Urology Subspecialists Are Still Predominantly White, Male

Racial/ethnic concordance between patient and clinician can help address disparities in health care services. Several studies have shown that when a patient’s race/ethnicity matches that of their primary care provider, they are more likely to use needed health services, less likely to postpone care, more likely to participate in health care decisions, and they report higher patient satisfaction.

By 2060 in the U.S., the number of people ages 65 and over is expected to double the number in 2018. Over the same time period, the older population will become more racially/ethnically diverse, as the proportion of non-Hispanic white people is predicted to decline from 77% to 55%. Building a racially/ethnically representative urology workforce is becoming even more important.

Elodi J. Dielubanza, MD, associate surgeon in the Division of Urology at Brigham and Women’s Hospital, and colleagues recently conducted the first study that describes demographic trends in urologic subspecialties. They present their findings in Urology.

Methods

The researchers focused on the field of female pelvic medicine and reconstructive surgery (FPMRS). They queried American Urological Association census data from 2014 to 2019 for urologists who self-reported FPMRS as their primary area of practice (with or without specialty training and board certification).

For comparison, they analyzed the demographics of urologists who identified their primary subspecialty as oncology, pediatric urology or endourology/stone disease.

Racial/Ethnic Distribution

In 2019, 602 urologists identified FPMRS as their primary area of practice. 72% self-identified as White, 16% as Asian, 6% as Black, 4% as Hispanic (any race), and 2% as multiracial/other.

Trends

Over the six-year study period, the proportion of urologists of races/ethnicities that are underrepresented in medicine (URiM) stayed flat: it was 6.7% in 2014 and 6.9% in 2019.

The presence of URiM urologists in each subspecialty declined from earlier highs:

  • FPMRS—5.6% in 2014; peaked at 15.2% in 2016 and declined to 12.4% in 2019
  • Pediatrics—13.8% in 2014; declined to 11.2% in 2018 and dropped sharply to 4.7% in 2019
  • Endourology—6.2% in 2014; peaked at 10.4% in 2018 and declined to 8.9% in 2019
  • Oncology—2.7% in 2014; peaked at 6.9% in 2015 and declined to 3.5% in 2019

Gender Distribution

In 2019, women represented 10% of practicing urologists. FPMRS had the greatest gender diversity (47% female), followed by pediatric urology (25%).

Equity Is a Long Way Off

The progress to date in improving equity in FPMRS may be due in part to the inclusive mentorship and outreach programs of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction. It offers a resident travel award, a resident preceptor program, a committee that offers a formal mentorship program to trainees and a Women in Urologic Oncology subsection.

As a whole, the field of urology is still a long way from racial/ethnic and gender equity. Practicing urologists, particularly those in academic medicine, have opportunities to increase equity through early exposure and mentorship of undergraduates, medical students and residents.

It can be rewarding to establish partnerships with student groups such as the Latino Medical Student Association, Student National Medical Association, R. Frank Jones Urologic Society Interest Group, Urology Unbound, Latinas in Medicine and local undergraduate chapters of the Association of Women Surgeons.

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