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What's Gender Got to Do With It? Differences in the proportion of traditionally female cases performed by general urologists of each gender.
Katherine Rotker, MD1, Sarah Iosifescu, Bsc2, Simone Thavaseelan, MD1, Kathleen Hwang, MD1.
1Brown University, Providence, RI, USA, 2Alpert Medical School, Providence, RI, USA.

Introduction: To examine surgical case volume characteristics in certifying urologists associated with common female urologic procedures to evaluate practice patterns, given the long-standing understanding but unproven hypothesis that non-fellowship trained female general urologists perform more common female urologic procedures compared to their equally trained male general urology counterparts.
Materials and Methods: Case log data from certifying and recertifying urologists from 2000 to 2015 was obtained from the American Board of Urology. 37 CPT codes were chosen to represent traditionally urogynecologic cases. Logistic regression analysis models were used to determine the percentage of total CPT codes logged during certification period made up by traditionally urogynecology cases. Male and female non-fellowship trained, self-described general urologists were compared.
Results: The case logs of 4,032 non-fellowship trained, general urologists were reviewed from 2000-2015, 297 of whom were female and 3,735 of whom were male. Urogynecology cases made up 1.27% of the total CPT codes logged by female urologist and 0.59% of those codes logged by male urologists (p=<0.001). In fact, females performed 2.2 times more urogynecology cases then their male counterparts (p=<0.001). When sorted by certification period, within each certification period, urogynecology cases represented a statistically significantly higher percentage of the total codes logged for females than for males. For the 198 females undergoing initial certification, 1.11% of their logged codes were urogynecologic compared to 0.65% in the 1,133 males undergoing initial certification. Urogynecology cases represented 1.57% of codes logged by the 98 females in their initial recertification and 1.31% of those logged by the 30 females in their second recertification. For their 1,479 male counterparts performing initial recertification and 1,472 performing second recertification, the percentages were statistically significantly lower at 0.63% and 0.54% respectively (p=<0.001). For the 255 male surgeons recertifying for the third time, 0.36% of codes logged were urogynecologic. No females were in their third recertification period.

When the data was evaluated by age of surgeon, the percentage of urogynecology cases increased with age for female general urologists and decreased with age for male general urologists. Trends were also seen by region, practice size and practice type.
Conclusion: Traditional urogynecology cases represented a significantly greater percentage of the total cases logged by certifying non-fellowship trained female general urologists when compared to their non-fellowship trained, generalist male colleagues. Although this supports a belief that patient populations differ for male and female general urologists, the percentage of total urogynecologic cases performed by both is very small and may not be significant enough to sway career decisions.

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