John T. Barnard, MD
Board Certification: American Board of Urology
Medical School: West Virginia University
Residency: West Virginia University
Fellowship: University of California, Irvine - Eric S. Wisenbaugh Fellowship in Genitourinary Reconstructive Surgery
Faculty Rank: Assistant Professor of Urology and Associate Urology Program Director
Special Clinical/Research Interests:
Reconstructive Urology
I am open to advising all student populations.
A day in the life of a reconstructive urologist will typically fall into one of three categories: major operative, minor operative, or clinic. For major operative days, I will typically perform a full day of open or robotic reconstructive surgeries in the main ORs. This is typically anywhere from 2-5 major cases depending on complexity. Often there will be a second room in which minor procedures or add-ons are covered as well (stents, hematuria treatment, I&Ds, etc). Minor operative days are spent performing diagnostic evaluations for upper and lower tract issues (usually stricture disease) and also post operative procedures such as stent and catheter removals after confirmatory imaging. Clinic days will involve seeing 20-25 patients in the clinic in combination with local procedures such as cystoscopy, insertion of testosterone pellets, stent removals, and urodynamics, etc.
By far, the biggest challenge that I face is the navigation of a heterogeneous group of complex surgical problems within the context of an extremely unhealthy, low medical literacy patient population that often has an unstable or non-existent support system. My patients typically have advanced and/or delayed presentation of one or multiple complex problems that they have accumulated over years. This means that their treatment often involves a multi-step algorithm over a period of 6-18 months. Patients often have a hard time understanding, committing, and therefore adhering to the treatment plan as a result.
There will be continued technological advancements in the realm of minimally invasive surgery, tissue regeneration/regenerative medicine, and targeted systemic therapy for abdominopelvic cancers. This will hopefully result in prevention of some current genitourinary complications, improve patient outcomes/recovery times, etc. There will also be wider spread education of urology residents with respect to reconstructive urology problems. There is a benefit of access to these procedures in the community with the trade off of a higher complication rate when these surgeries are performed by less experienced/specialized urologists. This will most likely mean that at high volume, concentrated reconstructive urology centers like WVU and GURS Fellowship sites we will continue to see a rising trend towards redo and revision reconstructive surgery (ie patients had a reconstructive attempt somewhere else and we are seeing more and more of the primary treatment failures at the academic center).
Urology is awesome as a field of study within medicine. Nearly all patients will have some form of urologic problem within their lifetime. My advice to a prospective urology resident would be to come and spend time in the OR, clinic, and weekly Wednesday conference early and often. Immerse yourself with the residents and faculty (all of us are approachable and want to work with students). This field allows you to treat the full spectrum of age, genders, and practice settings. It is at the forefront of technological advancements in surgery and will continue to push the boundaries of what is possible with respect to minimally invasive surgical treatments. Urology also gives you the opportunity tailor your practice to whatever suits your lifestyle. You can be a rural community urologist with predictable hours and mainly outpatient low acuity patients, a private practice subspecialist in a large city or suburban area, or be a high volume, high acuity surgical specialist at a major academic center. If you know you want to be a proceduralist in some capacity, it is worth your time to at least spend some time with us to see if you are drawn to the great field of Urology!