Stephen Williams, MD
From the onset of our medical training, and continuing into residency, we are exposed to academic medicine. Seldom do we have any interaction or experience with private practice. After residency, many of us choose to enter a fellowship program for additional specialized training. Others, including myself, decide to enter private practice. Many fellows are disgruntled, as they believe their colleagues who opted for private practice are making a substantially greater income and “getting on with their lives.”
My path is unique. I decided to pursue private practice upon graduation from residency. However, after a couple of years of practice, I realized that I missed research and teaching and returned to academic medicine by entering a fellowship program. I completed my training in urology in the Harvard Program in Urology at Brigham and Women’s Hospital in Boston, Massachusetts. Additionally, I accumulated over 60 publication credits, which included numerous presentations primarily dedicated to urologic oncology and supported my interest in pursuing fellowship after residency. Many of these presentations were delivered during national and sectional American Urological Association (AUA) annual meetings.
I also interviewed with fellowship programs in urologic oncology, with the intention of accommodating my wife’s desire to move closer to family. However, some programs not located in close proximity to family also interested me. While pondering this dilemma of whether to pursue my academic interests or satisfy family obligations, an opportunity emerged to enter community practice in Southern California. I interviewed with the practice and after considering the balance between work and family interests, I decided to pursue community practice. Community practice offered the clinical appeal of managing my own patients and encountering diverse types of clinical urology cases. During my time in practice, I treated a variety of urologic conditions, from stone management to female urology; however, I enjoyed urologic oncology cases the most. From the initial diagnosis, to treatment, to patient follow-ups, I found great joy in managing prostate, bladder, kidney, and testicular cancers. I also kept track of my patient outcomes and quickly realized there was a void in practice that I wanted to address.
I approached the administration at St. Joseph Hospital to ask if I could become involved with committees and organizations to help improve the quality of care provided to our patients. I found this opportunity satisfying, as it allowed me to embrace not just my own practice, but also practices in other disciplines in and around the community. After working on several fund-raising events, I was elected to the Foundation Board of Directors at St. Joseph, and received the hospital’s support in hosting a Los Angeles-based radio show, “The Men’s Health Hour.” A weekly, hour-long talk show, it featured discussions on relevant men’s health topics ranging from urinary disorders related to benign prostatic hypertrophy to prostate cancer.
Despite the amazing opportunities I was offered and the wonderful relationships I developed while in private practice, I greatly missed the investigative research and teaching components of academic medicine. While clinical practice was intriguing, it often left me wondering what more I could do to improve medicine. One evening, while I was reviewing my billing (which should be the highlight of the day and why we put forth all of our hard work), I remember saying to myself, “I would rather be writing a manuscript or contemplating my next research project.” In that instant, I realized that I did not want to continue my career in private medical practice. Rather, I decided, I wanted to get back into academic medicine. I was torn between continuing at my current practice or pursuing my academic interests. During my time in Boston and thereafter, I had stayed in contact with colleagues who respected my intention to pursue opportunities outside of academia.
These colleagues recognized my work ethic and were aware of my contributions to a variety of publications. Naturally, this made it easy for one of them to call my bluff when a fellowship opportunity at a leading urologic oncology program opened up. After some serious thought and discussion with my family and previous mentors (including the chairman from my residency), I decided to leave community practice and enter fellowship at The University of Texas MD Anderson Cancer Center in Houston.