This career profile is a blessing to everyone on the physician career path - from premed to attending. Below, Dr. Milhouse discusses why she chose to stay in state for her premed/medical studies, how she chose urology, matching urology, and the sacrifices all of that has required from herself, her mother, her children, and her husband. I am humbled to present this interview to you.
Name: Fenwa Milhouse
Hometown: Lagos, Nigeria and Plano, Texas
Current city: Chicago, IL
Undergraduate with major: University of Texas Austin - Biology
Medical school: University of Texas Houston
Residency program: Urology, University of Chicago
Fellowship: female urology at Metro Urology in Woodbury, MN
Take me back a decade, what did you want to be when you grew up? A physician - considering between urology or gynecology.
Tell me about your college application process? How did you decide on a school and major? I wanted to go out of state but my smart father advised me to stay in state. At that time, UT Austin was a highly regarded and very affordable state public school and the only Texas school I was interested in, so I focused my efforts there. I applied using the state wide application and was admitted automatically due to the Texas top 10% rule. I chose my major because I knew I wanted to me a physician or dentist and I did well in biology in high school.
What was the hardest part of your undergraduate studies? How did you get through it? Honestly, I went to a fabulous public high school in Plano Texas that prepared me tremendously for college- especially my freshman year. The harder part came with balancing my extracurricular pursuits with my academic goals. I pledged DST [Delta Sigma Theta] and became extremely busy thereafter with being involved in a very active sorority. I had to be very disciplined to keep my grades up. I always knew where I wanted to end up (medical or dental school), and I knew I had to have a strong, competitive GPA- not an average one- so I couldn't just study like the average person. For me, that was the motivation enough throughout my entire undergraduate education
This meant late nights at the library when everyone else was sleep, pre-reading before class so I would be prepared, and carving out study time after events or after parties. My hardest class was actually an elective finance class which I ended up dropping because I was making a D.
Elyse add: One of my medical school interviewers actually commented on how so many black pre-medical students' grades decline after they pledge a sorority/fraternity. I saw it happen within my own sorority. Have fun in college, but keep your eye on the prize!
Did you take time off between undergrad and medical school? Why or why not? and if you did take time off, how did you spend it? Yes, 6 months because I graduated a semester early. I spent it working at the Texas Dept of Public Health in Austin. BUT, if I could do it over again, I would taken off a whole year and travel or work abroad because after medical school, you will never really have that kind of opportunity to take time off again.
How and when did you decide on medical school? I always knew I wanted to go into some sort of medical field. I decided medical school definitively in my junior year. I knew I probably wanted to work with my hands but wasn't sure how yet.
What did you do to be a good medical school applicant? I had a strong GPA. Prepared for MCAT using Kaplan Review and got a solid MCAT score. I got REALLY STRONG letters of recommendations- which I think is the most important thing that can make a candidate really stick out- not just for medical school but for residency and job application (more advice from Fenwa on letters of recommendation here). I also did a tremendous amount of community service to demonstrate my well-roundness. I made my personal statement unrelated to medicine in any way. Related: Components of your medical school application
How and when did you decide on urology? What other specialties did you consider? I was introduced to urology in the first week of school when a new friend I met told me he wanted to go into Urology. Before that, I had never heard of the field. When I learned about it, I figured it was a field for men- I had no real interest. I thought about dermatology for a moment then decided I didn't want to look at skin and do biopsies all day. I thought about neonatology- but hated rounding and did not want to deal with parents. Then, as second year, we had the Interim Dean of Urology - A BLACK WOMAN give us a talk about Urology. I was shocked that a black woman was a urologist- not because black women can't do anything they want but I was curious why a woman of color would go into such a field. I introduced myself to her and started shadowing her and her colleagues (my program did NOT have any dedicated urology rotation). I was able to see what a urologist actually does in the OR and in clinic. I realized it matched my desires/goals perfectly. I had been seriously considering gynecology at this point but urology seemed much more fitting. I also really liked the personalities of most of the urologists I met. They all seemed genuinely happy with the career path, have fun at work, and not too overworked. Related: Why I chose dermatology,
What do urologist do? Urology is surgical sub-specialty that focuses on the genitourinary tract. Urologists perform surgery on the adrenals, kidneys, ureter, bladder, urethra and male reproductive system. A sub-specialty called female urology also involves vaginal and female pelvic surgery for urogynecologic conditions. Other sub-specialties in urology include: pediatric urology, urologic oncology, minimially-invasive surgery, endourology, male reconstruction, male infertility, sexual medicine, and neurourology. Urologists usually split their work-week into some part clinic days and some part operating days. There are several urologic conditions that are medically treated (i.e recurrent UTIs, benign prostatic hyperplasia, overactive bladder, erectile dysfunction, etc.). Some examples of the most common surgical procedures performed by a urologists include cystoscopic procedures, kidney stone procedures, transurethral prostatic procedures, radical prostatectomy, robotic procedures, circumcisions, vasectomies, and scrotal procedures to name a handful.
Urology is a very competitive specialty. Any tips on how to excel in medical school? this answer was so good, we made it it's own post. see here - tips to excel in medical school and match urology from a urologist.
I recently read that only 8% of urologist are female, the smallest proportion of any medical specialty. What was it like to train in such a male-dominated field? Did you feel you had to compensate for your gender? Yes the 8% prevalance is true. Fortunately, the percentage of female trainees in Urology is higher and only going to continue to grow. Clearly, this is my own personal experience, so I can not speak for the average experience of female urology residents nationwide. Having said that, most of the female colleagues I personally know in the field do not have any horror stories and have had mostly positive experiences during training. I trained at the University of Chicago. When I entered my residency, the program had already had 3 previous female residents who left good impressions. Furthermore, one of my chief residents was a woman. Therefore, I felt no misogyny. I wouldn't say I felt like I had to compensate for my gender. But I did feel like I couldn't wear my emotions on my sleeve- but that had more to do with being a surgical resident than being a urology resident. I had all male attendings who treated me exceptionally well. My program was fond of female residents because they were usually high achievers and better organized. During my pregnancy, my program completely supported me.
Now, some of the male patients can definitely be apprehensive about a woman urologist. Majority of my encounters with male patients went smoothly. I have had a handful of men initially refuse to be seen and/or examined by me. Fortunately, most of the time, I have been able instill confidence, drop their guard down, and change their minds. I have also had other male patients who have said inappropriate things to me as women (i.e. flirty advances, sexually jokes, etc.). Those incidents never put me at any physical danger but made for unforgettable work stories to share.
How did you go about making your rank list? This is different for every person. A urologist at MD Anderson once told me as a medical student "go somewhere where you are busy when you are at work but where fun is readily available when you get time off work"- these were exactly my goals. I wanted to be well trained but needed to be in a good location as a young, fun-loving adult. I did not care about "big names" since there are plenty "big names" that don't actually train residents well surgically and plenty of non "big names" that do. Location was #1- I wanted to live in a big city. Surgical case load/volume/diversity was #2. I asked residents when I interviewed how they felt about their case volume and preparedness for the real world. You won't always get an honest answer but at least ask. I also used Urologymatch.com - which is basically THE go-to forum for all things urology match- it is FOR applicants. You can be completely anonymous. So there are plenty of posts that talk about individual programs either posted from folks that did away rotations there, interviewed there, or just plain have the inside scoop.
Lastly, I followed the almighty "gut feeling" that has yet to let me down. A great gut feeling goes a long way. I had that exactly about Univ of Chicago and it changed by life (for the best). Related: How the NRMP Match algorithm works (and how I made my rank order list)
What advice would you give to a freshman premedical student? What about a 1st year medical student? My motto: Work hard. Play hard
- Get really good grades and get involved in something you can be passionate about outside of school.
- Enjoy this time- do something exciting if the opportunity presents itself. It may not again!
- Take time off if you need to- don't be ashamed or worried. Especially if you are already in medical school, once you are in the door, it's hard to get thrown out. You're going to be older than all your friends anyway when you start your first real job!
- Enjoy the journey- I have lifelong undergrad and medical school friends and timeless memories.
life outside of medicine
What's your favorite city that you've lived in? Where do you see yourself ultimately? New York- I only spent one month there but LOVED it.
I not only want to be the private practice urologist that I am now. I want to be regularly involved with surgical missions trips in under-developed countries. I had the opportunity to perform urethroplasties in Rwanda 2 years ago- I want to make this a habit.
What does work-life balance look like to you and suggestions on maintaining it during intern year? Being able to excel as a trainee and also maintain your sanity as a person. Maintaining important relationships. You will NOT have the same free time as most of your friends and those that are real friends will be understanding because they want to see you succeed. But when you can make time (which can take some effort especially as residency life can wear you down)- try to. My intern year was my easiest year of the entire time. My 2nd year and chief years were the hardest. I had to sacrifice some social time with friends, weddings and other life events, etc.
Somehow, I managed to meet and date a wonderful man and become a wife and mother in my 5th year so the juggling act got more complex. I am not going to pretend that you can master it all. My mother helped raise my daughter while I was a resident. My husband took care of household stuff. So I was not the best wife/mom for that time. Now I can enjoy the fruits of our sacrifice, be much more involved in the home, and affirm old relationships that had to be put on hold. Residency is a sacrifice but it can be rewarding. It was for me.
Talk to me about being a wife and a resident. What are the challenges and rewards? Is your husband in medicine? OK- this is where things get really real. THERE ARE CHALLENGES. My husband is NOT medical- he is a teacher. He is fortunately very selfless and understanding and happens to cook and clean. I could not have married a needy, lazy man. Because the reality is that after working on my feet and thinking all day, I am lazy. This was particularly bad during my very stressful chief year. Our marriage suffered greatly. I just did not have time or energy because my chief year was so demanding. My laziness at home got much worse. I did sometimes take advantage of his self-sufficiency and hard working nature. He became bitter and resentful causing arguments sometimes publicly. We ended up going to counseling during my fellowship and because my fellowship was basically NOT stressful at all- we were able to spend quality time fixing these issues. Talking to other wifey-urologists/surgeons- we are not alone. Marriage alone is a challenge. Sometimes, I have to put work down and pay attention to my husband. And that was a learning lesson. Our marriage now is more rewarding. I think I have an amazingly understanding husband who has never held me back from being a fabulous urologist. Communication and honesty in the relationship can not be understated.
How old are your kids? How do you balance motherhood and such a demanding career? My husband and I have a 3 year old together. I have 2 stepkids from my husband's previous marriage- 14 and 16.
Again, I DO NOT have it all. I am highly blessed (probably spoiled) to have had my mother look after my daughter full time during my last 2 years of residency. I also have a husband who is a tremendous father that does everything around the house. Being a mother-physician- I have a lot of mommy guilt. The daycare barely sees my face. I sometimes don't get in until after she's gone to bed and then have to leave before she wakes up in the morning. On weekday nights, when I do get to see her before bed time- I spend all my time with her. I also get her ready as many mornings as I can (basically on my clinic, non-OR days). And on weekends, we all 5 spend time together. Mommy guilt is so normal and I try not focus on it, instead focusing on the example that I am hopefully setting for all my kids.
What does your ideal career look like? Doing what I am doing now- specializing in female urology. I would love the idea of residents rotating in my practice if that opportunity ever presented itself and practicing urology abroad in the form of surgical missions trips. Staying up to date in my field, being involved in my specialty organizations
Where do you see yourself in five years? Hopefully a home-owner. Well-known, respected urologist in the greater Chicago-land area.
What sacrifices have you made for your career? I sacrificed LOTS OF time for others. My mother sacrificed by moving away from my father in Dallas all the way to Chicago to help me raise my daughter when I had her during residency. My husband has had to sacrifice every day in keeping the fort down at home. Even today as I type this, I am on call and have 2 add-on cases that will keep me away from home until 10 pm tonight.
This is real life.
Thank you so much Dr. Milhouse for this wealth of information and insight.
Leave questions and comments below!