The gatekeeper disparity--why do some medical schools send more medical students into urology?

Urology continues to be a highly desirable specialty despite decreasing exposure of students to urology in American medical schools. We assessed how American medical schools compare to each other in regard to the number of students that each sends into urological training. We evaluated the reasons why some medical schools consistently send more students into urology than others.

We obtained American Urological Association Match data for the 5 match seasons from 2005 to 2009. We then surveyed all successful participants. The survey instrument was designed to determine what aspects of the medical school experience influenced students to specialize in urology. Bivariate and multivariate analysis was then done to assess which factors correlated with more students entering urology from a particular medical school.

Between 2005 and 2009 a total of 1,149 medical students from 130 medical schools successfully participated in the urology match. Of the 132 allopathic medical schools 128 sent at least 1 student into urology (mean ± SD 8.9 ± 6.5, median 8). A few medical schools were remarkable outliers, sending significantly more students into urology than other institutions. Multivariate analysis revealed that a number of medical school related variables, including strong mentorship, medical school ranking and medical school size, correlated with more medical students entering urology.

Some medical schools launch more urological careers than others. Although the reasons for these findings are multifactorial, recruitment of urological talent pivots on these realities.