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Ruchika Talwar: Hi, everyone. My name is Ruchika Talwar and I'm excited to welcome you back to UroToday's Health Policy Center of Excellence. Today, I'm joined by Dr. Guerrios from the Caribbean VA and University of Puerto Rico, who'll be discussing some important data recently published in the Gold Journal out of the Society of Women in Urology's Census Information. Dr. Guerrios, thank you so much for being here with us today.

Lourdes Guerrios Rivera: Thank you so much for the opportunity. It's really a pleasure to be able to share this information with all of you. So, as Ruchika, you mentioned, this is an SWIU initiative. So, basically in July 2021, SWIU created several task forces, so it was focused on different areas. It was to engage industry, equity, pay disparities, diversity in residency, and including the census creation. So, it was really a first step to describe the current demographics of needs and challenges of women in urology. So, these are the rest of the team. This was really a great experience for us and basically we created an electronic survey distributed through social media members, residents, fellows, female urologists practicing in the US and territories. So, it was between February 2022 and May 2022. So, we had 379 respondents for a 27.6% response rate, and almost all the respondents were from... 98% were from the AUA.

So, basically the majority of the participants reported practice in urban locations and 55% were in academics, so that's very important. And almost 90% of the female urologists reported working full-time, so only 10% were part-timers. In the next slide, we can see how that practice was distributed. So, 55% of the participants were in academic. So, it's very important because we think that still, even though in academic, most of them are in academia, still the compensation patterns are different depending on the areas that they work. So, it is interesting because even though the compensation has increased, still we earn less than our male counterparts. So, this is very important. We have also, in terms of the representation of ethnicities and races, the majority were white, 71%, and 16% were Asian or Asian-Americans, and 6% were African-Americans. So, although these responses are significant, still are better than the AUA census with only 2% of the participants were reported as African-Americans.

So, it's very important also that this has several implications because there is a younger group of female urologists that are joining the current workforce. So, basically there are also... That I'm not presenting here, there were also issues related to sexual harassment, reproductive needs that they were in the future are planning to be published. But also what are the barriers that we women in urology experience? So, it's important because we have to inform future initiatives.

We obviously have activity and for the common generation of urologists. So, as the number of women urologists continuously increase, we need to pay attention to these needs, and obviously this census is part of a continuous effort to address this unmet need for gender-specific information for urologic surgeons. So, I think one of the other things that is very important is the work hours. Our studies show that a lot of the increasing hours in terms of the residents, the fellows, and comparing in terms of the reproductive age, most of this is basically during residency or just after residency. So this is important, we need to create, how to protect this younger population. So, I don't know if you have any questions, Ruchika, to include in this discussion. I really enjoy this effort because basically this will help us to delineate what are the needs and obviously in the future incorporate exchanges into the culture of the urology.

Ruchika Talwar: Thank you so much for presenting that quick overview of your data. I would love to engage in a discussion now about some specific points that you all were able to identify. The first point that you bring up is really interesting. The majority of women who practice in urology are in an academic setting, and as you mentioned, that does have an implication on pay structure and may also contribute further to some of the pay disparities that have been described in the female population of urologists.

Lourdes Guerrios Rivera: Yes, I agree, and this is very important also because there is a lack of female representation in academics. So, if you look at only 16%, and full-time academic faculty are females, and there are even programs that they don't have any female in their ranks. So, this is very important because as there is an increasing population of residents that are female, it's important to have that accordance in terms... Obviously, gender has an impact on specialty choice and obviously the exposure to gender discrimination and harassment also influences what residents are going to decide in the future. So, there is evidence that the lack of female roles obviously discourage future residents to select surgical careers, for example.


Ruchika Talwar: I agree, and the other thing to point out is that although the majority, 55% of women were in an academic setting, as you mentioned, overall women are still significantly underrepresented, but I'll take it a step further and highlight the fact that even within academic leadership structures, women tend to be underrepresented at the top of the triangle. We know that there are very few full professors of urology who are women, even fewer women in leadership roles, such as in a chair position of a department or a division or a section even.

So, I think not only do we need to do a better job of promoting equity and opportunities both in practice and academics, we need to ensure that we are being mindful about promoting women within leadership structures. Because as you said, you can't be what you can't see. So, when women residents see other women faculty members excelling along the academic ladder, I think it is very, very inspiring. And you bring up another important point, I think that although we know we have a long way to go in terms of racial and ethnic diversity, both within urology as a whole and within our female population, the female population tended to look different in terms of racial ethnic makeup. So, let's dive into that a bit. What are your thoughts there?

Lourdes Guerrios Rivera: So, basically I think even selecting residency, if you are an underrepresented minority, if you are a female, it's even difficult to reach those areas. So the career development, let's say for a Black, African-American women and Hispanic urologist is completely different. The challenges that they need to overcome in order to achieve the same goals of other populations, it's overwhelming and sometimes they need to compete with even the resources like the exposures, and it's really difficult to do it. Here, for example, in Puerto Rico, we only have six female urologists in our whole island.

Ruchika Talwar: Wow.

Lourdes Guerrios Rivera: It's hard, so you don't have a model to see yourself in that role model. So, it's part of the process and we get used to it, but I think we need to make that change. So, obviously there are barriers and challenges in any field and especially surgicals, but I think this needs to be improved in the future, so others could get into our specialty.


Ruchika Talwar: Absolutely, and especially I'm grateful that you're here, especially given your perspective on being one of six female urologists in Puerto Rico. I think it's really important that we hear your perspective and how we as an entire field can support you better, so that we can make marked improvements in this space.

Lourdes Guerrios Rivera: And now actually there are younger female residents that are upcoming too, but years ago it was not like that. So, I'm really, really happy that we are able to share this because there is a need for a change.

Ruchika Talwar: Yes, and another important point that you brought up was the idea of women who are of childbearing age having children either during their training or after their training. And although the majority of survey respondents did have children after their training, the number that had children during training was almost equivalent, and that's an important point. This has been a focus of organized urology and of programs across the country making sure that they are supportive for women and actually men who are growing their family during this critical time in our lives that we're in training, but it is our primary reproductive year. So, let's dive into that a little bit. What is your message for urology training programs? What can they take away from this data?

Lourdes Guerrios Rivera: I think it's important to know how to support women in urology who choose to have a family during their residency because we need time off there, we need access to healthcare for complications during the pregnancy. We need to develop consistent accommodations for all the programs. It's something that needs to be either the AUA, or the Accreditation Council of Graduate Medical Education... Right now, there is no certain example of accommodations for females who get pregnant during residency. I didn't have any maternity leave. I had my first child, I only had three weeks for maternity leave and it was from my vacations. Why do we have to do it like that? I know that things have improved, but still, we need to develop strategies to have a balance between work life and these accommodations because they'll impact the career progression of this new generation.

Ruchika Talwar: Absolutely, I think the AUA has done some important work along with the American Board of Urology in trying to standardize six weeks of parental leave, but I hear your point, that there really needs to be further standardization and a good process that can be applied across the board to ensure that surgeons who have received adequate training, but still do not need to put their lives on hold and can integrate this aspect of life during residency training. So, I think you're spot on there. As we wrap up here, I'd like to ask you, after doing a deep dive into this data, what are your messages for the broader urologic community?

Lourdes Guerrios Rivera: The thing is that knowledge, is basically everything. So, we need to engage in these critical issues like sexual harassment, like reproductive needs, what barriers we have in urology to develop initiatives that obviously can improve the upcoming generation of urologists because there are a lot of the younger generation that are upcoming, they will enter the workforce and if we don't know what their needs are, we are going to miss a lot of these challenges. So, one of the important things that I think SWIU wanted, is that we need to know what our challenges are and in order to increase our urologic workforce. So, with SWIU as an organization, we need to identify those needs.

Ruchika Talwar: Absolutely. Well, thank you for presenting this important data and thank you to SWIU for embarking on this sort of study. I think it's really important that we start these conversations by understanding our current state and then hopefully as we look to the future, we can do a better job of fostering a strong generation of a diverse urologic workforce. So, thank you so much for your time and for sharing your expertise in this space.

Lourdes Guerrios Rivera: Thank you, Ruchika. Thank you for this opportunity.

Ruchika Talwar: Thanks to our UroToday audience for tuning in to this important discussion and we look forward to seeing you next time.

Lourdes Guerrios Rivera: A pleasure.