With the recent celebration of National Women Physicians Day, it is important to stop and reflect on the past and current presence of females within our great specialty of urology. The first female urologist in Canada was Dr. Christina Hill, who graduated from urology training at The University of Toronto and began practice in 1976.¹ Dr. Hill was not only a leader in the field of urology but set the groundwork for women in leadership roles in the Ontario Medical Association and the Council of the College of Physicians and Surgeons of Ontario.

Over the past 45 years, there has been a slow rise in the number of women training in urology, with now nearly 100 female urologists practicing within Canada. The number of women in medical training and practice has steadily increased in Canada. In 1968, only 14% of medical students were women; however, in 2016, more than half (56%) of medical students were women.² Despite over half of Canadian medical trainees being female, there remains a small cohort of women represented in surgical specialties, and specifically urology. Recent data from practicing physicians in Canada reveals that 28% of surgeons in Canada are women³; however, only 11% of urologists in Canada are female.⁴ In training, we do see a slightly higher number of women as 25% percent of residents and 18% of fellows currently training in urology in Canada are female. Despite a rise in the number of women pursuing this specialty in Canada, urology continues to have some of the lowest numbers of females of all specialties. The Canadian Medical Association survey from 2019 identifies urology as being the specialty with the fourth lowest percentage of females across all specialties.⁵

Recently, our group assessed trends in acceptance of female medical students to the twelve accredited urology training programs in Canada. We analyzed match data from the Canadian Residency Matching Service from 2007 to 2017. We performed a retrospective analysis of males and females who listed urology as their top preference and subsequently matched to the specialty. We also assessed the rates of growth of female population in urology compared to that of general surgery. We identified that overall there are fewer female urology applicants than males, but there was no evidence to suggest that there is any difference in success of matching to urology based on gender (p=.045). There was also no difference in rates of success of females matching to urology when compared to rates of admissions of females to other surgical specialties combined (p=.045). When we compared the rate of growth of females in general surgery compared to urology since the year 2000, there was a significant difference, wherein rate of growth of females in general surgery was much higher than in urology (p=.016).⁶

Overall, Canadian women currently practicing urology are content with their career.⁷ A recent study by Hird et al showed that 96.6% of Canadian female urologists surveyed were very or somewhat satisfied with their career and most would choose to pursue urology again. Importantly, 65% of female urologists have experienced gender discrimination at work and 40% felt that they had a difficult time finding mentorship during their training. These disparities highlight some of the major barriers for women to pursue careers in urology and need to be recognized and addressed during training and at an institutional level.

Reassuringly, there is no difference in the rates of females being accepted to Canadian urology programs. However, it is clear that there is still a lot of work to be done to increase the number of women practicing urology in Canada. The small percentage of female urologists cannot be attributed to bias in the application process, thus we need to take a deeper look at what other factors may be impacting the expansion of females in urology. While gender parity is not the goal, we want to ensure that there is equal access and opportunity for women who do wish to pursue urology. With an increase in diversity and representation, hopefully there will be more work done to assess potential causes and solutions for the lower number of women currently training and practicing in urology in Canada.