Why Dr. Nathan Starke Says Urology Is One of Medicine’s Best-Kept Secrets

For medical students weighing their specialty options, the decision can feel overwhelming. Which field will keep you intellectually engaged? Where will your personality fit best? And, most importantly, which path will let you make a meaningful difference in patients’ lives while maintaining work-life balance?

Dr. Nathan Starke, a fellowship-trained urologist in Houston, faced these same questions during his training. His journey from pediatric neurosurgery observer at age 14 to board-certified urologist offers valuable insights for anyone considering a career in urology.

What Is a Urologist & What Does a Urologist Do?

A urologist is a surgeon who specializes in diagnosing and treating conditions affecting the urinary system in both men and women, as well as the male reproductive system. This includes the kidneys, bladder, ureters, urethra, and in men, the prostate, penis, and testicles. Urologists are surgical specialists, meaning they complete extensive training in both medical management and surgical procedures. 

To become a urologist, physicians must complete four years of medical school, followed by a five-year urology residency program that provides comprehensive training in both open and minimally invasive surgical techniques.

Dr. Starke’s work in men’s health involves addressing quality-of-life issues: “In my subspecialty of men’s health, also known as andrology, I do a ton of quality of life improvement for men for very particular, often highly-personal male-specific issues,” including helping with sexual health, urination, and infertility. This level of sub-specialization allows andrology-focused urologists to develop advanced expertise that makes a meaningful difference in patients’ daily lives.

Why Urology? Personality Matters As Much As Skills

Like many medical students, Dr. Starke explored several surgical specialties before making his final decision. His parents, who are also physicians, suggested that he consider personality traits within a specialty.

With that in mind, he narrowed his choices to three fields: urology, plastic surgery, and orthopedic surgery. 

Orthopedic surgery, while impressive, felt too limited in scope. “While very interesting and fun, the focus on the musculoskeletal system wasn’t quite the right fit for me,” he explains. 

Plastic surgery offered the artistic creativity he found appealing, but the personality fit wasn’t quite right. “The personality type of the plastic surgeon is very specific. Highly detail-oriented, but maybe a bit too aesthetics-obsessed for me,” Dr. Starke says candidly.

Urology, however, offered the perfect combination of factors that mattered most to him.

What Makes Urology a Great Specialty

According to Dr. Starke, several key factors make urology an attractive specialty:

Diverse Surgical Opportunities

As Dr. Starke explains, “The range of procedures we perform is so diverse. You learn everything from robotics to laser surgery on the prostate and kidney stones, from reconstruction and microsurgery to major cancer surgery and kidney transplants.”  This variety keeps the work intellectually stimulating and allows urologists to develop multiple skill sets.

Better Quality of Life

Unlike many other surgical specialties, urology has relatively few emergencies. “There’s a pretty limited number of things that we get called in for,” Dr. Starke explains. “As opposed to orthopedics or neurosurgery, where nearly every car accident means you need to head into the hospital.” This means more predictable schedules and better work-life balance.

The Personality Fit

Perhaps most importantly, Dr. Starke found that his personality meshed well with other urologists. “Everybody’s smart because it’s a competitive field, but at the end of the day, everybody’s a penis doctor,” he says. “So while we are very capable surgically, everybody’s very down to earth, very funny, laid back.”

This collegial, unpretentious atmosphere creates a supportive professional environment that can be harder to find in some other surgical specialties.

Strong Compensation

While not the only consideration, urology offers excellent earning potential. It consistently ranks among the top 10 highest paid medical specialties. Combined with fewer emergencies and a better lifestyle, the financial aspect makes it a sustainable long-term career choice.

Discovering the Subspecialty: Men’s Health

During residency, Dr. Starke found his true passion within urology: men’s health and andrology. This focus area offered several appeals that aligned with his values and interests.

“You don’t deal with a whole lot of life-or-death, potentially lethal, bad cancer-type situations,” he explains. “You do a ton of quality of life improvement for men for personal male issues.”

The ability to connect with patients on a personal level became a hallmark of Dr. Starke’s practice. His direct, conversational approach helps men feel comfortable discussing sensitive health concerns. “I’ve always made it a priority to connect with the men I see in the office in a real, genuine way,” he says. “I make an effort not to speak like a scientist who talks in medical jargon. People appreciate that. Men are more at ease when  you level with them and act like a normal person.”

The Value of Fellowship Training

After completing his urology residency, Dr. Starke pursued an additional year of specialized training through an andrology fellowship at the University of Virginia. This decision proved invaluable for his career.

The fellowship provided two critical benefits. First, it offered advanced training in areas not covered during residency, including testosterone replacement therapy, male infertility, and microsurgical techniques like vasectomy reversals and varicocele repairs.

Second, and perhaps more importantly, the fellowship served as a transitional year between training and independent practice. “In my particular fellowship, in addition to learning a new set of skills, I also got to have my own small private practice in the clinic and operating room. I was able to learn to be a grown-up doctor, but with lots of other more experienced colleagues always around to help,” Dr. Starke recalls. “It was sort of the perfect introductory step following residency that enabled me to really hit the ground running once I got my first big job.”

This fellowship training directly led to his appointment as Director of the Houston Methodist Men’s Health Center immediately after completing his training, a remarkable achievement for a newly minted attending physician.

Looking Forward: Career Evolution 

Dr. Starke’s career also demonstrates that urology can open doors beyond traditional clinical practice. His role as Chief Medical Officer at Vivifi Medical, a surgical device company, allowed him to engage with the innovation and biotechnology side of healthcare.

“It completely reinvigorated my passion for medicine in a very different way,” he reflects. “There’s this whole other side of healthcare and medicine, especially in terms of innovation and biotechnology, that helped me use my brain in a completely different way.”

This career evolution underscores an important point for medical students: specializing in urology doesn’t lock you into one career path. The field offers flexibility to move into medical device development, healthcare technology, research, or academic leadership while maintaining clinical skills.

Is Urology the Right Specialty For You?

Choosing urology as a specialty isn’t just about the technical procedures or the income potential. It’s about finding a field where your personality fits, your interests align, and the work remains engaging throughout your career.

For Dr. Starke, urology checked all these boxes. The combination of diverse surgical techniques, meaningful patient relationships, a reasonable lifestyle, and opportunities for innovation made it the ideal choice.

“Surgery was fun. Seeing patients in the office was nice. I like helping people,” he says. But what made urology special was how all these elements came together in a sustainable, fulfilling package.

For medical students standing at the same crossroads Dr. Starke once faced, his journey offers a roadmap: explore widely, pay attention to personality fit, consider long-term lifestyle goals, and don’t be afraid to pursue additional training in areas that truly excite you.

How to Become a Urologist: Advice for Medical Students Considering Urology

Based on his experience, Dr. Starke offers several insights for students exploring urology as a career:

Find Your Personality Match

“You tend to go and do a specialty where your personality meshes very well with the people who already do it,” Dr. Starke advises, quoting the same advice his parents gave him. Spend time with urologists during rotations. Do their personalities, communication styles, and approach to patient care resonate with you?

Consider Work-Life Balance

Think about the lifestyle you want to maintain. If having predictable hours and minimal emergency calls matters to you, urology offers significant advantages over many other surgical specialties.

Look for Variety

If you’re someone who needs intellectual diversity to stay engaged, urology provides exposure to multiple organ systems, various surgical approaches, and both medical and surgical management options.

Evaluate Your Interests Within Urology

Urology encompasses several subspecialties, including oncology, female urology, pediatric urology, male infertility, and reconstructive surgery. Use your residency to explore these areas before deciding whether to pursue additional fellowship training.

Consider Fellowship Training

For those interested in specialized areas like andrology, pursuing a fellowship can provide competitive advantages in the job market and allow for immediate leadership opportunities in your chosen subspecialty.