Jennifer Miles-Thomas, MD, FPMRS – Spearheading Female Urology, Health, and Innovation

Jennifer Miles-Thomas, MD, FPMRS, is a distinguished urologist specializing in female pelvic medicine and reconstructive surgery. With a background in both medicine and business, Dr. Miles-Thomas has made significant contributions to the field. She served as president and CEO of Urology of Virginia and is completing an MBA at the Massachusetts Institute of Technology (MIT), enhancing her expertise in financial management and technological innovation. Additionally, Dr. Miles-Thomas was recently named Treasurer-Elect of the American Urological Association (AUA), a testament to her leadership and dedication to advancing urologic care and research.

GU Oncology Now spoke with Dr. Miles-Thomas about her journey to becoming a urologist and her specialization in female reconstructive surgery. She shares insights into the evolution of her career, the challenges and rewards of her specialty, and her vision for her upcoming tenure as AUA treasurer, focusing on advancing both clinical and business aspects of urologic care to better serve patients and practitioners alike.

Can you tell us about your journey to becoming a urologist, what inspired you to specialize in this field, and how you ended up at Urology of Virginia and Chesapeake Regional Healthcare?

Dr. Miles-Thomas: In medical school, I knew I wanted to go into a surgical field. Initially, I thought it would be neurosurgery. On my rotation for urology, whenever we saw female patients, they would ask, “Oh, you are going to be a urologist?” I wondered why they reacted that way, thinking it was mostly older men. However, after some research, I realized urology was fascinating because it offered various practice settings: office-based, procedure-based, or an operative practice. It was a field I could commit to long term, with the flexibility to adapt as my interests evolved. In addition, the diversity of patient populations, including men, women, and children, appealed to me.

After medical school at Northwestern, I moved to Johns Hopkins where I completed my residency and fellowship. It was eye-opening because of the abundance of resources and the opportunity to explore any subspeciality in urology. Initially, I leaned toward pediatrics as I enjoyed reconstruction and found working with children rewarding. However, I questioned if I could achieve the impact I desired solely in pediatrics.

After considering reconstructive surgery and focusing on female reconstructive surgery, I found my niche. It offered me the chance to significantly improve patient quality of life (QOL) by addressing issues like incontinence, prolapse, and fistulas.

With regard to female reconstructive surgery and pelvic medicine, could you elaborate on some key research, findings, or advancements you have been involved in?

Dr. Miles-Thomas: Many of the advancements have come from technology. The utilization of the robot for reconstruction of the pelvic floor has opened up additional avenues for minimally invasive care for women. Neuromodulation has advanced over the past few years, opening the door for additional research into overactive bladder beyond drug delivery. I am also pleased to see more interest and research in female pelvic medicine over the past few years. The field is expanding as more female patients are focusing on QOL.

As someone with extensive experience in female reconstructive surgery and general urologic care, what do you see as the most pressing issues or challenges in this field today?

Dr. Miles-Thomas: There is a shortage of fellowship-trained surgeons available to perform these specialized surgeries. Across the country, there is a workforce shortage in urology which is partly mitigated by advanced practice providers handling some aspects of urologic care. However, there is a need to emphasize the importance and privilege of performing these surgeries and encourage a diverse range of individuals, regardless of gender identity, to pursue this subspecialty.

While urology frequently focuses on prostate cancer, reconstructive surgery is vital for improving patient QOL, and I hope to continue to see more training opportunities in the future.

Why do you believe this manpower shortage exists?

Dr. Miles-Thomas: The world has changed and numerous career options beyond medicine are available. Medical training is lengthy and expensive, requiring a deep commitment. Individuals must genuinely love what they do and find fulfillment in providing care. Otherwise, alternative paths may seem more appealing.

Urology has always been appealing, but there is competition among specialties for our best and brightest students. Residency and fellowship programs must highlight the significance and rewards of urologic care to continue to attract more trainees.

On a different note, congratulations on your upcoming appointment as treasurer of the AUA. What motivated you to pursue this leadership role, and what do you hope to achieve during your tenure?

Dr. Miles-Thomas: I have been actively involved with the AUA since residency. Applying for this role was a natural professional progression, given my recent experience as President and Chief Executive Officer of Urology of Virginia and completion of my MBA at MIT. Throughout my career, I have also combined financial acumen with a current understanding of digital transformation, ensuring that organizations such as the AUA not only grow but evolve in a rapidly changing financial landscape. Whether it is optimizing operations, enhancing profitability, or interpreting financial data for diverse stakeholders, I will approach my new role with a combination of academic insight and practical experience.

During my tenure, I aim to ensure all members are educated in both clinical and business aspects of urologic care, especially considering the changing landscape post-COVID-19. The ecosystem of healthcare post-COVID is an entirely different environment than the one most of us were accustomed to working within. Inflation, clinic staffing, insurance premiums, patient expectations, hospital staffing, and reimbursement have all pivoted in different directions. This is true for all of our urologists in private practice, hospital employment, as well as private-equity backed groups. The time to become active in collective advocacy is now, not tomorrow.

How do you envision your tenure impacting the AUA’s mission and initiatives, particularly regarding advancing urologic care and research?

Dr. Miles-Thomas: The AUA plays a crucial role in setting standards of care with guidelines, providing education, promoting research, and advocacy. I hope to contribute by advocating for a comprehensive understanding of both clinical and business aspects of urologic care among our members. This includes staying updated on new technologies and ensuring financial literacy to navigate the evolving health care landscape effectively.

In your opinion, what are some critical areas where urology research needs more focus and investment?

Dr. Miles-Thomas: Female urology warrants more attention and investment. While oncology receives significant research funding, non-oncologic conditions affecting women, particularly in the realm of female urology and reconstructive surgery, are underexplored. Balancing research priorities to include female urology can significantly improve QOL for many patients. In order to shift the current climate to focus on female urology, additional partnerships between institutions, physicians, the AUA, and our industry partners are needed. Women are living longer and have urologic needs that have not been fully addressed with today’s current solutions.

What advice would you give to aspiring urologists, especially those considering specializing in female reconstructive surgery?

Dr. Miles-Thomas: My advice is simple: just do it. Pursuing a female reconstructive surgical  career has been immensely fulfilling . Every day, I see the impact of my work on patient lives. It is an opportunity to care for those who often prioritize others over themselves, making it all the more rewarding.