The US population has never been more diverse. Between 2020 and 2022, at least 30.1% of the population was comprised of racial/ethnic minorities, 50.4% of females, and 13.9% of immigrants.^1,2 With anticipated growth in this diversity and new opposition to diversity, equity, and inclusion (DEI) within the broader education system, having a medical workforce that reflects and meets the needs of the population becomes vital.

Diversity in Urology

Urology has historically struggled with recruiting and retaining talent from underrepresented groups such as racial minorities, women, and LGBTQ+ individuals. Of the 385 students that matched into urology in 2024, a mere 30 of them were African American and 40 were Hispanic.³

Despite the growing number of medical school graduates, an inclusive urology workforce remains challenging to attain, though some progress has been made. For instance, 45% of matched applicants were female (Figure 1). In the quest for equity in urology, we must first determine what the value of a diverse workforce is in health care. Broadly speaking, an inclusive workforce improves patient outcomes, decreases health care costs for the medical system, and ensures the needs of both patients and physicians are met.⁴

Equitable Outcomes from an Equitable Workforce

A recent study highlighted that patients from minority backgrounds had better outcomes, including improved compliance and satisfaction, and reduced uncertainty surrounding diagnoses or treatment plans when they had racial/gender concordance with their provider.⁴ So how does this translate into urology? Dr J.J. Diah, a PGY4 urology resident at SUNY Downstate and first-generation Jamaican American woman, recently wrapped up a complex visit with a black female patient and her family. The patient’s daughter expressed gratitude for Dr Diah’s presence, stating “we never thought we would have someone who looked like us helping mom… .” Drawing from her experiences caring for minority patients in Brooklyn, Dr Diah notes that physicians from diverse backgrounds are uniquely positioned to aid patients who have difficulty navigating the medical system and may not discuss important aspects of their medical history due to prior negative experiences.

Notably, DEI also has real financial value in health care. In 2023, the US spent $4.3 trillion on health care alone.⁵ One study found that diverse teams were associated with increased profitability and improvements in innovation, productivity, and accuracy in risk assessment.⁶ In other words, an inclusive workforce is beneficial for patients, physicians, and the medical system’s financial interests.

The Intersection of Inclusion and Advocacy

While it’s important for patients to fare better and health systems to meet their bottom line, the ultimate power that urologists have is in shaping the policies that impact how we practice. Unfortunately, few urologists are engaged in advocacy and health policy. In fact, doctors often possess little knowledge of legislative processes and laws that directly impact their practice. In a survey of > 1000 physicians within the University of Wisconsin medical system, only 15% reported being highly engaged in health policy advocacy. Only 188 surgeons reported being involved in advocacy, with 19.5% of them having high engagement.⁷

Of course, surgeons, including urologists, have arduous schedules that limit participation in extracurriculars. However, without physician engagement in health policy, we run the risk of practicing under ill-informed policies that prevent us from delivering the best care.

Importantly, advocacy and DEI are intertwined. Indeed, some urologists, like Dr Brian McNeil, are bridging DEI and advocacy in both the clinic and the community. Dr McNeil is a black urologic oncologist, Chief of Urology at SUNY Downstate Medical Center, and the recipient of the AUA Diversity, Equity, and Inclusion Award. Drawing from the loss of his father to prostate cancer-related complications, Dr McNeil focuses on “mitigating the burden of prostate cancer” by providing culturally competent care to black male patients in Brooklyn. He also participates in the annual AUA Advocacy Summit, educating legislators on urologists’ concerns and advocating for legislation that supports at-risk communities. As an expert on tackling disparities in prostate cancer, Dr McNeil is motivated to “ensure that those lost to cancer or facing cancer diagnoses fuel a collective commitment to equity and access to health care.”

Advocacy is not just for seasoned urologists. For Nancy Quintanilla, a medical student at UCLA and Executive Committee member of the AUA’s Policy and Advocacy Resident Workgroup, engaging in advocacy as a trainee allows her to “critically engage with the profession of urology and better understand the unique difficulties urology patients face.” Indeed, her experiences have challenged her “to understand…the legislative and health care systems within which we operate, innovate local initiatives, and communicate larger scale policy to improve patients’ outcomes.”

Looking Ahead: The Future of Equity and Advocacy in Urology

So where do we go from here, and how will urology recruit and retain diverse trainees who will effectively advocate for themselves and their patients? One solution is to highlight underrepresented, practicing urologists and strengthen mentorship for minority trainees. Certainly a lack of urology exposure often prevents underrepresented individuals from pursuing a career in urology. Further, lack of mentorship for women and minorities can result in decreased engagement in leadership within their organizations or practices. This may prevent them from gaining perspectives that could make them stronger advocates. In a 2016 study, out of 127 urology department chairs, only 2 were women. Across multiple urology subspecialty organizations, women made up < 30% of executive leadership.⁸

Missing opportunities for diverse entities to elevate their voices ultimately diminishes our chance to eliminate disparities within urology and fight inequitable policies. Fortunately, programs such as the AUA’s FUTURE (Future Urology Talent from UnderRepresented Entities) and organizations like the R Frank Jones Urological Society advance equity in urology through mentorship, which ultimately strengthens trainees (Figure 2).

Figure 2. Downstate urology residents at the New York Section AUA Empire Intern Boot Camp.

As we consider the future of urology, it is evident that an inclusive workforce is and will remain necessary for advancing health equity, supporting our patients, and improving our field overall.

Acknowledgments

We would like to thank the following individuals for their contribution to this article:

J.J. Diah, MD, SUNY Downstate Medical Center, Brooklyn, New York.

Brian McNeil, MD, MBA, FACS, SUNY Downstate Medical Center, Brooklyn, New York.

Nancy Quintanilla, David Geffen School of Medicine at UCLA, Los Angeles, California.