Dr. George Koch

And then I'm lucky to have, you know, a couple of partners who support me and are reconstructive partners and then a whole department of folks who are really supportive.

But when you come out of fellowship and that's what you want to do is that subspecialty care, you know, if you open a rural practice, you're going to see absolutely everything because they need a urologist.

So there will have to be some way to figure out how to

Kind of maybe it's like a maybe it's a group hire or pool hire where it's, you know, a rural place is going to say, OK, we're going to invest not only in bringing a GERS person, but we're going to get a GERS person, oncologist, a general urologist and a stone guy.

And we're going to group hire them or something like that, you know.

And now we're saying that there's a shortage of urologists and I'm just saying, you gotta, you know, you gotta hire four at once, but it's going to have to be something like that because from a subspecialty standpoint, I feel like I've learned so much because I'm at a big quaternary center.

I see tons of recon.

But it will be harder to pull a fellow who's so excited about starting their career as a reconstructionist to then go to a rural area and maybe have to see a bunch of elevated PSA or maybe have to see a bunch of BPH LUTs.

So it'll have to be incentive, but I think it'll have to be some sort of creative solution too.

Yeah.

I mean, for surgery, for, I mean, even if, even if you're saying we'll shoot your rug on the day of surgery or the day before or something like that, it's still like, you know, to get a rug, to get a Euroflow, to sisto somebody, you know, you're, you're probably talking about multiple, multiple visits, unless you have a local urologist that, you know, really, really trust their workup and they have, you know,

have a track record of like communicating things with you and that kind of thing.

You know, Dr. Wessel's had a great system and a great practice where like there were a bunch of urologists in Alaska who he's been working with for a long time, lots of more UW graduates, and they would come down and we used to call it one-stop shop where like they would come down and in one trip to Seattle, they would get like

all of their stuff down in a week period.

And, and you, you like rarely got burned because they had what, you know, they had, they knew what he was looking for and he knew that they would have what he was looking for.

And it was a good system, but you can't, you gotta have to, you know, that's, that's time and relationships to, to build that kind of thing, you know?

Yeah.

Last thing I know I've already asked you to solve the education and access issues in in urethral surgery already today.

But one thing that that you really are a leader in is reconstructive urologic research.

I was wondering if you could talk about how you've seen the research space in reconstructive urology and, you know, grow and change kind of over time.