Women in urology — closing the gap

Editorial https://doi.org/10.1038/s41585-023-00777-4 Women in urology — closing the gap Check for updates Urology is a historically male-dominated field and, although the number of women is increasing, gender equity is still far off. All members of the urology community need to work together to drive a change. I n 2020, women urologists surpassed 10% of the urology workforce for the first time in history1. This percentage further increased to 10.9% in 2021, which is the highest reported to date2. These data are encouraging, but the fact that this achievement is celebrated as a historical landmark highlights how far we are from reaching gender balance in urology. An analysis of workforce statistics of surgeons, trainees and applicants in US public databases from 2007 to 2019 showed an increase of 104% in female urology trainees during the study period3. However, the growth rate of women applying to and entering urology residency programmes was lower than other specialties3, indicating that a problem of recruitment and retention exists. This evidence is due to persisting gender stereotypes according to which some specialties are ‘more suitable’ for men than women, but also to women’s perception of urology as a sexist field4. This strong gender segregation across medical specialties led to urology being a historically male-dominated field, and, although the number of women urologists is increasing, women are still underrepresented as authors of scientific publications in highimpact urology journals5, as well as speakers and chairs at urology conferences6. Women urologists reported increased dissatisfaction regarding work–life balance, reduced time for personal and family life owing to work schedule, and increased burnout rate compared with their male counterparts2. The rate of academic promotions and career progression for women urologists is lower than that of male colleagues, and women urologists were shown to be paid less than men7. These disparities have been ascribed to multiple factors; for example, women are assigned a higher number of non-academic, non-retributed, administrative duties than male colleagues, and women are less likely than men to negotiate their salary and contracts7. Most of these biases could be mitigated by having a good mentor. Gender concordance can be very important in mentorship, as women urologists who went through difficulties navigating the urology field can support junior female colleagues facing the same issues. However, in a predominantly male field, few women are available as mentors, and might end up mentoring a disproportionate number of colleagues, subtracting a substantial amount of time from clinical and/or academic duties. This bottleneck reflects the need to educate male colleagues towards the themes of gender equity. nature reviews urology “the journey towards gender equity cannot go far if men are not on board” Women have the right and the duty to fight their own battles and attempt to raise public awareness, but the journey towards gender equity cannot go far if men are not on board. Results from a survey circulated among the members of different international urological societies showed that male urologists perceived the work culture towards women (in terms of work–life balance, leadership support and other subcategories) as more equitable than that perceived by female colleagues8. Similarly, in a survey distributed to medical students in Italy, urology was considered a sexist environment by 23% of women and by only 3.2% of men (P < 0.001)4. These worrying data highlight that gender unbalance is not even perceived as a problem by some men. To overcome gender-based discrimination, specific policies need to be introduced at institutional and national levels to prevent discrimination, finding a system to reward non-academic duties, and providing women with equitable possibilities to get promoted. However, putting these plans into action cannot rely on women alone and requires a combined effort from all members of the urology community. At Nature Reviews Urology, we want to be a part of the change towards gender equity, both by actively increasing the number of female authors5 and reviewers in our manuscripts and by providing a space to give voice to under-represented women. Thus, we are proud to present a collection of Comment articles from members of the Society of Women in Urology (SWIU) to discuss the main issues that women face in medicine and academia with a focus on urology, and to propose solutions to improve representation and well-being of women in urology. Published online: 28 April 2023 References 1. American Urological Association. Female urologists make history in urology. AUA https://auanet.mediaroom.com/2021-05-27-Female-Urologists-MakeHistory-in-Urology#assets_all (2021). 2. American Urological Association. The American Urological Association releases 2021 AUA Census results. AUA https://auanet.mediaroom. com/2022-04-12-The-American-Urological-Association-Releases-2021AUA-Census-Results (2022). 3. Findlay, B. L. et al. Path to parity: trends in female representation among physicians, trainees, and applicants in urology and surgical specialties. Urology 172, 228–233 (2022). 4. Reale, S. et al. Is urology a gender-biased career choice? A survey-based study of the Italian medical students' perception of specialties. Front. Surg. https://doi.org/10.3389/fsurg.2022.962824 (2022). 5. Suarez Arbelaez, M. C. et al. Authorship gender composition in urology literature from 2015 through 2020. Urology 165, 81–88 (2022). 6. Hüsch, T. et al. Gender representation at scientific congresses: focus on functional and female urology—a study from the EAU Young Academic Urologist Functional Urology Group. World J. Urol. https://doi.org/10.1007/ s00345-023-04355-6 (2023). 7. Solomon, E., Reeves, F. & Challacombe, B. Women in urology: breaking down the barriers. Trends Urol. Men Health 14, 2–4 (2023). 8. Martin, L. H. et al. Perceptions of gender equity by urologic subspecialty. Urology https://doi.org/10.1016/j.urology.2022.12.039 (2023). Volume 20 | July 2023 | 385 | 385  (...truncated)