Gender Inequities In Urology

Women urologists in training and in practice face a number of distinct challenges. Microaggressions, societal expectations about interactions with women, expectations about family/mother roles, lack of representation in leadership, fertility—the list goes on.

Despite the growing number of women in the field, there are still significant data that suggest women are promoted at a slower rate than male colleagues,¹ are paid less even when controlling for work hours,² and may have fewer academic opportunities when it comes to publications, awards and recognition.³ On top of this, women physicians face hurdles in their daily work environment. The National Academies of Sciences, Engineering, and Medicine reported that 20%-50% of women trainees reported sexual harassment or assault.⁴ Discussion surrounding work environment for women and perceptions of equity in the workplace are important steps towards achieving inclusion and ultimately success.⁵ While these topics are frequently discussed amongst women, in order to exact meaningful change these conversations need to include our male peers.

What Is Allyship?

In 2021, Dictionary.com identified “allyship” as its Word of the Year, defined as “the status or role of a person who advocates and actively works for the inclusion of a marginalized or politicized group in all areas of society, not as a member of that group, but in solidarity with its struggle and point of view, and under its leadership.”⁶ With respect to women in the urological workforce, this definition implies that allies should be working towards greater inclusion for women within urology. Inclusion goes beyond simply increasing the number of women in the field (ie, increasing representation); inclusion means that women who are urologists have equal access to opportunities, are given a seat at the table, and are valued within our historically male-dominated specialty.

An important and related concept is “sponsorship,” typically where a more senior individual uses their connections and experience to help create greater access to opportunities for individuals not as far along in their career pathway. Finally, another important term in this space is “upstander,” which Elisa van Dam defines as an individual who speaks or acts on behalf of someone else, especially when that person is being ignored or attacked. In addition, an upstander can be a person with influence who works to undo systems and/or structures with inherent bias.⁷

Why Is Allyship Important?

Allyship is important for a number of reasons. Individuals within marginalized groups, such as women in urology, often lack access to power or influence that can overcome inherently biased structures in the workplace, whereas allies may be more readily able to change these structures. For example, if a women urologist is experiencing harassment by staff in the operating room, an ally in a position of power can act to help identify the negative behaviors and address the infrastructure of the biased system to put a stop to the harassment. Additionally, an inclusive work culture should not impose the burden of demolishing structural and cultural biases upon members of the groups most disadvantaged by those biases.

How Can I Be an Ally?

Allyship is a continuous journey of learning and advocacy, even for individuals with a long history of allyship. Here are some easy actions to incorporate allyship into your practice:

1. Learn about becoming an effective ally by reading. Numerous resources about allyship are available online, in print, and potentially at your local institution. It is important to recognize that allies understand the burden of learning is on those seeking to become an ally, rather than asking members of marginalized groups how to be an ally.
2. Learn about your implicit biases. Everyone has implicit (sometimes call unconscious) biases; in many ways these biases are absorbed from societal expectations, media, or personal experiences, even as early as childhood. One way to gain insight into your own unconscious biases is to take an Implicit Association Test (free at https://implicit.harvard.edu/implicit/takeatest.html).
3. Do a network and mentorship biopsy. Examine the demographics of individuals you have mentored and/or sponsored over the past 5-10 years. How many of those individuals are women? How many are from other marginalized groups? If you have few or no women among those individuals, that suggests an opportunity for you to increase your knowledge and experience as an ally for women.
4. Listen to the experiences of women who you work with. Your colleagues have lived experiences that may differ from yours, and spending some time listening is helpful in establishing yourself as a trusted ally.

An excellent way of listening and supporting is by lending your voice to women in the room. For example, sometimes women experience their ideas being dismissed or repurposed in a meeting or conference. As an ally, you can lend support to those ideas, and make sure credit is given where credit is due.

5. Speak up when you witness offensive comments and microaggressions. Being a supportive ally entails being able to support someone when you see harmful behavior, and calling out negative treatment. It is okay to use your position to raises concerns with leaders to identify necessary changes to policies and practices as well as organizational climate and culture.
   Be an upstander!
6. Transparency is key in achieving equity. Transparency is often lacking in medicine, whether it’s salary structure, administrative support, or even leadership advancement/opportunities.

All salaries, incentive structures, and support should be made public within your group. Although potentially uncomfortable, the pay gap in urology will never be closed until we know exactly how much people are getting paid for their work.

All leadership, funding, and promotional opportunities should be advertised publicly. Although it feels easy to tap a colleague you trust for a position, the opportunity to apply should be made available to all who are interested. This process will help improve opportunities to women, and urologists from historically marginalized groups, who may be overlooked.

7. Be intentional about sponsorship. Sponsorship is the active support to help someone’s career advancement goals. Mentorship is different from sponsorship in that it focuses on guidance and can come from colleagues at any career level.

Some intentional ways to be an ally and a sponsor:

• Nominate women for positions of leadership within your group/department/institution.
• Nominate women for awards. Data show that women are underrepresented in AUA career recognition awards, and the process towards equity starts with nominations.
• If you are unable to give a talk or attend a meeting, suggest a woman take your place.
• If you are invited to give a talk and the panel lacks diversity, recommend a woman or diverse speaker joins the panel. It is okay to withdraw or say no to an all-male panel.

8. Support fair pregnancy/parental leave/lactation practices.

Other Marginalized Groups in Urology

While the focus of this article is allyship for women within urology, it is critically important to recognize that individuals from many backgrounds remain marginalized within urology. Individuals from minoritized racial or ethnic groups, gender diverse urologists, LGBTQ individuals, and others often face structural and implicit biases in their work life and beyond. Importantly, women who also belong to another minoritized group (eg, Black women) can face multiple disadvantages from biases and barriers in the workplace, which is termed “intersectionality.”

For urology to continue to thrive as a field, particularly in the setting of the twin demographic challenges of an aging workforce and an aging patient population (which will increasingly require urological care), it is important for our specialty to embrace inclusion of women and other minoritized and marginalized groups. Allyship is an important way that everyone can contribute to the growth and future success of urology—take the first step to becoming an ally today!