The gender divide in urology: Surgeon gender shapes the clinical landscape

Although female certified urologists are still a minority within the specialty, they perform many more procedures on women than their male colleagues, who perform more procedures on men than their female colleagues. As more women opt to specialize in urology, attention needs to be paid to the way gender shapes the clinical landscape, report researchers in The Journal of Urology.

Urology has traditionally been dominated by men, but more than 50% of medical school graduates in the United States are now women, and the number of female urologists has risen from a mere 34 women in 1981 to 512 in 2009—a thousand-fold increase. The percentage of female urology residents has increased even more quickly, from 5% in 1989 to 23% in 2011.

There is a perception that female urologists may be "pigeon-holed" into caring for more female patients and female-specific urological issues than their male colleagues. With the gender landscape quickly changing, researchers decided to look at the surgical practice patterns of male and female urologists over time and the influence of surgeon gender on patients treated.

"An assumption is often made that women prefer to go to female physicians and surgeons. There have been reports in the obstetric and primary care literature documenting a preference by female patients for female practitioners; however, to our knowledge no study exists that directly analyzes the influence of surgeon or patient gender on the surgical practice patterns of urologists in the U.S.," explained lead investigator Daniel T. Oberlin, MD, of Northwestern University Feinberg School of Medicine; Department of Urology (Chicago, IL).

Investigators looked at six-month case logs of more than 6,000 certifying urologists from 2003 to 2012, which included over one million cases that were either gender-neutral cases (i.e., they could be performed on either male or female patients) or gender specific procedure groups. These data represented over two-thirds of all urologists in the U.S. based on current estimates. Gender neutral procedures included extracorporeal shock wave lithotripsy, ureteroscopy, transurethral resection of a bladder tumor, and nephrectomy. Female specific procedures included fitting a urethral sling for stress urinary incontinence. Male specific procedures included vasectomy and treatment of prostate cancer.

Female urologists accounted for 8.4% of the certifying urologists included in the study. The results showed that female surgeons perform a higher proportion of gender neutral index surgical procedures on female patients relative to their male counterparts (54% vs 32% female patients, respectively). This trend for female surgeons remained consistent for each individual gender neutral procedure that was assessed.

The surgical volume of gender specific female cases is higher for female surgeons. Among cases that were gender specific, female surgeons performed 14.5% of all urethral sling procedures in women, and only 3.1% of vasectomies and 3.6% of prostate surgeries in men. Male urologists, on average, performed three times as many vasectomies and over twice as many prostatectomies as their female colleagues. The proportion of female patients treated by female urologists was at least 1.65 times higher than their male counterparts in all six geographic regions in the U.S., with the largest discrepancies observed in the northeast and west where female urologists operated on twice as many females as their male counterparts.

"Our results are consistent with data from other specialties suggesting that female patients may gravitate toward female physicians," commented Dr. Oberlin. "Women are pursuing medical careers in numbers equal to that of men. As the number of women physicians going into urology grows, increasing attention to practice pattern discrepancies and gender biases is needed to better appreciate how these disparities will shape the clinical landscape."