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Ruchika Talwar: Hi, everyone. Welcome back to UroToday's Health Policy Center of Excellence. As always, my name is Ruchika Talwar, and I'm a urologic oncologist in Nashville, Tennessee. Today, I'm really excited to be joined by Dr. Andrew Harris, who's an associate professor of urology at the University of Kentucky, chief of surgery at the VA in Lexington, Kentucky, and chair of the American Urological Association's Workforce Task Force. He is here to share some important data that the AUA has gathered about our workforce, and we're really excited to hear his insights today. Dr. Harris, thanks for joining us.

Andrew Harris: I appreciate the opportunity to be here. Appreciate the opportunity to discuss a topic that is very important for us as a specialty, as well as very important for us from the AUA Workforce Task Force. So the title of the paper that came out in Urology Practice was An AUA Workforce Report. This is data from the census regarding workplace experiences based on gender. And what we did is, really, we looked over the census for the past several years back to 2015, '16, and really tried to see if we could put questions together to help us better understand some of these differences in our specialty. And what we know is there's been already a lot of work done looking at potential gender differences such as the pay gap, such as treatment in the office, types of patients we see.

And so there's a lot of those things out there, but what we had trouble finding as the Workforce tried to examine this issue was a lot of information in one place. And so that was really the goal, to try to put it in one place. And the AUA Census, as you know, is just a wonderful place to get data. It is so important when our members fill the census out because it allows for us to really get down to some granularity of the struggles we have from a workforce and allows us to trend it over time. And so when we started to put this information together, we found some very interesting trends that we saw. So when we look at negative differential treatment due to gender in primary practice, and if you see, the females are much lower having no negative differential treatment. When you look at issues with pregnancy and child care, the males really didn't have much problem at all or many issues, but a lot of the women did, a lot of the females did.

When you look at limitations on seeing certain patients, this has to be wildly frustrating for our women in practice if they're getting more women in their clinic because they're women, and that seems frustrating, and you see that bear out in the data. And that contributes to feelings of gender bias in the practice; up to 40% of the women may feel that there's gender bias in practice. We look at conflict regarding work and personal responsibility, again, a big difference between the genders in our specialty. Conflict resolved in favor of work responsibilities, and what this looks like is if your day is coming down to the end and you have to make a decision on whether you're going to make your kid's practice or dinner with your family, or you've got to take care of an issue and not pass it on to the on-call physician that night, a lot of the females in our specialty will resolve that conflict in favor of work, neglecting their personal responsibilities.

And that's really, really frustrating and probably contributes to a lot of burnout. And we don't see that in our male colleagues, so that's very interesting. When you see conflict resolved in favor of personal responsibilities, you see that the men or the males are a little bit higher there. Next part, very interesting: looking at percentage reporting barriers to professional success. A lot more females are saying, you know what, I have barriers to being successful in my career. And what's interesting when you look at the reasons for those barriers, they're not the same between males and females. And I should make a comment here—I'm using the men and males a little bit interchangeably, and that's because the census for a very long time until I think just in the past year used males and then just switched to men and females and women. So that's why I'm using them a little bit interchangeably.

But when you look at the differences in reporting barriers for our female colleagues, it's lack of control over staffing. Over 40% said that lack of control over staffing decisions or scheduling is their greatest barrier to success. Whereas for our males, it was just not enough time. And so there are ways, and I hope we talk about this a little bit, where you can use this information as a leader or as someone coming into practice. When we look at job satisfaction—are we satisfied or very satisfied with our work-life balance—we see that the male colleagues tend to be a little bit more satisfied. And the converse is true when you look at dissatisfaction, as you would expect that our female colleagues tend to have more dissatisfaction.

When you look at work schedule—does it leave enough time or not leave enough time for our personal or family life—our female colleagues really feel their work schedule does not leave them enough time. And when you think about the previous slide, the greatest barrier to professional success was control over their schedule, and so those go well, and we see a little bit of a trend there. Concerningly, when you look at burnout in 2016, our males and females were pretty close, right around the mid-30% or so. But in 2021, big change: our women and our females have become much higher, about 50% burnout compared to about staying the same in our male colleagues at a little over 30%. And that is a concerning trend that we need to keep an eye on. And also educational debt—not considered the same among our males and females as far as it contributes to burnout. A lot more stressful for our female colleagues to carry that educational debt, so something to think about.

So really, what's the take-home is that there are a lot of differences that exist between our male and female colleagues, and those are something to consider. Opportunity abounds both from a leadership perspective and if you are a female coming into practice, how you can use this to help negotiate to mitigate burnout on your behalf—these opportunities are significant. And really, we need a lot more detail; the number of studies I think that we can do and the more we can learn as we go forward is significant. So those are the thoughts I have, looking forward to discussing more with you, and appreciate again the opportunity to talk about this important topic with you.

Ruchika Talwar: Thank you so much, Dr. Harris. That's a lot of information to unpack there and a lot to think about. So you mentioned the fact that women entering the workforce can use this data to help negotiate their future job and make sure that they are optimizing themselves to try to avoid some of these pain points. But I'd like to expand a bit more on the opportunities from a leadership perspective. In your opinion, what are things that practice leaders, department leaders, and health system leaders can do to help mitigate some of these problems?

Andrew Harris: I appreciate your question, Dr. Talwar, and after going through trying to find jobs myself, it seems like a lot of times it's a very cookie-cutter approach. The contracts are the same. Here's how we do it. We're in clinic from eight to five, we operate this day. You'll just fit into the schedule. What this data I think tells us from a leadership perspective is we should open up that conversation. And if you were hiring me, I could come to you and say, "What are my opportunities to have a more flexible schedule because that's very important to me?" And if you think about it, we haven't really approached that question the way that we function. We're very much a nine to five or eight to four, whatever the clinic runs, but there may be opportunity to say, you know what—and this part doesn't matter if you're male or female, man or woman—if I want to take my kids to school because that's some time I get to spend with them, then can I start my clinic at nine?

Or if I want to go to their field trip or do something within that day or some other thing where I am not going to be in the office, can I run an evening telehealth clinic? What options do we have that allows us to effectively take care of the patients but also fit better into our work-life balance so that we don't run into that burnout to, well, I got to do what everybody else does, when the data suggests clearly that we feel those things very differently. The other thing that we would consider is allowing more control over what is important to the person. So I would have a discussion of what is most important to you in your workday that you would like to have the most influence over, and can we come to an arrangement and agreement to make that work for everybody?

So if it is scheduling and staffing, let's talk about that. If it's time, well then let's talk about that. If you're really worried that you are a woman and all of the women are going to get funneled into your clinic and you are not an FPMRS-trained physician, well then let's talk about that, let's figure out how we measure it together. Let's review that on a quarterly basis of how much your clinic is being full compared to everybody else, and let's take a look at it. So I think we can use these as discussion points as a leader to put things on the table, open up the conversation with those people with which we're trying to mentor and bring in to allow them a safe space to communicate these goals and then figure out how we track it from a scientific standpoint going forward.

Ruchika Talwar: Absolutely. And I think that's why these sorts of studies are so important because they allow us to measure and use evidence-based negotiating tactics to ensure that we maintain a healthy, long, successful, and fulfilling career. Because let's not forget that in the background of all of this is the fact that there is already a shortage of urologists in this country, and the shortage is only going to worsen over time as our existing workforce ages, so it is critical that both leaders and urologists who are practicing stay attuned to these sorts of points. So thank you so much, these are such important insights, we really appreciate your time.

Andrew Harris: I appreciate the opportunity to be with you, and as we continue to move forward, excited about the opportunities we have to continue to strengthen the health of our workforce so that we continue to take care of all the patients that need us. So thank you for the opportunity.

Ruchika Talwar: Absolutely. And to our audience, as always, thank you for joining. We'll see you next time.