The Modern Urology Pipeline: Career Trajectories of Recent Residency Graduates.

Abstract

Introduction: Urology residency graduates face a pivotal transition when deciding on fellowship training and eventual practice setting. While traditionally a fellowship was a gateway to academia, recent trends reveal increasing pursuit because of job market concerns and perceived gaps in operative preparedness. We aimed to identify factors influencing urological fellowship pursuit and subsequent career trajectories.

Methods: We analyzed a previously created database of publicly available information of ACGME-accredited urology residency graduates from 2022 to 2025. Data were obtained from institutional, residency, fellowship, and employment profiles. Outcomes included fellowship enrollment and employment in academia or private practice. Statistical analyses included Student t tests, Mann-Whitney U, chi-square tests, and multivariable logistic regression.

Results: Among 1310 graduates identified, 46.0% (n = 602) pursued fellowship training. Predictors of fellowship pursuit included female sex (53.0% vs 43.1%, P = .001), holding another graduate degree (64.6% vs 43.9%, P < .001), and graduation from a top-quartile Doximity-ranked program (51.9% vs 34.0% of graduates in the last quartile, P < .001). Overall, 75.2% of graduates entered private practice and 24.8% academia. Those within academia were more likely to have completed fellowship training (49.6% vs 11.9%, P < .001) and a 6-year residency with dedicated research year (33.0% vs 22.5%, P = .002). Female sex was also associated with fellowship subspecialty choice, comprising 80% of urogynecology and reconstructive pelvic surgery fellows compared with 22.1% of Society of Urologic Oncology fellows.

Conclusions: Despite most graduates entering private practice, nearly half pursue fellowship training. Meanwhile, those working in academia are more likely to have completed a fellowship or trained in a 6-year residency or a top-ranked program. Notably gender disparities persist in fellowship subspecialty selection.