Dr. Smith* is a general urologist who joined a hospital-based practice after residency. Prior to her arrival, word spread that there would be a new female urologist in the practice, and female patients jumped at the chance to schedule appointments with her. Instead of spending her clinic time booking ureteroscopies, transurethral resection of prostates and other general urological procedures, her clinics were filled with patients seeking care for recurrent urinary tract infections, overactive bladder and pelvic pain. Patients often commented on how much time she spent listening to their concerns, and many requested frequent followup visits. She felt as though she couldn’t perform the work she had loved most in training. Additionally, she produced fewer relative value units than her partners and ultimately received lower pay.

The story of Dr. Smith is not uncommon. There is certainly a great need for urologists specializing in the care of female patients. However, for many urologists entering the workforce, this was not the practice they had envisioned. I spoke with a fellowship-trained endourologist who, 3 years after fellowship, sees 95% female urology. She often feels that she is unable to tailor her practice to her desired subspecialty, and frequently wonders why she had chosen to do fellowship altogether. Over the last several months, I conducted interviews with 20 practicing female urologists in different sites and practice models across the nation, seeking advice for women starting their careers. Several common themes emerged from these interviews:

If possible, look for a practice that has employed at least 1 other female urologist. Women make up over 10% of the urology workforce, and this percentage continues to increase each year as residencies graduate more females.¹

Look for a practice with good advanced practice provider (APP) support. Currently, 74.4% of practicing urologists report working with at least 1 APP.¹ If there is a clear pathway to referring nonsurgical patients to APPs, there is decreased burden on the practicing urologist to accommodate new patients who prefer a specific provider.

Be clear about who is scheduling your clinic patients. Often in hospital-based practices, there is a centralized scheduler making scheduling decisions. In other settings, the scheduler is someone internal who you can clearly communicate your expectations with. Additionally, it is helpful to ask about scheduling transparency.

Are you able to see which patient referrals go to other partners in the group? Do the other partners in the group have a say in which conditions they are willing to see? This can be important in determining if 1 provider is disproportionately seeing nonoperative patients.

Know the statewide discrimination policies in your area. Schedulers should not be permitted to schedule based on the gender of the physician, and in many states this is illegal. A well-meaning scheduler may be speaking with a female patient and inquire if they would prefer seeing a female physician, but this is considered discrimination. Certainly, most people would feel this way if schedulers asked male patients if they would prefer seeing a male provider.

After many years of learning a broad skillset of urological procedures in residency, females desiring a general urology practice can experience unforeseen challenges. This article can help bring awareness of these challenges and provide a framework for graduating residents to build a successful, fulfilling practice in whatever area of urology in which they choose to specialize.

*Name has been changed to protect the anonymity of the contributor.