The story of the growth of women in urologic oncology started in 1954 when Willet Whitmore trained Elizabeth Pickett, the first female urologist to complete the oncology fellowship program at Memorial Sloan Kettering Hospital. It was over 30 years later before a few more of us started entering the field. By 2000 there were still only a handful of women practicing in this subspecialty across the country. At that time less than 10% of urology residents were women, and they were often encouraged to focus on pediatrics or female urology, which were considered more acceptable fields for women. Those of us determined to focus our career in oncology were fortunate to find male mentors who encouraged and sponsored us in the field.

Over the next 2 decades there was a slow but steady increase in women entering urologic oncology fellowships as the percentage of women in residency rose to about 20% across the country. By 2010 we began seeing more women complete their training and taking junior faculty positions in academic centers across the country. A few years later we started meeting informally at the winter Society of Urologic Oncology (SUO) meeting and realized how powerful it was to meet other women with similar interests and facing similar challenges in our careers. In 2019 we reached “activation energy” and through a concerted campaign we obtained the support of the SUO leadership to establish a formal subgroup of the SUO called WUO—Women in Urologic Oncology. This was supported by the handful of senior women in the field, but it was really led by a group of the next generation of women who were emerging as young leaders in their institutions.

Women still make up a small percentage of all urologic oncologists in practice, but the number of female applicants to SUO fellowships has more than doubled since 2014 and there are nearly 100 female members in the SUO organization today (see Figure). However, we are still short of a minimal goal of matching the 11% of urologic oncology patients who are female.

We have learned a number of lessons on the way that are applicable to all of the subspecialties in urology and, in many cases, also to the general field of urology as a whole.

• Mentorship. This is critical in all aspects of professional life, both in and outside of academic medicine. Mentors can provide guidance, motivation, emotional support, and/or role modeling, and can help with exploring career paths, setting goals, developing contacts, and identifying resources. While role models of successful female urologists are incredibly helpful, often male mentors can be equally effective in this role for many women. Many, if not most, successful professionals may have multiple mentors during the course of their career, and looking outside your department or even outside your institution may be necessary at times.
• Sponsorship. In recent years it has become increasingly evident that minority groups, including women and Underrepresented in Medicine (URM) urologists, need sponsors as well as mentors. Sponsors will help you become visible by recommending you for local, regional and national speaking opportunities, panels, committees, and other activities. Only in retrospect did I realize how often my mentors did this for me and how critical this was to my ultimate career growth.
• As many of our male colleagues have started to recognize the importance of reaching out to bring women onto panels and speaking roles at our meetings, their support has been crucial. Many are now speaking out when asked to participate in a “manel.” The WUO and the Society of Women In Urology, among other groups, maintain potential speaker lists as a resource to help in this endeavor.
• Affinity groups. The power of this type of networking is invaluable, especially for individuals who may feel isolated in their own institution. These groups are often informal but do require some effort to foster and sustain. The achievement of gaining official recognition for the WUO was surprisingly empowering, and I would encourage groups in other subspecialties to try to achieve this within their own subspecialty society. In addition to official recognition and some funding for our activities, we were able to gain approval for some travel fellowship and research awards for our group, heightening our potential impact for our junior members.
• Help our field adapt to having women members. We need to work toward helping the field of academic urology adapt to recruiting and keeping women in the field. Many of us got where we are by adapting to the male-dominated world we work in. While there is lots of discussion of work-life balance, in fact there is no question that 5 or 6 years of training and then fellowship and the intense first few years of academic career conflict directly with the typical years of having and raising young children. There is very little flexibility in the system right now to allow for this, and I suspect that has scared away many female students and residents from pursuing an academic urology career, or may result in them dropping out along the way. The effects of the pandemic have really highlighted the tenuous balance many young faculty have been juggling. We need to come up with some creative solutions and to work with our institutions to try them out.
• Be an ally in your work. Help to eliminate discrimination and microaggressions experienced by women and URM students, trainees, and faculty. These comments come from patients, colleagues, nurses, faculty, friends, and others. Be aware of them, call them out, and intervene to support the victims.
• Pipeline development. Few students start medical school thinking about urology, and even fewer about urologic oncology. Fortunately, now almost a third of applicants to urology residency are women, so it is no longer considered an oddity to pursue this career path. Getting junior students involved in urology research, shadowing, and other clinical activities can often spark an interest that they had never considered.

Figure. Female applicants to SUO fellowships. Data provided by the Society of Urologic Oncology administrative office.

Conclusion

The growth of women in the field of urologic oncology over the past 3 decades has been steady, and in recent years almost exponential. Our development of a formal affinity group within our national subspecialty organizational structure may be a good example for other subspecialties and under-represented groups to consider. In addition, both women and men have important roles to play in continuing to support our URM and female trainees and junior faculty in their careers, regardless of their subspecialty or practice settings.

Acknowledgments

This article summarizes the presentation of a plenary panel at this year’s AUA annual meeting in New Orleans, with contributions from the following panel members:

Cheryl Lee, MD, Professor and Chair, Department of Urology, The Ohio State University School of Medicine; Sarah Psutka, MD, MS, Associate Professor of Urology, University of Washington School of Medicine; Sima Porten, MD, Associate Professor of Urology, University of California San Francisco School of Medicine; Kristin Scarpato, MD, MPH, Associate Professor of Urology, Vanderbilt University School of Medicine.