Will India too face a shortage of Trainees in Urology in Future?

Dear All,

Maybe, this issue of lesser trainees for Urology has not crept into Indian Scenario as yet. But it is likely to occur. This is an issue worth a discussion among the peers in Urology as well as trainees in Urology. The Peers can address what it is that have to be done to keep attracting more towards Urology while the trainees can address as to what their needs are during training and what are their goals at training.

In India, Urology as a speciality commenced in 1965 with the first candidate Prof. C, Chinnaswami obtaining M Ch (Urology) in 1966. We had 4 centres as training centres in the early days but it increased as and when those having qualified could get the necessary teaching experience. The main problem faced during that time was lack of approved centres and this was mainly not due to non availability of manpower but at many academic centres there was disinterest to commence Urology Centres.

Slowly but steadily Urology developed into a robust speciality and now there are many centres offering training for both MCh and DipNB courses in Urology.

With the prolific advances that have occurred in the recent past, there is a growing need to commence Subspecialty training in Urology in India. There are some centres offering such Fellowship courses but subspecialty centres are yet to develop in a big way. It is here that USI should come forward and encourage many of the present generation to take up one or other subspecialty.

Unfortunately, when a trainee is asked what he would like to be after completion of his training, majority will answer without batting an eyelid ‘Endourology’. This could be because of the glamour of instruments that are used and also it could be that it can fetch more financial returns when compared to other subspecialties. It is sad but true that because of such a attitude prevailing, we have handed over many subspecialties to other specialists. To recapture these from the clutches of other specialist section is going to be an uphill task. It is here that USI should make all efforts to reestablish all our subspecialties under the umbrella of Urology. If we fail in this, it could well be the beginning of End of Urology.

I am providing an article concerning the present situation in USA where with all facilities available; there appear to be paucity for takers for Urology. The article addresses the ways and means as how such a situation could be rectified.


Even in India, there is a lack of interest among females to take up Urology as a specialty. The main problem we are going to face is lack of Urology teaching at both Undergraduate as well at MS General Surgery level. MCI in its wisdom has decided to offer limited training in Urology at this level. It is again for USI to take necessary steps with authorities and see that Urology training gets more time during their training curriculum.

All of us Urologists along with USI should take necessary steps in order that Urology will fly higher among other specialties.

This is a subject that needs attention of all of us. I am sure many would be having different views as how to accomplish this. Hopefully there will be meaningful discussion which will benefit Urology for the future. The participation of all is solicited.

With warm Regards,




  • Nitesh Jain
    Nitesh Jain
    10 Aug 2020 07:46:08 PM

    Sir, I think you have raised some very pertinent issues and if not taken care off by we as Urologist we will see many more subspecialty going away from us. The main reason behind this is the glamour of Endourology, Laparoscopy and Robotics or Urooncology which everyone wants to chase along with probably more gratifying result and remuneration. Majority of the work done even in the primer institute revolves around this field and fields like reconstructive surgery, transplant, urogynaecology , andrology takes a back seat.

    I feel the priemere institute should start more and more subspecialization programme which latter can be taken up by the resident. USI can take a lead in identifying this institute as the nodal center and a year or at least 6 month of research focused training should be there to take the specialty to next level. There is no dearth of work in subcontinent given the population to urologist ratio, but we hardly produce any landmark paper or study. 

    The other set of issue is in private practice unlike in west no one wants to refer a case to his colleague even if he knows he does a much better job than himself again as we know all have to earn his own leaving unlike many countries in the west where they are on permanent payroll and can refine their skill and subspeciality without any worries. But atleast it can be started at premiere institute level and probably few years to come by we can see it being practiced more widely

    Urology as a specialty is still the most sought after branch, and before it gets saturated probably we will see the death of many other speciality.

  • pavan surwase
    pavan surwase
    12 Aug 2020 10:51:25 AM

    As a resident I have  developed  interest in what I am seeing and doing on daliy basis that is endouro ,lap and transplant and my future plans also guided by my seniors n colleagues who  specialise in endourology ,Lap and transplant .I have minimal exposure to above mentioned subspecialities so at present not thinking of pursuing career in any above mentioned subspecialties sir .

  • aditya parikh
    aditya parikh
    12 Aug 2020 12:18:31 PM

    Respected sir,
    I feel that there are adequate number of Urologists in the cities and not enough as we go to the smaller towns and villages. This makes it extremely important to provide adequate training in basic Urology and Urologic emergencies to the Undergraduates and Post graduates as they often act as a stop gap mechanism providing primary care. This is important because often these cases are mismanaged at the smaller centers before being referred.

    The con to adding more pg seats in Urology would be an increased competition in practice and Urologists not getting their due once in practice. A better way would be to enable the current crop of people to manage a wider range of cases in their practice.

    For this it's important to consider two approaches.
    Firstly a complete change to the residency system where one directly enters Urology after MBBS (2 years of rotation in relevant general surgery branches+ 4 years of dedicated Urology training) and also a structured rotation of residents in the later half of training to institutes practising a particular subspeciality more than their existing institute. 

    This would enable more in-depth knowledge of the subject, wider exposure and make the existing lot of people capable of managing the case load in the community. 

    Also every one wants to 'settle' down early which would be enabled by this. Use of bond year in helping the Urologist subspecialise would also be an effective way of promoting subspeciality training and keeping the various subspecialities under the realms of Urology.

  • Naveen Kumar Reddy M
    Naveen Kumar Reddy M
    12 Aug 2020 12:43:12 PM

    Respected sir, 

    This is an important discussion without any doubt and you have struck the right string at the right time.
    Constant progress and improvement is the way of life to sustain.
    We being in the Subspecialty of Urology by itself shows the progress of the surgical field. 
    More sub specialities in Urology would help one concentrate and master that particular field thus providing the best possible treatment to any patient. 
    Sub specialisation within Urology would also help one dig deep into the subject triggering more ideas, thus paving way for more helpful research.
    We in India are definitely lagging behind research infact in all fields. Incorporation of more clinical research at MBBS and post graduate level would bring in more interest and better ideas in sub specialisation and even more in Sub-Sub specialization. For this, more research labs for  in-vitro studies have to be initiated at all possible institutes. This then translates to better Clinical research. With which probably one day, we might have our own Indian guidelines in Urology. 
    With one of the most active medical societies in India, USI in association with MCI and NBE has all the potential to ignite this in the near future. 
    Travel research fellowships may help one get motivated bring in more ideas and implement it here.
    Research fellowships of 6months or 1 year before or after getting into a particular sub speciality may help. 
    Posting the residents to those institutes where they could see more of a particular sub speciality work being done may trigger interest. 
    Overlapping of subspecialities in Surgical field is inevitable. We being in the field of Urology would be able to give the best care and treatment to the Urology patients irrespective of what others might give or not. Thus, strengthening the sub specialities in the field of Urology would definitely elevate the patient care profoundly. 
    Taking this as a responsibility, we can escalate the number of sub specialists in Urology by
    1. Incorporating research at the earliest possible time after entering into MBBS, and further fine tune it during post graduation and master it during the sub specialization. 
    2. Incorporating research in the form of labs for in-vitro and invivo studies at subspecialisation level.
    3. Posting the trainees to the institutes where they can get some idea about a particular sub specialisation.
    4. Compulsory research fellowship before getting into a particular sub specialisation
    5. Incorporation of travel research fellowships
    6. Making it a part of curriculum in residency to attend premier sub speciality conferences in India compulsorily.
    7. Providing decent salary during the subspecialisation training.
    8. Making way for new fellowships in subspecialities in Urology and conducting an All India entrance exams for getting into it might help people apply easily and definitely get into it. 
    Finally, I feel the system of doing General surgery first and then getting into Urology will have to change as learning in depth about thyroid, breast etc in not at all required for a Urologist and kills time (Apart from giving free advices to friends and relatives). If there's a way to by pass general surgery, increase the period of Urology training to 5 or 6 years with 6months of general surgical rotation and 6months of dedicated research might help expand our field of Urology. 

    Thanks for the insightful thoughts and inspiration sir.

    Dr Naveen Reddy
    MPUH, Nadiad.

  • Shashank
    12 Aug 2020 01:40:08 PM

    Respected sir,

    As a  resident , we feel to pursue our career in the subspecialty which we witness during our training period. As most centers have endourology and laparoscopy access in appropriate amount , the upcoming urologists frame their own mindset to pursue their carrier further in that field. 
    We should have a complete exposure to all the subspecialty during training period to help us to choose our future subspecialty in urology.
    Resident should be given an opportunity to observe the various sub speciality cases from resepective apex institutions .

    Recently in covid times we have seen a drastic change in mode of learning. We can get access to many subspecialty fields at our doorstep.
    So combination of learning and listening from top most faculty members and visiting those apex institutions will put the resident in better position to choose one of the subspecialty path.

    Thank you sir.

    Shashank agrawal, MPUH,Nadiad

  • Rohan Batra
    Rohan Batra
    12 Aug 2020 03:48:30 PM

    Respected Sir,

    You have raised a very valid issue pertaining to the issue of Urological training. Sir, I feel , at present, the structure of 3 years of surgery + 3 years of urology should be changed. In fact, institutions like NIMHANS already have 5 year combined neurosurgery program, so even we can develop direct 5 year Urological residency  programs. This will benefit the candidate in terms of saving his precious 1 year in preparing for entrance exams , as well as he can finish his residency earlier than the conventional way. In this way, he can think of fellowship programs/sub specialisation in urology. Otherwise, what happens is that,when a candidate comes out completing his urology residency, he already has a family to sustain and has not even started earning a decent amout of living. So , majority candidates go for private practice instead of institutional practice. Also, I have seen that many govt institutes do not have adequate seats for srship . So even if one is interested in joining one, he cannot join it due to lack of seat. So, it's better to increase seats of srship also. 
    I feel , we should start with identifying and developing one mother  institute for each subspecialty and and ensure free movement of residents in those institutes through a roster ,zone wise. 
    That way, many residents will be exposed to all subspecialties. 
    Thank you sir.
    - Dr Rohan Batra, MPUH , Nadiad

  • Rohan Sharma
    Rohan Sharma
    12 Aug 2020 04:20:30 PM

    Respected Sir,

    What i feel that within this 3 year time frame,initial 6 months in the 3rd year of residency should be used for rotation into various sub specialities of choices like Robotic/Lap,Andrology,female urology,Endourology,Pediatric Urology,Uro oncology,Reconstructive urology etc,2 months each so as to get a good grip on atleast few subspeciality groups in which the person wants to progress.
    During the residency & rotation period,adequate hand on should be ensured so as to produce "Quality Urologist or Leaders" by some  strict vigilance policy under expert teacher. If a good number of immediately pass out resident urologist can do a laproscopic Radical nephrectomy, which no Oncosurgery resident was trained in their residency,definately no overlapping of Urooncology cases will happen between Oncosurgery and Urosurgery speciality. But on the other hand,if majority urology resident doesnot know how to do a Lap nephrectomy, definately he is equivalent to a general surgeon/Oncosurgeon and in future can feel he had no advantage in doing Urology residency.
    Times & Teaching patterns are changing very fast in the last decades but we should understand that We are ultimately a SURGICAL FIELD & the only way to learn fast is Supervised Hands on under an Expert. A good Hands on with well established training structure definitely attracts a Good & Hard working candidates and this TREND passes onto the Generations. These days many residents are even struggling to do a TURP/PCNL/Basic procedures.So these kind of training will definitely discourage future urology aspirants to take up Urology as their first choice.
    Another thing is to discourage the allotment of Urology seats in hospitals without adequate UP TO DATE infrastructure. Many hospitals have residents just to do the paper work & assistance rather than giving hands on. This produces poor quality Urologists giving bad reputation to the Urological society. 
    As Trends of sub specialities are increasing and length of training is ever increasing, this is discouraging to upcoming generations.6 year urology courses should come up(2 yr General surgery + 2 yr Basic Urology + 2 yr Speciality training rotation).
    But at every level, it is better to ensure the level of quality of surgical skills is maintained. In india, most of the surgery done is unsupervised/under immediate resident senior.
    Easy access to subspeciality fellowships should be made available on the single available website under USI. 
    Short(15 days)Student exchange programs during residency to better understand urology training at different centres across the world.

  • Zeeshan Kareem
    Zeeshan Kareem
    12 Aug 2020 05:45:17 PM

    Respected Sir,

    There is no question that Urology is one of the most sought after branches currently. Being in my final year of urology residency currently, retrospectively I would want to change a lot of things in the training program. The age old dictum that we learn the most by working in the wards holds true even today. However, changing trends in the structure of hospitals and institutes all over the country have incorporated a lot of paperwork that invariably has to be done by the residents working in the wards. Doing all the paperwork throughout the day not only makes us mentally exhausted but also makes us lose interest in learning about patient management. 
    Retrospectively, I feel that if there wasnt so much time wasted in paperwork we might have had more time to actively think about patient care and learnt more. So this is one aspect that should definitely be looked into.

    Secondly, the amount of exposure to various types of surgeries in different institutes all over the country is different. There should be structured programs where all institutes should only be allowed to enroll residents if they meet a certain number of monthly or yearly surgeries that one can observe and perform at these institutes. At present, most institutes across the country involve first year residents spending an entire year doing just paperwork and hardly applying their minds in patient management.

    Thirdly, I would agree that the solution is not to increase the number of seats but instead focus should be to improve upon the current programs that are being conducted across the country. Also, exposure to Urological surgeries should start right from starting your MS residency. Some institutes still have the rotation policy in superspecialities but during these postings also we are more involved with paperwork and ward work rather than get any actual exposure to surgeries, which eventually leads to a waste of time.

    Lastly, I think the USI should allow travelling fellowships within the country during residency training itself so that we can choose which subspeciality we are interested in and go to that institute for a few days to get more exposure about these subspecialities. This will increase the whole urology training experience and widen our perspective before starting practice.


    Zeeshan Kareem.

  • Saurabh Arya
    Saurabh Arya
    12 Aug 2020 07:38:39 PM

    Respected sir

    In my opinion, students gets interest in particular speciality if they get enough clinical exposure.As We know mostly all urology Sub specialities are at their infancy And most of the institute lack in proper Clinical exposure for most of sub specialties.

    In our medical education system ,it takes on an average 15 years to get urology speciality degree ,so we cant afford to increase this duration to increase exposure to these sub-Specialties 

    Some of the modifications that I can suggest are.

    1. exposure to general urology should be increased right from general surgery training.

    2. The provision for direct 5-6 year training course For urology should be encouraged.

    3.compulsory rotatory postings in all subspecialties during urology training.

    4.observership/ travel fellowship programs should be encouraged to cover sub specialties which are lacking in parent institute.

  • abhijit patil
    abhijit patil
    13 Aug 2020 06:34:13 AM


    You have raised a very valid point.
    Though there are lot of urologists passing every year, there is uneven distribution of them.
    Majority of them are roaming urologists and some of them are in institutions.
    Majority of them try to settle down in and around city.
    There is shorter of urologist in tier 3 cities and rural areas, sir just increasing number of urologists will just add to increase in density of urologists in city.
    There should be equal distribution of urologists.
    There are very few urologists ready to work in state government run hospitals or medical colleges. The shortage of urologists in this aspect can be sorted by proper remuneration and facilities.
    At last, sir you currently pointed out that majority of urologists perform only Endourology and it would soon be end of urology. The reason for this is that Endourology is bit easy to practice for roaming urologists. Sub speciality is difficult to practice in that scenario.
    Sub speciality is the need of the hour.
    But again there should be equal distribution in all sub specialities.
    Otherwise, it may happen as in US there is overflow of robotic surgeons.
    Abhijit Patil
    MPUH Nadiad

  • Ravindra Sabnis
    Ravindra Sabnis
    13 Aug 2020 01:05:01 PM

    Most of the points I had in mind, have been answered by those who have replied. 

    Sir, you have raised 2 issues, = shortage of trainees. & inadequate exposure of subspecialities. 

    Respected sir,

    You have raised 2 issues – One is shortage of trainee & inadequate exposure of subspecialties.


    Shortage of trainees – As you rightly mentioned after humble start in 1965, we have progressed well & after 55 years, we have completely different picture. Today we have more that 100 institutes offering DNB/MCh courses. Today we have close to 275-300 seats – both put together. Majority of the students who take up course, eventually pass out (if not today – tomorrow). Which means that in every 3-4 years we are producing 1000 urologists in India. If you see the statistics, as per population, we still have shortage & will need huge no of urologists. But this shortage is misleading. Abhijit has rightly pointed that, Large population in India is in villages & taluka places, where still there are hardly any urologists. Whatever new urologists who are coming, are settling in big cities, & may be few in district places. So just by increasing number, this imbalance is unlikely to disappear. No urologists will go & settle in smaller place, because of various other problems. So by increasing number we are creating super saturation in cities, which starts cut throat competition. If you see major cities, we have surplus urologists per lakh population. So, what we need is proper distribution of Urologists. Unless we address basic problem, no point in increase in trainees.


    About sub specialties, again problem is same. All urologists are competing with each other. Very few in bigger hospitals, govt hospitals, do not have to worry about competition. Endourology has glamour, because of cases load, & lucrative nature of specialty. One can earn decent money by practicing endourology. Same thing is true for uro-oncology. So people will be there to practice these exclusive specialties but this will not be true for smaller specialties.  Unless hospitals, gives fare remuneration to all, smaller sub specialties will never flourish. Those who are presently doing smaller sub specilities have to do gen urology to sustain. This way, sub speciality does not develop. We have to create atmosphere – at least in major teaching /govt hospitals, where dedicated person develops that sub speciality. Although this is happening in India, but number is very small. As pointed out by most trainees, if they do not get adequate exposure during their training, how will they develop interest.

    This is very major issue you have raised, & it needs to be tackled at multiple levels. 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    13 Aug 2020 06:32:07 PM

    Dear Sir,

    Great topic and equally great debates/responses.
    Almost agree with all the trainees and teachers posted their responses.
    This Diwali I got opportunity to meet Dr. Mahesh Desai and Prof. Glenn Preminger.
    While our interactions he asked me " are you doing only paediatric urology?". I replied no as I can not sustain as remuneration for paediatric urology procedure is very less in compare to endourology/oncourology and other.
    He informed me it is same in USA. But in his institute they all contribute in income of person who is taking responsibility or showing interest in subspeciality like paediatric urology. 
    In India we can do this simply referring patients to hospitals doing best in that particular subspeciality. Secondly as proposed by many our PGs in their write up they should exposure of all the subspecialites of urology during their training. If their own institute is lacking in one or two subspeciality than they should allow to have rotation or fellowship in institute where those subspecialities are doing better.
    I think USI has recently taken this issue very seriously and council is trying best to uplift all the urological subspecialities.
    There was recent survey from Prof. N P Gupta, unfortunately only 188 responses from such a huge society.
    USI has identified institutes with their high potentials in specific subspeciality and initiated fellowship program but because of COVID 19 progress is hampered.
    I have read responses submitted by PGs very carefully. I feel our future is good. Future of urological subspeciality is good to my understanding reading their thoughts.
    Little puch from USI, Institutes, teachers and trainees and we will be on path of success.

  • Venugopal P
    Venugopal P
    14 Aug 2020 05:04:46 PM

    Dear All,

    Prof. C. Chinnaswamy (Prof. CC to all and Chinna to those who are close) was the first Qualified Urologist of this country having obtained his M Ch (Urology Degree in 1966. He was the Prof of Urologist Madras Medical College for long.

    I am posting a write up provided by on his views on the topic that is under discussion. Uroacademy should be thanking this great Urologist for sparing his time and for penning his views.


    Write up of Prof. CC

    Thank you for giving me the opportunity to air my view on the MCh /DNB course in urology.

    At the end of a three year course in urology, the candidates from most of the institutions in the country venture out without enough confidence to start independent urology practice. To have a reasonable exposure to all sub-specialties in urology a candidate must spend at least 5 years in urological training.

    Many years ago, when the urology course was introduced in our country, Prof.H.S.Bhat was asked as to who he considered an urologist. He replied saying any general surgeon capable of passing a ureteric catheter after cystoscopy can be considered a urologist. That was nearly sixty years ago. Urology has grown so much since then, that we have more than ten sub specialties under Urology. It is very difficult for a trainee to get adequate exposure in most of the sub specialties.

    The idea of insisting on a general surgical qualification before starting on urology training was founded on the necessity of candidates having training in basic surgical principles, which is necessary for any surgical practice and to get experience in handling bowel which may be necessary in reconstructive urology. This concept is becoming quite outdated. There is no necessity for a three year course to get trained in basic surgical principles. With so much diversification in general surgery, experience in handling bowel gets limited, with most of it being handled by M.Ch. certified G.I surgeons.

    Direct admissions for higher speciality (without a general surgery qualification) have been in practice in neurosurgery for more than 20 years. These direct neurosurgeons are as good as those who did neurosurgery after M.S. General Surgery. In Urology also, there are many distinguished gynaecologists who have established themselves as internationally recognized urologists (all without M.S. General Surgery qualifications).

    Insisting a full three year general surgery qualification before joining M.Ch or DipNB course in Urology is a gross waste of human resources, and a waste of highly productive years of young medical professionals.  To further elaborate on this; let us consider two smart candidates completing their schooling. One of them chooses medicine, and starts with MBBS (~6yrs), does general surgery (3yrs) and then a M.Ch urology (3yrs).  The other candidate chooses engineering (4yrs) at a reputable institution, followed by a masters (2yrs) or an MBA (3yrs), allowing him to complete all of his education within 7yrs at most. This difference doesn’t take into account the time, the medico has to spend preparing for the entrance examinations at each level. The earliest this candidate can achieve it, is when he turns 29yrs of age, but on average is much higher (32 years of age), while his contemporary who choose engineering has already established himself as a senior executive before he reaches thirty. Not to mention the uncertainty at each checkpoint along the process. This in itself is becoming a major deterrent to people choosing the profession.

    In the current set up, an M.Ch urology candidate can become a senior resident in his early thirties and become a consultant only when he reaches his late thirties or hits forty. The additional requirement of exposure and knowledge becomes a barrier for a candidate to practice independently. While spending two years extra with a urology set up and an entire year devoted to a particular sub speciality may not solve this problem entirely but will most definitely go a long way in addressing it.

    I would propose that we start M.Ch urology as a five year course period with the candidates starting their course with a four to six month training in General surgery to understand the basic surgical principles. They can further have rotations in paediatric surgery, neuro-surgery, vascular surgery and nephrology departments. In the final year they can select one sub speciality and work for 6 months in that field. This way, at the end of five year, he can end up as an accomplished and adequately trained urologist.

    Lastly, I would like to point out that other urological associations across the globe have also found merit in this approach. The American Urological Association, one of the oldest ones, does not require general surgical qualification. While we do not need to adopt the western practices blindly, we should look for practices to adopt and streamline our own system. I firmly believe this will aid in making the course more beneficial for the young medical professionals. The benefits of having diversely trained and capable urologists will not only help the Urological community but the entire community as a whole.

    Prof. C. Chinnaswamy


  • Ravindra Sabnis
    Ravindra Sabnis
    14 Aug 2020 05:37:21 PM

    I totally endorse views of Dr Chinaswamy sir. It is high time we need to start all superspecialities as direct 5 years course after MBBS. I have following reasonings 

    1) Previously whether urology or gen surergery - most of the things were open surgery. That time urology was different from Gen surgery only as TUR, VIU...etc That was time when full MS degree & training in Surgery was needed & was of value. However now things have changed Open surgery in urology is <5-10% However we have still not changed the system,. Now system of 3+3 should be changed to direct 5 years. 
    2) What is use of Urologists spending time in Thyroid, breast surgery when in his life time , he is not going to do it. SO 2 yrs are sufficuant enough fro him to rotate in Gen surgery onl for basics & what is pertinant to urology. - Like bowel handling, basics of lap, critical patient care ..etc . For that MS degree is not required 
    3) Previously students had no knowledge of what is superspeciality - they were imature to take decision at the end of MBBS. Gen surgey degree gave them exposure of all branches. However that is not true now. WIth google, & internet, present generation is 1000 times smarter that what we were at their age. They are aware of everything. Their maturity level is very high. SO they are entitled to take decision at end of internship 
    4) 2+3 is very good where 2 yrs is gen surgery rotation & 3 years in Urology training. In fact a step further can be 2+3+1 - where last year is compulsory rotation in any subspeciality - This is possible when we have sufficient training centers of all sub specialities. But till then 2+3
    This may true for all super specialities - like plastic, CVTS, Ped Uro, gastro...etc 
    SO I also feel that direct 5 yrs is need of an hour.  

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