While women physicians are growing in numbers globally, urology largely remains male-dominated. Participation by women in the urology workforce varies widely worldwide, reaching as high as 22% in Columbia and 18.2% in Australia, while in some countries it is nonexistant.¹

Women represent 41% of practicing physicians in Israel and 59% of Israeli medical students.² The Israeli Urologists’ Association (IUA) was founded in 1956, and through the 1970s all its members were men. An initial trickle of women urologists in the 1980s and 90s has become a steady stream, reaching 35 in 2022, representing roughly 8% of Israeli urologists (see Figure). Currently, 19 women urologists are accredited specialists and 16 are residents (sources: IUA, Israeli Scientific Council, and urologist community).

Women urologists in Israel face challenges like our peers worldwide, with several unique struggles and opportunities. In response to the article by Dr. Albareeq and Dr. Turki on the Middle Eastern women urologist,³ we thought to share our perspective as Israeli women urologists in various career stages.

Cultural Gender Roles

Israel is a democratic modern Jewish state with a large Arabic minority and multiple ethnic, cultural, and religious groups, each with its own views of gender roles and its expectations of doctors. Gender perceptions may influence patients’ comfort with gender-concordant or discordant urologists,⁴ but it may also affect the perception of who looks like a urologist, by patients, fellow doctors, and ourselves.⁵ Can we view men and women as equally knowledgeable, caring, and competent?

Intersectional barriers also exist, and while the numbers of Jewish secular and traditional women are increasing, representation of women from ethnic and religious minority groups still lags behind.⁶

Figure. Women beginning urology residency in Israel, by decade. Source: the Israeli urological community.

In gendered languages, such as Hebrew or Arabic, many words have no gender-neutral form, including “doctor” and “urologist.” The male form is traditionally considered neutral, unintentionally excluding women and nonbinary physicians. Many societies and institutions with male names are changing into gender-inclusive, and recently the IUA has been challenged to do the same.

Tokenism and Pigeonholing

While some patients prefer a gender-concordant urologist,^3,4 urologists shouldn’t be restricted to see gender-concordant patients. Our experience echoes findings from other countries, where women urologists perform a significantly higher percent of women procedures.⁷

As for other professions, urology has a gender pay gap. Though men and women urologists work equal hours, women are more likely to work in less profitable settings, perform fewer procedures, and see fewer patients,⁸ a health care version of low-rewarding, “invisible labor” expected of women in the workplace. As the number of women urologists increases, our profession must advocate for fair compensation of all urological care and ensure that all our trainees are provided with equal opportunities for training and exposure.

System Structure

In the Israeli public medical system everyone is entitled to receive government-funded, high-level medical care. The relative resource shortage in such a system burdens interns and residents with administrative and technical duties, adding to the load of invisible labor and affecting the quality of training. The need for formal fellowship training, mostly overseas, creates a barrier, especially for families, and disproportionally affects women.

Family-Work Balance

Being a surgical profession dem­anding long training and radiation exposure, urology disproportionately impacts women’s reproduction and family life. Due to mandatory military service, many Israeli men and women begin their higher education at an older age, translating into women spending a greater proportion of their childbearing years in residency. Compared to their male colleagues, women surgeons carry a larger share of household and parenthood duties.⁹ Women surgical residents continue to voluntarily delay childbearing, have fewer children than the general population, and experience more infertility and obstetrical complications.¹⁰ Israeli society values family, holding the highest total fertility rate among the Organization for Economic Co-operation and Development,¹¹ evident in paid maternity leave and funding for infertility treatment. With men surgical trainees showing increased interest in work-family balance and active fatherhood,¹² it seems like paternity leave is the next logical step.^13,14

Education and Mentorship

The scarcity of women in urology presents challenges to their male mentors as well, and equal opportunities in surgical training may mean different things for different people. For instance, surgical instruments originally designed for men pose ergonomic difficulties for the woman urologist which her male supervisors may not realize,¹⁵ and socialization may cause differences in how men and women display confidence.

Men urologists tend to perceive their work environment as more gender-equal than women do, implying that a man mentoring women urology residents may benefit from his women peers’ input on challenges he is unaware of.¹⁶ Sponsorship of women and minority trainees is another important approach to improving health care diversity.

Upstanders calling out discrimination, however subtle, can have a great effect on women inclusion,¹⁷ as did my senior when correcting a patient who mistook me for a nonmedical professional on rounds.

Dr. Albareeq described the hardships and triumphs of becoming the first woman urologist in her country. Some of these are true for many, often the only woman in a room of men. We encourage women to seek women colleagues from other departments and generations for guidance and perspective. Being a woman in a male department can feel like a constant spotlight, where one’s shortcomings seem to represent the whole gender. ­Sharing successes and failures with our peers, we accumulate knowledge and confidence to pass down to future generations.

Conclusion

Urology is held back when we don’t utilize the full potential of our community. We cannot afford leaving out half of our potential talent and diverse points of view.

Women urologists are making notable progress in Israel and worldwide, but there is yet room for improvement and obstacles to remove. Scarce but influential, we strive to lead by example and give our patients the optimal treatment, to practice gender-oriented urology, and to encourage the next generation of women urologists for the benefit of our patients of all genders. As more women join the IUA, achieving academic and leadership positions, the Israeli urological community has much to celebrate as we continue to face the challenges ahead of us.