MedicalPhysician Q&A

20 Questions: Jennifer H. Yang, MD, Urology

Dr. Jennifer H. Yang is a pediatric urologist and assistant professor of clinical urology at UC Davis Children’s Hospital in Sacramento, Calif. Her practice involves the diagnosis and treatment of prenatal and congenital hydronephrosis, undescended testicles, hydroceles, hernias, neurogenic bladder, urinary infections and vesico-ureteral reflux. Her expertise also includes complex genitourinary reconstructions including hypospadias repair and management of disorders of sex development.
Yang received a bachelor’s degree in engineering from University of Pennsylvania in Philadelphia (1998), and her MD from University of Texas Medical School at San Antonio (2002). She completed an internship at New York Presbyterian Hospital/Weill Medical College of Cornell in New York (2004), and went on to complete a residency at the same facility (2008), followed by a fellowship at UC San Francisco (2010). Dr. Yang is board certified by the American Board of Urology and is a member of the American Academy of Pediatrics Section on Urology, American Urological Association, and Society of Women in Urology. Dr. Yang received the John Coleman Resident Teaching Award in 2007, and she has been published in UrologyBiological Reproduction, the Journal of Urology, Current Urology Reports, and the American Journal of Neuroradiology.
When did you first decide to become a physician? Why?
I came from a family of engineers, and was therefore a bioengineering major in college. Through some friends, I joined a community service fraternity and discovered how much I enjoyed helping people. During that same time period, both of my grandparents were diagnosed with cancer, and our whole family was very active in their care. My grandfather’s oncologist became a close and influential role model for me during those early years. It was this combination of personal experiences, and the utility of applying science and technology to help people, which transformed my career aspirations.
How/why did you choose the medical school you attended?
Interestingly, I did not have many choices regarding which medical school to attend. As an engineering major, my GPA was far below those of the majority of applicants. In fact, my college advisor did not support me in applying for medical school that year. I received only one interview from a medical school in my state of residence. As many of my friends received their letters of acceptance to medical schools around the country, I had made back-up plans and was in the third round of interviews for a consulting firm in Washington D.C. When I finally did receive my letter of acceptance to the University of Texas, San Antonio, I felt overjoyed and at the same time completely at peace with my future in medicine.
What surprised you the most about your medical studies?
I was the most surprised about how much I enjoyed almost every subject matter in the first two years of medical school, from biochemistry to pharmacology to neuroscience. Another surprise was how much I enjoyed being in the operating room. As a first-year medical student, we were paired with a community physician preceptor. Mine happened to be a busy general surgeon who specialized in gastric bypass procedures. This excitement about surgical specialties continued into my third year, much to my chagrin, as I had planned on becoming a pediatrician.
Why did you decide to specialize in urology?
My first exposure to urology was fraught with painful memories. My grandfather died of prostate and bladder cancer when I was in college. It wasn’t until a lecture in my second year of medical school that I even thought about urology again. The lecturer had such an ease and humor when describing the management of erectile dysfunction. Then during my third year rotation in urology, I discovered the amazing breadth of disease processes managed by a urologist. I observed complex oncologic surgeries such a retroperitoneal lymph node dissection for testis cancer, assisted on endoscopic kidney stone procedures, and counseled patients in clinic. Finally, it was also the invaluable mentoring and inspiration of the chairman of urology which completed my decision.
If you had it to do all over again, would you still specialize in urology? (Why or why not?)
Throughout my training, I dreamed of doing other specialties in moments of exhaustion and sleep deprivation. The only thing that kept me going was the unquestionable excitement I had in doing urology. I can remember the first time I extracted a ureteral stone, the first time I fired a stapler across the renal hilum during a laparoscopic donor nephrectomy, and the hug I received from a patient who was finally dry after a mid-urethral sling procedure. I cannot reproduce that kind of enlightenment and fascination for anything else, which is why I would probably still specialize in urology if I had to do it all over again.
Has being a urologist met your expectations? Why?
All politics and policy aside, being a pediatric urologist has far exceeded my expectations. The reward of caring for children by and large makes all of the effort worthwhile. I also thoroughly enjoy working with residents, expanding their fund of knowledge and watching them progress into confident and independent surgeons.
What do you like most about being a urologist? Explain.
One of the things I like the most about being a urologist (aside from everything else discussed prior, of course) is our ability to relate to people. It is uncanny how our field tends to draw a certain type of individual who can bring together medical knowledge and surgical expertise to solve complex problems involving the most intimate bodily parts.
What do you like least about being a urologist? Explain.
I least like the common stereotype that the field of urology is a good ol’ boys club. These days in certain areas of the U.S., women applicants to urology programs outnumber males. I myself was only the third woman to graduate from my residency program. It is wonderful to see so many motivated young women who will change the face of urology in the next generation.
What was it like finding a job in your field–what were your options and why did you decide what you did?
After my fellowship in pediatric urology, it wasn’t difficult to find a job. But since it is such a specialized field, there are not many sustainable positions in every area. The other issue was of course considering my husband and his career. At the time, he was already employed and very happy with his career, but there was not a job for me in the same city. We eventually found jobs in the same city, which was one that was agreeable for both of us to live and work in.
Describe a typical day at work–walk me through a day in your shoes.
I have a lot of variability day to day. Some days are in the operating room, others in the clinic, and still other doing urodynamic procedures. Most days begin quite early, hopefully with a half hour carved out for a short run before heading into the operating room. I spend time speaking with the family of the first patient and then the day starts rolling. I typically perform four to five cases, ranging from straightforward orchiopexies and hernia repairs to distal hypospadias repair to laparoscopic nephrectomy, and on some days robotic pyeloplasties. In between cases I am often called to the pediatric wards or the NICU to see a consult.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work 10 to 12 hours a day most days of the week, on average 50 to 60 hours a week. Sleep can be elusive for me, since I have two young children and many other things to add to the work load. I usually sleep five to seven hours a night. In my current position in an academic center, we receive two days of vacation for every two months worked, plus the holidays that I am not on call. I currently have 10 partners and I cover both adult and pediatric urology call for one week at a time every two months.
Do you feel that you are adequately compensated? Why or why not?
Unfortunately, physicians as a whole are not compensated as well as in past times, and often it is not the actual monetary compensation which is problematic. The logistics of medicine have become so complex – new electronic medical records, more regulation, increasing emphasis on patient satisfaction and national survey rankings, less autonomy and health care delivery debates. Adequate compensation is not a sufficient reason to pursue medicine as a career these days.
If you took out educational loans, is/was paying them back a financial strain? Please explain.
Educational loans are definitely an added financial burden, especially since both my husband and I have loans to repay. That is one difficult part about the education and training it takes to become a physician – delayed gratification. Once you actually secure your first job after residency or fellowship, you feel entitled to certain things—a new car, a house for your family, etc. Then the added financial responsibility of educational loans and previous debt start to really add up. Medical schools and residency programs should provide better education on financial investment and management strategies.
In your position now, knowing what you do – what would you say to yourself when you were beginning your medical career?
Enjoy your time and be selfish. Often young people are consumed by ambition and the idea that they are supposed to do certain things with their career, because a particular career path is what is expected of them. It is so important to picture what you want as a practice and career, as life is not always going to be like residency.
What information/advice do you wish you had known when you were beginning your medical studies?
I wish I had known how complex the practice of medicine would be from every perspective. As a student, one just does not have the opportunity to appreciate that being a physician is actually more than just caring for patients. There is a steep learning curve when you first start your practice, even beyond establishing your clinical practice patterns. Appreciating the business aspects of medicine, comprehending billing/documentation and maintaining relationships with our referral base has been time consuming. I also often struggle with the same political dynamics which exists in every organization.
From your perspective, what is the biggest problem in health care today?
Currently, there are numerous facets to the health care debacle which need to be addressed. The issue is where to start. For physicians, our focus should be changes that can be made now, in our day-to-day practice, which can increase quality of care, decrease morbidity and excessive or unnecessary dollars spent. Leaders in our field continue to drive important research to provide the information we need to make the right decisions. Until the policy makers can feasibly overhaul our entire health care system, it is the responsibility of the provider to be educated and fastidious in the care they provide.
Where do you see your specialty in five years?
The field of urology as a whole has received a lot of press recently regarding the management of key disease processes, such as the U.S. Preventative Task Force Recommendations on prostate cancer screening. I think these criticisms are an excellent way for us as a group to reconfirm our practice patterns. I hope to see continued enthusiasm for well-designed clinical and research trials to elucidate the information for the benefit of all.
What types of outreach/volunteer work do you do, if any?
At this time, my clinical practice does not include any specific urology-related outreach. Our institution is looking into telemedicine as a proponent of outreach and facilitating health care access, especially in the more rural and remote areas of Northern California which we serve. Many of our faculty support the student-run clinics, an amazing collection of community clinics entirely staffed by medical students and undergraduates, with faculty mentoring and support. Many of the underserved populations in the Sacramento region depend on these clinics as their only resource for both routine and acute health care, as well as an invaluable basis for health education.
Do you have family? Do you have enough time to spend with them? How do you balance work and life outside of work?
I had my first daughter while in residency, which was unheard of at my program. I then had my second daughter while in fellowship. I firmly believe that being a mother has made me into a better physician. In that respect I find time to prioritize my family, which often means less productivity in my career. Balance between work and home equates to peace, satisfaction and happiness in life, and this can only be achieved if you listen to yourself and do things to make yourself happy.
What is your final piece of advice for students interested in pursuing a career in urology?
Spend a little time every day for reading and learning something new. Whether it involves reviewing the basics in Campbell’s or searching Pubmed for the latest Phase III clinical trial on castration-resistant metastatic prostate cancer, prioritize your education. It is this habitual self-promotion of always expanding your fund of knowledge which will pay off in the future.

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