Women in Urology

Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey

OBJECTIVE

To understand the experiences of urologists and obstetricians-gynecologists (obgyns) with patient-perpetrated sexual harassment (PPSH) since the clinical focus of these specialists may make them particularly vulnerable to PPSH.

METHODS

A multiple-choice anonymous online survey was administered in the Departments of Urology and Obgyn at a single institution from 22 September, 2022-18 October, 2022. The survey assessed if clinicians had experienced PPSH, including gender harassment, unwanted sexual attention, and/or sexual coercion from patients, where PPSH was witnessed or experienced, and whether implementation of chaperones impacted their experiences with PPSH. We conducted descriptive analysis by clinician sex, department, and form of PPSH experienced. We also performed logistic regression analysis to identify clinician factors associated with experiencing PPSH.

RESULTS

Majority of respondents reported that they experienced or witnessed PPSH (78%, N = 100). Gender harassment was the most common form of PPSH experienced by clinicians (53%, N = 68). PPSH was most often experienced or witnessed in clinic (74%, N = 70) and inpatient wards (66%, N = 62). Of those who utilized chaperones, 80% (N = 57) of clinicians reported they either did not reduce or were unsure if they reduced PPSH. When adjusting for clinician factors, being a female clinician (adjusted odd ratio [aOR] = 5.1, 95% confidence interval (CI) 1.5-17.3), trainee (aOR = 6.9, 95% CI 1.1-44.6), or a urologist (aOR = 18.1, 95% CI 2.0-166.1) were associated with experiencing PPSH.

CONCLUSION

Our study highlights the pervasiveness of PPSH among urologists and obgyns. Future studies should elucidate what policy changes can be effective in protecting clinicians from PPSH.

The Future is Female: Urology Workforce Projection from 2020 to 2057

Multiple estimates have approximated a urologist shortage per capita of around 30% by 2030. In the context of the impending urologic workforce shortage, it is critical to have a nuanced understanding of the degree of workforce shortage in comparison with the US population to mitigate the negative downstream effects in the future. In continued growth and stagnant growth projection models, we found that female urologists make up a significant proportion of the workforce growth over the next four decades. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support and retain female urologists.

Current status of female urologists in Korea

PURPOSE

The number of female urologists, including residents, has gradually increased and has recently exceeded 50. This study aimed to investigate the current status of female urologists in South Korea.

MATERIALS AND METHODS

Total number of female and male urology specialists and residents, annual new Korean board-certified female and male urologists recent 5 years were obtained from the Korean Urological Association database. Data on working status, region, and subspecialty were collected via a telephone survey.

RESULTS

Fifty-four female urologists including 40 urology specialists and 14 urology residents participated in the study. Since the first female doctor received a urology board in 1999, zero to five female doctors have obtained urology board annually. Approximately 50% of female specialists and residents worked in metropolitan areas. The proportion of female urology physicians working in university hospitals was 52.5%. Three had only urology-oncology subspecialties, while the rest had non-oncologic or both subspecialties.

CONCLUSIONS

Female urologists are evenly distributed across the country, following the population distribution of Korea. Female urologists are employed in various fields. More female urologists chose non-oncology and double majors as subspecialties than they chose oncology. It is necessary to pay attention to female urologists, who form a minority within the Korean Urological Association, so that they can be continuously produced and actively engaged in various fields.

Women in Irish urology: An examination of female representation amongst attendees of the Irish Society of Urology annual meeting (2008-2020)

BACKGROUND

There is underrepresentation of women at surgical conferences. We examine the representation of women in Irish urology by looking at gender balance within the Irish Society of Urology (ISU) conference.

AIMS

ISU programmes over thirteen years from 2008 to 2020 were assessed and female representation in session chairs, guest speakers, poster and oral presentations identified. Gender distributions of authors for each year was examined. To investigate changes in female representation temporally, the period of this study (2008-2020) was subdivided and compared: 2008-2013 and 2014-2020.

RESULTS

76 sessions were presided over by 138 chairs, of which 6 (4.3%) were female. Eight conferences had zero female chairs. 62 guest lectures were given, 6 (9.6%) by women. Of total 340 poster and 434 oral presentations, women delivered 24.9% (0-47.5%) of posters and 31.6% (10.3-59.4%) of oral presentations. We found no significant difference in the percentage of female poster presentations between the time periods 2008-2013 (m = 18.2, sd = 13.7) and 2014-2020 (m = 34.3, sd = 17.8), t(11) = -1.4, p > 0.05. However, we found a significant difference in the percentage of female oral presentations between the periods 2008-2013 (m = 18.7, sd = 14.2) and 2014-2020 (m = 40.6, sd = 14.5), t(11) = -2.8, p < 0.05.

CONCLUSIONS

Our study is the second to examine female representation in Irish urology. Session chairs and guest speakers were grossly overrepresented by males as were oral and poster presentations. Despite lacking female influence overall, in more recent years there was an increased representation of women. Societies should strive to increase female representation, as this perpetuates a positive feedback loop, encouraging future female trainees to pursue urological surgery.

Gender Disparities and Differences Among Urologists Included in Top Doctor Lists

OBJECTIVE

To understand gender trends among urologists included in "Top Doctor" lists as more women practice urology, we (1) Evaluated whether Top Doctor lists reflect a contemporary distribution of urologists by gender; (2) Describe regional differences in gender composition of lists; (3) Report similarities and differences among men and women Top Doctors.

METHODS

All urologists in regional Top Doctor Castle Connolly lists published in magazines between January 1, 2020 and June 22, 2021 were included. Physician attributes were abstracted. American Urological Association (AUA) census data was used to compare the number of men and women Top Doctor urologists to the number of practicing men and women urologists within each list's zip codes. Log odds ratios (OR) and (95% confidence intervals) were used to compare likelihood of list inclusion by gender overall and by region.

RESULTS

Four hundred and ninety-four Top Doctor urologists from 25 lists were analyzed, of which 42 (8.50%) were women. Women urologists comprised 0%-27.8% of each list, with 7 lists (28.0%) including zero women urologists. Using AUA census data, OR for list inclusion of men urologists compared to women was 1.31 (1.01, 1.70) overall, with OR = 0.78 (0.36, 1.72) in the West, OR = 1.39 (1.03, 1.89) South, OR = 1.46 (0.8, 2.67) Northeast, OR = 1.90 (0.50, 7.18) Midwest. Women top urologists completed fellowship more often than men (66.7%, 55.1%) and were significantly more likely to complete female pelvic medicine and reconstructive surgery (FPMRS) fellowship (P <.001).

CONCLUSION

Men urologists were significantly more likely to be included in Top Doctor lists than women urologists. Top women urologists were significantly more likely to complete FPMRS fellowship.

Path to Parity: Trends in Female Representation Among Physicians, Trainees, and Applicants in Urology and Surgical Specialties

OBJECTIVE

To characterize recent trends among practicing female surgeons, surgical trainees, and surgical residency applicants to assess potential progress toward gender parity.

METHODS

Workforce statistics on U.S. practicing surgeons, trainees, and applicants among 9 surgical specialties were obtained from the Association of American Medical Colleges and Electronic Residency Application Service public databases. Physician and trainee data during 2007-2019 and residency applicant data during 2016-2020 were analyzed by surgical specialty. We used Cochrane Armitage trend tests to assess changes over time.

RESULTS

Female practicing urologists increased 104% during the study period, the third-largest increase among 9 surgical specialties (range 36%-114%, all P < .01), representing continued growth in the prevalence and proportion of women among surgical trainees in all surgical disciplines. In contrast, the overall change for female urology residents (28%) lagged significantly, ranking eighth among the 9 specialties (range 9%-149%, all P < .01), suggesting slowing growth in the training pipeline. Finally, while the proportional change in urology applicants has been significant (33%, P < .01), growth rates have markedly slowed in the past 5 years compared to women in practice and training since 2007.

CONCLUSION

While female representation among practicing urologists has improved relative to other surgical disciplines, declining rates of women entering and applying to urology residency suggest a longer trajectory toward gender parity.

[Feminization of urology and glass ceiling: Survey of women urologists in France]

INTRODUCTION

Urology has long remained the least feminized specialty. The objective of this study was to assess the demographic characteristics of female urologists and their feelings in terms of discrimination.

MATERIAL

The survey consisted of a questionnaire of 12 questions, sent by mailing to all female urologists, a first time in May 2016 (n=84), then a second time in January 2020 (n=98). The anonymized answers were analyzed and compared in order to assess the evolution over the last 4 years. The participation rate was 46.4% in 2016 (n=39 respondents) and 50% in 2020 (n=49 respondents).

RESULTS

The majority of women worked full time (73.5%), with a hospital (38.8%), liberal (46.9%) or mixed (14.3%) activity. Their main theme was women's urology (57.1%). In 2020, 59.2% of respondents had encountered difficulties related to their status as women during their career and 28.1% difficulties related to motherhood. Female urologists in private practice were significantly less concerned than their counterparts with hospital or mixed activity (43.5% versus 73.1%, P=0.035). Women felt that they were underrepresented in association committees at 95.9% (vs. 82.1% in 2016) and in university positions at 79.6% (vs. 89.7% in 2016). Finally, 91.8% were in favor of the creation of an association of women urologists (vs. 53.8% in 2016).

CONCLUSION

Women urologists may encounter difficulties related to their status as women during their professional career. Between 2016 and 2020, there is an increase in the feeling of under-representation within association committees and an increase in the need to federate.

NIVEAU DE PREUVE

III, étude rétrospective cas-témoins.

Rules and regulations for a pregnant endourologist: the European perspective

Introduction

Working in surgery while pregnant is challenging. Navigating this period safely is of paramount importance. Anecdotal observation suggests that there exists great variation among European nations in regard to maternity leave and radiation safety.

The aim of this article was to gain insight into policy patterns and variations across Europe regarding these issues.

Methods

A series of core question items was distributed to representatives across 12 nations Austria, Belgium, Germany, Greece, Iceland, Italy, Netherlands, Norway, Poland, Republic of Ireland, Spain and the United Kingdom).

Results

The total number of weeks with full pay ranged from as little as 4 weeks in Belgium to 32 and Iceland. All countries included in this study give the option of additional weeks beyond the initial period, however at reduced pay. Some offer unpaid leave beyond this. Only 5/12 countries had a specific policy on when the pregnant surgeon should come off the on-call rota. Only Austria, Italy and Poland stipulate a requirement for the pregnant clinician to be replaced or be completely exempt in cases involving radiation. Only Germany, Iceland, Norway and Poland highlight the need to limit radiation dose in the first trimester. Beyond this, Germany alone provides written guidance for reduction in gown weight and along with Poland, display arguably the most forward-thinking approach to resting.

Conclusion

There is a marked range in maternal leave policies across Europe. There also exists a lack of universal guidance on radiation safety for the pregnant urologist. There is urgent need for this void to be addressed.