How and why did you become a urologist?
You learn in medical school whether you have a surgical or medicine orientation, and I found I was more surgical. I made a list of the surgical subspecialties with pros and cons, and urology was the winner. It allowed me to be a subspecialist in something that interested me, and I felt I could truly become an expert in it. I’d rather be an expert in one or two things than be a jack of all trades and master of none. Since I’ve been in the specialty, I’ve become increasingly more subspecialized, and now most of my practice is robotic surgery.
A big plus is that urologists are almost universally a bunch of good people. The specialty requires a certain personality. They are caring, well-balanced, and they don’t lose sight of the big picture of patient care. They are a fun group of people to be around.
I grew up in Temple, right up the road, went to Austin College in Sherman, and then medical school in San Antonio. I did general surgery at the University of Louisville, where I met my wife. I finished urology training in Georgia, then spent three years practicing in Portland, Oregon.
We loved the Pacific Northwest, but moved back to Austin in 2005 after a subspecialty fellowship in laparoscopic and robotic surgery. At that point, I joined a small practice with four other physicians who were in conversations with three other groups to form a large group. That was the origin of Urology Austin, and I was one of the founders back in 2007. We started with 14 partners and have grown and evolved so much since then. I’ve been on the executive committee here since the group was formed, and served as president for 10 years.
What is an average day like for you?
I do spend time in the clinic, but where many urologists spend about 75 percent of their time in the office and 25 percent in surgery, I have been able to tailor my practice to about 50/50 clinic and surgery time. I spend two, sometimes two and a half days in the operating room each week. The majority of that is robotic surgery for prostate cancer. I do a lot of kidney cancer and reconstructive surgery. Roughly 75 percent of my patients have prostate cancer.
What is your favorite part of working in urology?
I love the surgery. I have a relatively narrow focus, so I work hard to hone that craft and always strive for a perfect operation. There is a difference between doing a procedure and doing it perfectly. I’ve done almost 2,000 surgeries in my career, but I’m still continuously tweaking and changing techniques to give each patient the very best possible outcome.
The thing I get the most satisfaction from is the aspect of teaching patients and their families. Most patients may have done some research on or spoken to other doctors about their condition, and I try to reframe the way they think about the disease process. I spend an inordinate amount of time teaching, drawing, describing and making sure each patient understands more about their disease.
I tell patients all the time that I want everything to be an open book. If we have to talk it through 15 times, that is what we will do. The patient is going to gain just from the teaching aspect. My favorite thing is when I see a patient light up and say, “Nobody has ever explained this to me so well.”
What is your approach to patient care?
It’s always a team approach with the patient and family. If we are doing a consult on a surgery, I want to have everyone in the family come in, and let’s all talk. They are the ones who would be asking questions when the patient gets home. It has to be a team approach.
The good news is that we have the best surgery technology around. I have been fortunate to be one of the earliest adopters of the newest generation robotic surgery, the da Vinci® Surgical System, which requires just one incision. This surgery is less traumatic for patients and gives me more access to do cases and approaches that can’t be done with earlier technology.
It’s overcome a lot of barriers, and I’m lucky to be one of the first surgeons in the world to start using it and to have been able to train other surgeons at hospitals around the country. That has opened up opportunities for me to be exposed to surgical leaders around the world, and I’ve given talks about it in meetings with some of the biggest names in urology. Most of them are on the academic side, so they are really interested in learning about what I’m doing in private practice. Their experience helps me counsel patients better on what to expect one month later or even three, four or five years after surgery.
What do you like to do outside of work?
My daughters are in the 8th and 10th grades, and my wife and I stay busy with all of their activities. They play lacrosse, so we spend a lot of time traveling around with their teams. On a personal level, it’s important to me to stay in shape. I do a lot of distance running and marathon training. When I “grow up” and have more free time, I want to get in more time for fresh water and saltwater fly fishing and upland bird hunting with my English springer spaniel, Rascal.
Read more about Dr. Ruff here.