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20 Questions: Alan William Shindel, MD, Urology

 
Dr. Alan William Shindel is currently assistant professor in residence in the Department of Urology at University of California, Davis. His areas of interest include erectile dysfunction, hypogonadism, Peyronie’s disease, priapism, health promotion, premature ejaculation, alternative medicine, infertility, sexual dysfunction, and female sexual dysfunction. Shindel earned his bachelor’s degree in biology from Illinois Weselyan University in Bloomington (1998), followed by his MD from Washington University Medical School in St. Louis (2002). He completed a surgery internship at Barnes-Jewish Hospital in St. Louis (2002-2003), followed by a urology residency at the same facility (2003-2007). Dr. Shindel completed a fellowship in andrology at University of California, San Francisco (2007-2010), and he is currently earning a master’s degree in clinical research at University of California, Davis. His previous work experience includes clinical instructor in urology at University of California, San Francisco (2007-2010), and urology staff physician at San Francisco VA Medical Center (2007-2010).
Dr. Shindel is a member of the American Urological Association, American Society of Andrology, Sexual Medicine Society of North America, Society for the Study of Male Reproduction, and the International Society for Sexual Medicine. He has been published in Urology, Journal of Endourology, Journal of Sexual Medicine, Journal of Trauma, Indian Journal of Urology, J of Urology, Urologic Nursing, European Urology, Current Pharmaceutical Design, Cytotherapy, Reviews in Clinical Gerontology, Asian Journal of Andrology, International Journal of Impotence Research, and International Journal of Gynecolgical Obstetrics. Dr. Shindel is currently involved in several research projects, including the investigation of endothelial function after treatment with Epimedium extracts, the analysis of serum vitamin D level and its association with erectile problems in men, the analysis of selective inhibitor of phosphodiesterase type 5 (PDE5I) use in the UCD medical system and study of men using PDE5I without the diagnosis of erectile dysfunction, the multivariate analysis of erectile dysfunction and its associations in an ethnically diverse population of men, and the effects of sex steroid hormones on wound healing in cultured genital and non-genital skin.
When did you first decide to become a doctor? Why?
I first considered it in high school. Previously I had thought about being a veterinarian, an author, even a minister. In high school I decided that a career with science was what interested me most; conveniently enough, being a doctor encompasses some aspects of all three careers that I had previously considered so it seemed a good fit.
How/why did you choose the medical school you attended?
I went to Washington University in St. Louis. I didn’t apply too far abroad from my hometown in Northern Illinois because at the time I wanted to stay in the Midwest. I got about 15 some-odd interviews and selected Wash U because it felt right. I put a fair amount of stock in intuition for decisions like that and I felt comfortable when I visited, liked the people I met, and thought I would do well in St. Louis. They offered a competitive package for financial aid and the high ranking of the university was also a plus as well.
What surprised you the most about your medical school studies?
Tough to answer this one; I don’t know that anything surprised me per se. I did find it fascinating to learn how much there is that we don’t know. A corollary to that is that I was impressed with how our understanding is constantly evolving. What we hold as cherished truth now may be proven false in the future so it’s important to keep an open mind.
Why did you decide to specialize in urology?
The quick answer is that it is the only rotation I really enjoyed during third year. I had good experiences and good teachers on every other rotation too but urology just felt right, in large part because of the urologists I met. Urologists have a reputation as easy going and happy people, particularly in comparison to stereotypes about surgeons in general. We also have a pretty well developed sense of humor, which is helpful when addressing sensitive issues like sexual function and urination.
Urology offers a nice variety of practice options; medical and surgical, young and old, male and female. Urologists can do big oncological cases or small office procedures; this permits a lot of flexibility over the course of a career. We also have lots of cool toys…robots, lasers, etc.
If you had it to do all over again, would you still specialize in urology? (Why or why not? What would you have done instead?) I can’t think of a specialty within medicine that would suit me better than urology. Other specialties are somewhat interesting (pathology, radiology, etc) but I don’t think I’d like them as much.
Has being a urologist met your expectations? Why?
I’d say so. (See below for more detail.)
What do you like most about being a urologist?
Urology in general offers a lot of opportunity to help people with sensitive problems that can have crippling effects on quality of life. Most people don’t think about how incapacitating urinary control issues or sexual dysfunction can be until they experience it. However, once they happen it’s clear how important these issues are.
Sexual problems are my sub-specialty focus. I like facilitating conversations about this sensitive topic and helping people reclaim their sexual lives after trauma or illness. Although sexual issues are my main focus, urology is great in that there are lots of other ways to help people within the field…urologists can specialize in treatment of cancers, kidney stones, urinary incontinence, prostate issues, there is a lot of flexibility within the field. On top of that, we get to do both medical and surgical management so we don’t get stuck in monotonous routines.

What do you like least about being a urologist?

The things that I like least about urology aren’t really specific to the field. Dealing with “business of medicine” issues, challenging patients, having to work weekends and some nights, time away from family…these issues are challenges for all doctors, not just urologists.
What was it like finding a job in urology?
What were your options and why did you decide what you did? A wise man once told me that when you are looking for a job there are three major considerations: living where you want to live, making good money, and doing what you want to do. If you can score two or more of those starting out you are doing pretty well. I’d say that most urology graduates can be confident of getting at least two of those starting out.
I like academics…teaching, research, and education. So when I applied for jobs I looked only at universities. I also wanted to stay in Northern California. I was fortunate to find a position at UC Davis and have been there since finishing my fellowship.
The good thing about urology is that there is lots of demand and a limited supply, so it’s usually possible to find a job anywhere you look. Obviously some areas are more competitive than others but the market in general is good for us.
Walk me through a typical day at work.
I have two clinic days a week where I see patients and do office procedures (vasectomies, cystoscopys, etc). During mid-week, I have academic/research time that I use to write grants, work on university committees, and do surgical cases.
On average: How many hours a week do you work? How many weeks of vacation do you take?
I work maybe 40 to 60 hours a week. It’s hard to precisely quantify since I have clinic days two days a week and then fill up the rest of my time with OR cases, administrative service for the university, teaching, writing, and extra-curricular obligations to professional organizations. So I don’t have set hours per se, I’ll take work home and sometimes work on weekends but I enjoy that flexibility. I also have call duties about six weeks of the year and those weeks my schedule can be very unpredictable. Many urologists in private practice or large health care organizations have more fixed schedules.
Vacation is variable. Because I am in academics I often travel to conferences and meetings. Since these are typically in desirable locations I’ll often schedule some extra time to visit before or after the meeting. It’s a nice way to travel.
Are you satisfied with your income? Explain.
More is always nice but in general yes. Urology tends to pay pretty well because you have a nice mix of clinic and surgical duties. You generally don’t make as much money in academic urology but I like the flexibility and the opportunities for research and teaching.
If you took out educational loans, is/was paying them back a financial strain? Explain.
I did. It was more of a strain as a resident. I make enough now that it’s not a terrible strain but it is a nuisance and when you factor in the interest it represents a pretty substantial cost.
In your position now, knowing what you do – what would you say to yourself when you started your medical career?
Be open to changes and unexpected discoveries. I started medical school thinking I would do gastroenterology but that changed. I started residency planning to do private practice in minimally invasive urology but wound up doing academic andrology (men’s reproductive and sexual health). Keep an open mind and explore all of your various options, you might discover that a field you would have never considered is the perfect fit for you.
What information/advice do you wish you had known when you were beginning your medical studies?
It’s natural to go to medical school eager to help people and optimistic that your patients will have good outcomes. Obviously we always strive for good outcomes and we oftentimes get them but that doesn’t always happen. So you have to be ready to accept that sometimes things don’t go the way you hope they will.
What’s even more difficult is that patients aren’t always appreciative of even our best efforts and not all patients are nice. Patients are human beings, so they have good days and bad and some are just plain difficult. Keeping that in perspective is an important part of staying sane when dealing with people (patients and colleagues) who can be challenging. Realistic expectations are key to avoiding disappointment and burn out.
From your perspective, what is the biggest problem in health care today?
Cost and quality. In the U.S. we pay more to get less…by most every metric our health outcomes are inferior to other developed countries despite the fact that we spend a lot more money. In my opinion, too much of that spending goes to pad corporate bottom lines rather than optimize the health of populations.
There aren’t any simple solutions for the complex problems of health care in the U.S. but I would posit that unhealthy lifestyles are a huge reason why Americans are so sick. If people had better diets and exercised more I am confident we would spend less money taking care of the inevitable health consequences of unhealthy lifestyle choices. Addressing that is another huge sociopolitical issue that extends way beyond health care into issues of education, economics, and public health. Be that as it may, improving how we live could yield huge benefits (health and economic). In simpler terms, I think we should focus more on prevention (which costs less) and less on whiz-bang heroic technology (which costs lots).

Where do you see urology in five to 10 years?

I don’t know that there will be any groundswell changes, at least not any that will be specific to urology. Health care is going to have to change to make it affordable, accessible, and outcome driven so there will be big changes but that will apply to all of us.
In the end, urology is very much a niche field and no other field is really competing with us to deal with our clinical problems. As an illustration, cardiac surgeons used to do lots of coronary artery bypass graft (CABG) procedures. This changed when cardiologists started doing stents and now the number of CABGs has dropped precipitously. I don’t see us losing ground to other specialties given the specialized nature of our work.
What types of outreach/volunteer work do you do, if any?
I serve on the admissions committee for my university and have done so at various institutions over the past 10 years. I’m on a number of other committees here at the university as well. I also make it a habit to do outreach to support groups and at a number of health fairs and such.
Do you have family? If so, do you have enough time to spend with them? How do you balance work and life outside of work?
I am just recently married. My wife is a gynecologist so she understands what it’s like to be a physician. We do plan to have a family and I think we are both committed to the idea of being present for our children; this might mean curtailing work hours if/when children come along. Of course we are both committed to our careers too so we’ll likely rely on family and possibly a nanny to help out sometimes too.
It’s really important to keep time for things you enjoy. You could devote every waking hour to medicine and still have it demanding more. So, at some point (which is different for everyone) you have to say “enough” and make time for yourself and the people who are important to you.
What is your final piece of advice for students interested in pursuing urology as a career?
Urology is a great field which really offers a lot: nice colleagues, patients you can help, cool technology, reasonable hours, good compensation, and lots of diversity/options in terms of practice and practice patterns.
Urology is competitive so it’s important to have good grades, good letters, and/or competitive test scores. But even if you don’t have the best grades don’t get discouraged, there are lots of ways to beef up your application if you are really dedicated to a career in urology.

5 thoughts on “20 Questions: Alan William Shindel, MD, Urology”

  1. This guy’s household income is easily in the 99%-ile of US households when added to his gyn wife’s and he says “more is always better.” People amaze me sometimes…
    Good point that not all patients are nice. Don’t write that in your application, though.

    • Get off the guy’s back. He said his income was fine and was honest. Who wouldn’t want to make more if someone was offering? You can talk when you’re in his position with his enormous debt load…

    • no…people like you are the people who amaze ME. What’s your problem with his statement? umad that he makes a ton of money and you’re probably an overzealous, pompous, fake pre-med who would rather work for free than see doctors make lots of money. You have some growing up to do. Good luck with your finance goals of life if you don’t think more is nice…really? are you suggesting more is worse? that doesn’t sound very logical..how do you know that this doc doesn’t donate tons of money to charity? In that case, more income would be awesome right? lol…the only thing you got out of this whole interview was salary…you care more about money than this “overpaid” doctor does.

      • McDude is right. He’s greedy to want more money with no kids and a Gyno wife. Growing up in a family of six, my father, who is a PM&R doctor, was offered a HUGE amount of money at the later point of his career and ended up turning it down because he thought the amount was too much and did not feel the need for that kind of salary. We all had a great life growing up, dispite the fact, and I continue to do so without the need to make huge amounts of money in order to be happy with my life. I will always admire my father for doing the RIGHT thing.

  2. I guess what’s really interesting is that almost all the SDN MD interviewees weren’t completely satisfied with their income. I’m guessing it’s in relation to the amount of work and responsibility they are liable for though along with massive loans for recent graduates.

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