Women physicians make up a growing proportion of the urological workforce. According to the 2019 American Urological Association Census, 9.9% of practicing urologists, ¹ 29.4% of urology residents and 30.9% of urology fellows are women. ² Despite growing numbers of women practicing medicine, women physicians continue to earn less money than their male counterparts. This gender pay gap has been found in every field of medicine and has been previously reported in urology. ³

Many have attributed the gender pay gap to women choosing less profitable fields of medicine. Others believe it is due to women physicians working fewer hours than men. Our study sought to better understand if a gender pay gap exists in our specialty and then explore potential factors using the 2017 AUA Census data.

Of the 12,517 practicing urologists in 2017, 2,323 completed the AUA Census that year (18.6%). Women urologists tend to be younger and have fewer years in practice compared to males, so our sample was limited to urologists 34 to 63 years old to ensure age comparability. We also matched men and women for number of years in practice. Since $350,000 per year was the median take-home pay reported on the AUA Census in 2017, we grouped data into higher pay (more than $350,000) or lower pay ($350,000 or less).

We evaluated demographic information (age, race, ethnicity), education and training (fellowship lasting 1 year or longer), practice characteristics (primary and other subspecialty areas, primary practice setting, employment vs practice ownership), workload (number of hours worked in patient care and other duties per week, number of patients seen per week, number of inpatient operative procedures performed per month, number of minutes spent with a patient in a typical office visit) and geographic location of their primary practice (zip codes). ⁴

A greater proportion of male urologists earned more than $350,000 than did female urologists on bivariate analysis (56.9% vs 39.7%, p=0.01). Importantly there were no significant gender differences in self-reported weekly mean number of clinical hours or nonclinical hours worked. Men reported performing more major inpatient procedures per month (7.8 vs 5.6, p=0.02) and having more patient visits per week (78.4 vs 68.4, p=0.04). Women urologists reported spending more time with each patient in a typical office visit (17.6 vs 14.9 minutes, p <0.01).

On unadjusted logistic regression analysis men were still more likely to earn more than $350,000 than women (OR 2.01, p=0.02). Gender was no longer statistically significantly associated with income. However, the model could not exclude a moderate effect size favoring the ability of men to earn more than women (OR 1.59, p=0.11).

Several factors were associated with increased odds of earning more than $350,000, including working more clinical hours, working fewer nonclinical hours, having shorter mean office visits, having more office visits, performing more inpatient surgical procedures, private practice setting, subspecialty training, practicing in the Northeast, and nonWhite race.

Our study found that the gender pay gap in urology is mediated, at least in part, by women spending more time with each patient, which leads to women seeing fewer patients per week. Women also perform fewer inpatient procedures. What is unclear is if women urologists are choosing practices that require fewer inpatient procedures or if their referrals tend to require less surgery.

We also know that women urologists are more likely to be employees and being in private practice is also associated with earning more. This may be, in part, because the general trend in medicine is toward being employees, and women tend to be younger and in practice fewer years.

Our findings are echoed by a recent article by Ganguli et al, which evaluated the gender pay gap in primary care. ⁵ They found that women generated 10.9% less revenue from office visits than their male counterparts in primary care. Similar to our study they found that women spent more time per patient, which led to fewer patient visits. Instead of finding that women primary care doctors worked less than men, they found that women spent more time in direct patient care per visit, per day and per year. The pay gap was due to seeing fewer patients overall.

A gender pay gap exists in urology with men more likely to earn more than $350,000 per year than women. As was found in primary care, women spend more time with each patient, which leads to fewer weekly patient visits. Further study is required to understand if practice differences between male and female urologists are due to the preferences of the providers or if women in urology are being pushed into practices where they need to spend more time counseling patients and do fewer inpatient surgeries.