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Gordon Brown: Hello, I'm Gordon Brown from New Jersey Urology here today with Dr. Eric Ballon-Landa of the University of California San Diego. He's a rising chief resident attending the Large Urology Group Practice Association Summit for a Rising Chief Residents. We're here today to talk about tips and tricks around the interview process for urology resident applications. Dr. Ballon-Landa, thank you for joining us.

Eric Ballon-Landa: Thanks for having me. 

Gordon Brown: We are spending some time here at the Large Urology Group Practice Association Resident Summit in San Diego. Thank you for your time. Welcome.

Eric Ballon-Landa: Thanks. 

Gordon Brown: So, help me understand. Why urology?

Eric Ballon-Landa: I kind of came into urology by accident, actually. I was pretty sure I was going to do medicine or some sort of internal medicine subspecialty, and I did my medicine rotation and realized I didn't like it very much and I actually loved surgery, but I still loved the parts of clinical medicine, having patients in your clinic, having a relationship with patients over a long period of time, and I found that urology is one of the couple of surgical fields that really allows you to do surgery, which is super fun and awesome, but also have that connection with your patients.

And I think more so than just having clinical patients, issues that we deal with in urology are obviously very personal, and so I think that talking about those kinds of issues with patients I found really gratifying in terms of really meaningful quality of life issues that patients have and also things that they aren't willing to share really with anybody else. Very intimate issues from men's sexual health and urinary habits and things like that. 

Gordon Brown: Yeah, I think it's a field which really is a hybrid really of both medicine and surgery and allows you to somewhat choose your path a little bit, as you're alluding to, one, and two, it really allows us to form very well defined, meaningful, longterm relationships with our patients, which a lot of surgeons don't have the ability to do, and I think that really is unique about urology and separates us from a lot of the other surgical subspecialties potentially.

As everybody knows, urology is a very competitive field, that the residency spots, I believe on the high end there's 75 applicants per one spot and on the low end, I think it's somewhere in the mid to low 30s for every available spot. So, take us through your journey as it relates to your application process, what was involved in there, what you did to obtain a successful spot and help us through some of the trials and tribulations as well as some of the potential goals and wins that you were able to achieve as you went along that journey. 

Eric Ballon-Landa: Sure. I think that one of the things ... My path is probably a little bit different from some in that I did an MPH while I was in medical school, so I did it between my third and fourth year of medical school, and I did really use that time as an opportunity to really build up a research portfolio. I obviously did the degree itself but also developed a relationship with the urology department at that institution, and that really helped me to dive into the world of urology and research in urology. Obviously, that research was a little bit more from an outcome standpoint, given my degree in MPH-

Gordon Brown: And that was at the University of California Irvine?

Eric Ballon-Landa: Actually, that was at UCLA.

Gordon Brown: UCLA. 

Eric Ballon-Landa: Yeah, which is where I was doing my MPH, so that was kind of a lucky opportunity that I fell into, but additionally I think obviously everyone will tell med students that you have to have certain board scores or whatnot to even think about doing urology, and you hear conflicting things. Some program directors will say they have specific cutoffs, but I think a lot of people do really look at the overall picture of an applicant, and they want people who are obviously intelligent, and board scores are part of it but definitely not everything, but more than that, they really want people who are motivated, interested, dedicated, and I think that the small nature of the field is such that people who really shine are those people.

Gordon Brown: Did you find that the interpersonal relationships you developed while doing your MPH were helpful in translating to a successful application process?

Eric Ballon-Landa: Yes. 

Gordon Brown: How many programs did you apply to? Were they geographically dispersed or were they pretty much centrally located? 

Eric Ballon-Landa: You're asking me to remember things from five years ago, so I think I applied to about 50 programs all over the country, which was sort of median at that point. I wasn't-

Gordon Brown: Pretty remarkable if you think about it, right? That's a huge number of programs. Did you interview with that many programs? 

Eric Ballon-Landa: No. I interviewed I want to say at about 15. Maybe a couple more than that, but I do think that the field is so small that any personal relationship that you have with somebody in urology, especially academic urology, that is going to be very valuable to you in the process. 

Gordon Brown: So as a piece of advice, that might be something that-

Eric Ballon-Landa: Definitely seek out somebody who can be sort of your champion.

Gordon Brown: Yeah. So, there have been some pretty remarkable changes in the field within the last five to 10 years. Give me your thoughts as to what you think where we've been the last five years or so and what some important advances or changes might have been, and where do you think we're going in the next decade or so as urologists?

Eric Ballon-Landa: Yeah, there's a couple of ... Obviously, technology is ongoing and constantly changing. Robotic surgery was probably the new thing 10 years ago, and now it's sort of established. And then there's always new technologies coming up with ... especially BPH management, which are-

Gordon Brown: It's been a dramatic amount of new technology and therapies developed in the BPH arena. 

Eric Ballon-Landa: Which is really interesting in terms of how you work those kinds of things into your practice and also getting to learn new skills on the go. At some point, one of the ... We do one of the steam treatments at UCSD, and one of the reps had commented that I was the largest, the highest volume provider at UCSD at one point because I had been involved in some of those first procedures. But I think it does keep you on your toes in terms of developing new skills and clinical skills in terms of determining when to apply them and how.

Gordon Brown: And that's one of the beautiful things about this subspecialty as a whole, right? That it's constantly changing and there's multiple arenas, whether it be oncology or female urology or voiding dysfunction or men's sexual health that we can look to apply our talents and take care of patients, and I think that the technology seems to be growing, certainly almost at an exponential rate in most of those fields, certainly BPH being one of them. 

Eric Ballon-Landa: Yeah. I think you could pick any one of those areas and find some equivalent story. 

Gordon Brown: Yeah, it is, and I think that also makes this a very exciting endeavor for us intellectually and from an interpersonal level, from a patient care side.

So, I guess we're just going to conclude and see if you have any suggestions, any recommendations for those people coming up who want to be where you are in say five years from now, in that rising chief seat, understanding what you've been through, the landscape of where you've been, if you can give them any tips or tricks or suggestions that might help them achieve what you've achieved so far. 

Eric Ballon-Landa: Yeah, I would say it's a great field and it's worth the energy, and obviously it's a long road. It's at least a five year training, more if you choose to do a fellowship. I think one of the things that we've been talking about at our meeting today applies to medical students too and is you really just have to feel passionate about what you're doing because there will be days that you have tough days and bad outcomes or difficult patient encounters, but those have to be balanced out by just a real feeling of the mission of wanting to help patients and be the best doctor you can be.

Gordon Brown: I think that's great advice. I agree. The sense of purpose and passion for your chosen specialty as well as being in an environment with a positive culture at your desired training site, I think, makes everyone more successful and translates into improved patient care.

I really want to thank you for your time today, and it's been a pleasure talking to you from the Large Urology Group Practice Association Rising Chief Resident Summit in San Diego, California.

Eric Ballon-Landa: Sure. Thanks again for having me. 

Gordon Brown: My pleasure.