A Contemporary Review of Barriers and Methods to Fostering Academic Urologists.

Urology has shown a gradual decrease in the number of graduating residents who plan to pursue a career in academic medicine. Our objective was to identify barriers to academic urology, present options to mitigate those barriers, and explore strategic ways to encourage trainees to seek careers in academic urology. The authors performed a contemporary review of relevant articles through PubMed assessing prior survey studies, editorials, and expert opinion articles that evaluated academic urology, perceptions of academic medicine, physician burnout, and barriers that have been identified to pursuing careers in academic medicine. Selected articles were then independently reviewed by three authors for relevance and application of factors mitigating perceived barriers to pursuing a career in academic medicine, specifically academic urology. Barriers at the academic levels of medical school and residency were found to consist of the following: lack of exposure to research early in their medical careers, inadequate mentorship, all-specialty leading levels of burnout, current average levels of medical school indebtedness contrasted to perceptions of pay disparity when compared to private practice urologists' income, and perceptions of difficulty in maintaining the academic "triple threat." More acutely, the decision to make Step 1 a pass/fail exam, with the addition of historically low match rates in urology, have resulted in additional complications and concerns for aspiring academic urologists. There are clear barriers that graduating urology residents encounter when considering a career in academic medicine. In this review, we present possible mitigating factors that may be instituted at the individual, medical school, and postgraduate levels to increase the number of practicing academics.