How much medical management is there in urology exactly? (is it just a few diseases here and there or can you decide not to do any procedures after residency and fare well)
6. Would Urology have a decent case load in a country with more youngsters and less elderly?
7. Do you regret choosing urology? (has a really the high burn out rate on medscape...)
I'm a urologist in private practice (large multi specialty group). I can't comment on Ortho, but will give the urology side of things.
1. Urology is perfectly suited for private practice. Demand for the specialty is great in most areas of the country so if you set up a shop, most can get pretty busy.. It benefits from using its own ancillary services (ultrasound, office procedures like cystoscopy, prostate biopsy, etc) which being in private practice you collect the revenue from. It does involve some start up costs, more so then a primary care office for example, as scopes, prostate US machines, etc are not cheap.
2. As a private practice urologist, I do a ton of different procedures. I do stones (ureteroscopy, shock wave, pcnl), cancer with both open and laprobotic approaches (TURBT, radical and partial nephrectomy, radical prostatectomy, upper tract urotheleal carcinoma procedures), BPH (TURP, urolift, HOLEP, and variations therof), incontinence ( mid urethral slings, botox, sacral nerve stimulators, etc), female urology (anterior/posterior repairs, robotic sacrocolpopexy), Urethrla stricture work (dilations, DVIUs, urethroplasties) and Prosthetic surgery (AUS IPP). The only things I don't do that fall within urology are really big oncology whacks (RPLND for testicular cancer, radical cystectomy for bladder cancer, large caval thrombi with renal tumors) or complex prolapse work, And vasectomy reversals. since i hate them.
The short answer is you can have a ton of variety as a PP urologist. In a larger group, you may subpsecialize in a subset of those procedures. You can also choose to send many of those cases to the academic center or your partners and focus mostly on work in the office or minor procedures. I was well trained to practice the gamut of urology and that was how I wanted to set up my practice.
3. Relatively little inpatient work. Most of the cases above are done as an outpatient or maybe a one night inpatient stay. That means very little time spent rounding in the hospital which is great. Depending on your group set up, you may choose to take ER call or cover hospital consults, but not all groups do this (with the exception of covering your own patients). If you do cover ER call and consults, which I do, it is often well compensated.
4. You do need resources like almost all specialties. You will need MA or LVNs to room your patients and do minor procedures like bladder scans, cath changes, etc to keep your clinic moving. You will need access to an OR or surgery center to do your cases and they will need specific uro instruments like scopes, lasers, disposables, etc. You will need equipment for your office proceures like scopes, ultrasound machines, disposables, and ways to sterilize your equipment.
5. There is a lot of medical management in a general urology practice. A lot of patients with BPH, ED, incontinence, or low grade cancers are managed with medications and/or surveillance. As mentioned above, you can choose to have more of an office focused practice and send cases to your partners, who would generally be happy to have them. Many urologists do this as they wind down and get older.
6. With a younger patient population, you will see a different case mix, but still plenty of things. You'll see more stones, recurrent UTI, infertility, etc and less cancer/BPH, but still likely plenty.
7. No regrets whatsoever. I love my job, I make a big difference in my patient's lives, I have a great lifestyle, and am well paid for it.