Women in urology: a reality on the rise


According to data from the American Urological Association (2018), the number of female urologists has been increasing, making up an estimated 9.2% of practicing urologists and 25% of residents in that specialty. However, urology still has one of the lowest percentages of female physicians compared to other medical or surgical specialties.


Is there a gender-based preference for care?


Several studies performed in the United Kingdom, the United States and Asia conclude that most patients do not have a definite preference for the gender of the treating urologist. However, it is of interest to analyze a recent investigation that deals in depth with this issue. In this study, conducted by Jessica Wynn and Lydia Johns Putra of the University of Melbourne (2021), they identified that patients were more likely to have a preference if they were female or had a condition they considered embarrassing, and most preferences were for a gender-matched urologist.


This behavior is mainly observed in patients during the office appointment, procedures, and physical examination as a result of their concerns about exposure of the genital region during medical intervention. Such preferences are based on the patient's degree of comfort and not on the perceived skills of the specialist physician.


Do female urologists receive the same recognition as their male counterparts?


Leadership and opportunity of promotion

Despite the fact that women are increasingly joining the urology workforce, pay inequalities are still observed for the same workload, practice setting, or training as a professional, as well as inequalities in job opportunities. Research by Cone et al (2021) concludes that North American female urologists have considerably lower salary expectations and express greater discomfort in contract negotiation than their male colleagues.


In addition, a gender gap in leadership also persists, with only 3% assuming senior positions in general surgery and urology programs. Gawad et al identified that female surgeons are less likely than their male colleagues to receive promotion, even in the latest studies conducted concluding that of the 2,926 academic urologists in the United States who were assistant, associate or full professors, only 11.2% were women and, on average, it took women 1.2 years longer than men to be promoted from assistant to associate professor.

Academic trajectory

Despite the number of female-authored publications still making up a smaller proportion of the urologic literature, a significant upward trend has begun to be noted from 2000 to 2019, as concluded in research published by the journal Urology (2021). However, a significant unfavorable difference in the likelihood of papers being cited versus those with male authors is observed, despite the higher proportion of women authoring research articles with higher number of citations compared to men.

International recognition

But it's not all gray, in 2020 leading specialists Stacy Loeb and Derya Tilki received recognitions from the American Urological Association and the European Association of Urology respectively, for their clinical and research work in prostate cancer. In addition, in 2021 the Urologic Oncology Society of America awarded the Huggins Medal to Eila Skinner as well as the Young Investigator Award to Angela Smith.

These distinctions break the schema that women urologists are only dedicated to pediatric or female urology and lay the groundwork for breaking down established gender barriers.


In first person: What is it like to be a female urologist?


The physician María José Requena was the first woman to be head of the Urology Department at the Reina Sofía Hospital in Córdoba, Spain. In an interview with Carmen Reina, correspondent of Diario.es, she commented that since she was a child it was clear to her that she wanted to dedicate herself to medicine. After passing the exam for medical internal resident (MIR), she expressed her desire to continue her studies in urology in Cordoba in front of an astonished Madrid court. There she perceived for the first time how the court judged her decision for wanting to enter a male specialty: "I never understood that I could not do the same as a man because I was a woman", explains Requena.



At the end of the specialty in 1987, women began to express their interest in urology despite the marked inequality visible especially in congresses and medical meetings: "it is not only that there were few women, but that those of us who were there aroused suspicion".


After three decades in practice, Requena continues to work in a position of leadership that has allowed her not only to devote herself to what she loves but also to open the doors to women who also want to join the specialty.


References:

- Wynn J, Johns Putra L. (2021) Patient preference for urologist gender. Int J Urol. 2021 Feb;28(2):170-175. doi: 10.1111/iju.14418. Epub 2020 Nov 4. PMID: 33150602.

- Kim SO, Kang TW, Kwon D. (2017) Gender Preferences for Urologists: Women Prefer Female Urologists. Urol J. 2017 Mar 16;14(2):3018-3022. PMID: 28299765.

- Devki C. Shukla, Vannita Simma-Chiang, Natasha Kyprianou, Ashutosh K. Tewari, Dara J. Lundon, (2021) Does Gender Matter in Academic Surgery? Author and Mentor Gender Impact Publication Citations in Surgical Research, Urology, Volume 157,2021, Pages 64-70, ISSN 0090-4295, https://doi.org/10.1016/j.urology.2021.04.049. - Chyu J, Peters CE, Nicholson TM, Dai JC, Taylor J, Garg T, Smith AB, Porten SP, Greene K, Browning N, Harris E, Sutherland SE, Psutka SP. (2021) Women in Leadership in Urology: The Case for Increasing Diversity and Equity. Urology. 2021 Apr;150:16-24. doi: 10.1016/j.urology.2020.07.079. Epub 2020 Sep 20. PMID: 32961220. - Laguna, P. (2021). The Rising Tide of Women in Urology . Société Internationale d’Urologie Journal, 2(6), 339-343. https://doi.org/10.48083/JHEK4332

- Eugene B. Cone, Mary E. Westerman, David-Dan Nguyen, Karen L. Stern, Juan Javier-Desloges, Kevin Koo, (2021) Gender-based Differences in Career Plans, Salary Expectations, and Business Preparedness Among Urology Residents, Urology, Volume 150, 2021, Pages 65-71, ISSN 0090-4295, https://doi.org/10.1016/j.urology.2020.04.123.

- Yang G, Villalta JD, Weiss DA, Caroll PR, Breyer BN. (2012) Gender differences in academic productivity and academic career choice among urology residents. J Urol. 2012;188:1286 –1290 - Breyer BN, Butler C, Fang R, Meeks W, Porten SP, North AC, et al. (2020) Promotion disparities in academic urology. Urology. 2020 Apr;138:16–23. doi: 10.1016/j.urology.2019.10.042. Epub 2020 Jan 7.

- Reina, C. (2018) María José Requena, the pioneer who opened the doors of Urology to women. Diario.es, retrieved from: https://www.eldiario.es/andalucia/5porlaigualdad/maria-jose-requena-pionera-urologia_1_2195639.html