The proportion of female medical students in the United States is increasing, and for the last 2 years women have comprised the majority of all medical students.¹ Coinciding with the increase in female medical students, the proportion of female urology trainees has also steadily increased. Despite this, women remain a minority of urology trainees and staff.² At our current pace, it will take 56 years to close the gender gap in urology.³ This begs the question, what can we do to close the gender gap in our field?

The earliest first point of intervention will be to correct the mistaken rhetoric that urologists primarily treat men and that men should primarily be treated by men. On a personal level, this was a platitude that we heard repeatedly as medical students, said not by urologists but by physicians of other specialties. Our initiatives must begin with a wide range of education practices aimed at medical students to help them understand the breadth and depth of our field. By promoting inclusivity of female medical students, we can expedite growth. It is not enough to passively await parity in our field as we wait for the increased number of female medical students to mature into practicing urologists and even longer for them to become leaders in our field.

Although women make up a minority of urologists (currently 9.9% of practicing urologists), this disparity is even greater in academic urology.² Barriers to success in academic practice occur at every step of the promotional ladder. For example, a critical metric of academic success is publication in academic journals. Even though women have steadily increased their presence in academic writing, they are trailing behind their male counterparts in senior/last author roles, which suggests a failure to progress to leadership roles.⁴ Similarly, women are less likely to serve on journal editorial boards, which leads to a less equitable peer review process.⁵ A double-blinded peer review process (with blinded editors and reviewers) would potentially lessen this disparity.

Figure 1. Social ecological model for recruitment, promotion and retention.

Institutional policies aimed at recruitment, promotion and retention of women are lacking in 40% of academic institutions.⁶ Given that women’s advancement in academic medicine has historically occurred more slowly than men’s, programs aimed to help advance the careers of women through recruitment, retention and promotion are essential, and can be aimed at 5 levels based on social ecological models: individual, interpersonal, institutional, academic community and policy (fig. 1).⁷ Initiatives that promote sponsorship of other women in academics are known to speed the process of career advancement for women, and these initiatives can start at the level of the medical student and continue throughout the academic career.⁸

Figure 2. Women in Urologic Oncology meeting at the Society of Urologic Oncology in 2015 (left) and 2022 (right).

Writing about the gender gap in urology can often have grim undertones. However, thought leaders in the field of urology are taking gender diversity seriously. In the past year alone, there have been important steps toward gender equity that are worthy of recognition. We have seen the promotion of several highly qualified surgeons to the title of Chair of Urology. Dr. Larissa Rodríguez and Dr. Kathleen Kobashi have joined the elite few female Chairs and have certainly proven themselves to be exemplary leaders, paving the way for others. In July 2021, the American Board of Urology implemented new parental leave policies, to guarantee a minimum 6-week parental leave. Providing nongendered leave is a huge step toward gender parity among trainees, while holding all training programs accountable for these policies. This year, we also saw the phenomenal success of the Women in Urologic Oncology meeting and the inaugural Women in Pediatric Urology meeting, embedded within the respective subspecialty meetings (fig. 2). Finally, the editors of European Urology committed to maintaining gender equity among panels and provided guidelines for other urologists to do the same.⁹ These institutionalized moves normalize the goal of gender equity and are greatly appreciated by women in urology.

This year has seen incredible growth and potential for the development of women as future thought leaders in urology. While there is still work to be done, committing to actionable changes could further our efforts for gender equity even more. As such, we challenge all of our colleagues and friends in the field to sponsor women at all stages and promote gender-diverse authorship, even if that requires reaching outside of your circle of colleagues.