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Are men and women really that different? An analysis of gender differences among urological providers in the AUA Census.
Lael Reinstatler, MD, MPH, Elias Hyams, MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Title: Are men and women really that different? An analysis of gender differences among urological providers in the AUA Census.
Authors: Lael Reinstatler, Elias Hyams
Introduction: The proportion of female urologists in training has steadily increased in recent years, reflecting cultural changes in the discipline and surgery overall. Background and practice differences between male and female urologists, however, are not well characterized. In this study, we sought to characterize the backgrounds and practices of female urologists and compare them with male peers within the 2014 AUA Census, a large representative sample of practicing urologists in the United States.
Materials & Methods: Using 2014 AUA Census data, providers were stratified based on gender. Bivariate analysis was used to assess differences in clinical and practice characteristics. Multivariable analysis was conducted using a priori variables hypothesized to differ by gender. In all analyses, post-stratification weights provided with the Census data were used to calculate national estimates (SAS 9.4, Cary, NC).
Results: There were 2204 survey respondents representing 11,703 practicing urologists. Almost 8% were female. There were no differences in race, country of origin, or practice setting (metropolitan vs rural) based on gender. Female urologists had more often completed a fellowship (55% vs 37%, p = 0.0003) and had fewer years in practice (68% practicing <10 years vs 28% of men, p<0.0001). Female urologists reported treating a lower proportion of male patients (<25% male patients reported in 23% of women vs 4% of men, p <0.0001). Women more frequently reported specializing in Female Pelvic Reconstruction and Transplant/Laparoscopic (24% vs 3% p<0.0001 and 12% vs 5% p = 0.0044, respectively). Men more often reported practicing General Urology (65% vs 45%, p<0.0001) and Male Sexual Health/Reproduction (5.7% vs 5.6%, p <0.0001). When analyzing clinic hours per week, women were more often noted to work <40 hours (p = 0.0088), however total work hours were not different between men and women. There was no difference in other practice characteristics such as practice setting and ownership interests. On multivariable logistic regression, female gender was associated with fewer years in practice, female pelvic/reconstruction or transplant/laparoscopic as a specialty area, and lower proportion of male patients seen (p<0.05). Female gender was not associated with fewer work hours on multivariable analysis.
Conclusions: While female urologists are growing in proportion, they still represent a small percentage of active providers. As female physicians increasingly enter urology and older urologists retire, this proportion will certainly grow. While we report expected differences in practice based on gender (e.g. focus in pelvic medicine), it is notable that female urologists are working equal hours to their male peers. As our field evolves, further study of training and practice differences will help us understand how to improve the diversity of our providers and ensure provider satisfaction over time.
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