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Trends in the Gender Distribution of U.S. Urology Residency Programs Compared to Other Surgical Specialties
Manuel Ozambela, MD1, Valary T. Raup, MD2, Nawar Hanna, MD2, Michael Zavaski, MD2, Ye Wang, PhD2, Lori Lerner, MD2, Douglas S. Smink, MD, MPH2, Steven L. Chang, MD,MS2.
1Harvard Medical School, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.

BACKGROUND
In the United States, urology, like many other surgical specialties, has historically been a male dominated field. However, this is quickly changing. In the last quarter century, multiple medical and surgical specialties have observed a rise in women within the field of medicine. Thus, we set out to examine this trend within the field of urology.
METHODS
Applicants, trainees, and graduates of urology residency programs were stratified by gender. Data was obtained from the American Urological Association (AUA) match statistics from 1996 to 2015 for applicants, annual U.S. graduate medical education reports published in the Journal of the American Medical Association from 1990 to 2013 for trainees, and the 2014 AUA Census Public Microdata file for graduates. We evaluated gender trends using descriptive statistics by calculating the change in the proportion of females over time for each phase of training. Among graduates, crude and adjusted logistic regression models were developed to evaluate the relationship between gender and likelihood of entering fellowship training and academic practice.
RESULTS
The proportion of female applicants in urology increased between 1996 and 2015 (13.6% to 25.9%), but the overall match rate for males (68%) and females (67%) were similar when averaged over the study period (p=0.58). Among trainees, the proportion of female urology residents rose from 5.3% to 22.7%, for a relative percent increase of 429%. Excluding obstetrics and gynecology, urology had the greatest annual percent increase in female trainees when compared to all other surgical specialties (Figure 1). Among graduates, women had a higher likelihood of entering fellowships and practice in academic settings when compared to men (ORs 2.10 and 1.77, respectively; p values <0.001 and < 0.012).
CONCLUSIONS
While urology remains a male dominated field, there has been a dramatic rise in the proportion of women over the last 25 years. This trend may in part be explained by a disproportionate number of women entering fellowships and academic practice, allowing them to serve as role models and mentors for female trainees. Further investigation should be directed at determining how this change in the demographic composition of the urologic workforce will continue to impact the delivery of health care in the United States.


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