World News

© istock.com/Dutko Stephens EH, Heisler CA, Temkin SM, Miller P. The current status of women in Surgery. How to affect the future. JAMA Surgery 2020; 155: 876–85 Chyu J, Peters CE, Nicholson TM, Dai JC et al. Women in Leadership in Urology: The Case for Increasing Diversity and Equity. Urology 2020; https://doi.org/10.1016/j.urology.2020.07.079 The issue is complex, but the basic facts are that in 2019, 10.3% of UK urological consultants were women while in the 2019 AUA census 9.9% of practising American urologists were female. These figures, which reflect a gradual, but slow growth of women within the specialty, are representative of most western healthcare systems. In younger cohorts, women have greater representation with 37% of UK trainees being female, while 22% of American urologists under the age of 45 years were women. Broadly speaking the main barriers to women in urology include implicit (unconscious) bias, issues around discrimination and harassment, matters of recruitment and training, difficulties in integrating professional and personal lives and very fundamental issues around the attractiveness of a surgical career. Although women comprise more than 50% of medical students in most western countries, attracting women into surgical specialties such as urology remains challenging. As the figures above show this is changing but challenges remain. A recent systematic review (https://www.sciencedirect.com/science/article/pii/S1931720420303500?via%3Dihub) showed that issues such as gender discrimination, perceptions of the surgical lifestyle and societal and cultural barriers tend to deter women from entering surgery. Female medical students can be positively influenced to enter surgery as a career if they receive appropriate mentorship, intellectual challenge and if they have practical experience of the specialty. “Although women comprise more than 50% of medical students in most western countries, attracting women into surgical specialties such as urology remains challenging” When they enter training there are often difficulties with flexibility, although in many countries such as the UK, there are active programmes in place to try to mitigate these problems. Despite this, there can be limited access to support for pregnancy and parenting, lack of flexibility in training programmes, concerns about work life balance, lack of female role models, lack of mentoring and a culture, particularly in surgery, that is not always conducive or attractive to women. Even when women are attracted into the specialty they have a high attrition rate with more women than men leaving training programs for similar reasons to those outlined above. It sadly remains true that in numerous surveys, women report frequent episodes of gender-based discrimination and sexual harassment. In the context of a traditionally male-dominated specialty with a hierarchical career structure (often) with an uninformed leadership, it remains the case that all too commonly the perpetrator is a supervising surgeon. The #MeToo movement has made women more willing to speak up about these issues and there have been a number of high-profile reports on them within the medical profession (https://www.bma.org.uk/media/1569/bma-daphne-romney-qc-report-oct-19.pdf). “The gender pay gap is greatest in the surgical specialties, including urology” Studies of pay and remuneration consistently show that female doctors are paid less than their male counterparts. This is true in healthcare systems, such as the USA where there is no standard rate of pay for a particular post, but it also true in those systems such as the UK National Health Service where in principal the rates of pay applies to the seniority of the post rather than to the person doing it. Known as the gender-pay-gap, this has its origin in a number of factors although the relative importance of these factors will differ between healthcare systems. There is a lot evidence that the gender pay gap is greatest in the surgical specialties, including urology. A study of the issues underlying the gender pay gap in the NHS, together with proposals to resolve this issue has been undertaken by the UK government and is due to be published in the near future. The ‘Women in Leadership in Urology’ paper in the Gold Journal explored the issues underlining the relative scarcity of women in leadership positions in urology. Specific examples were described including the paucity of women in senior academic positions, leadership positions within specialist societies, editorial and editorial board positions and faculty positions during national and international congresses. A case was made that there are a number of potential advantages to having women in leadership positions. Some are economic, while the leadership styles of women typically compliment those of their male counterparts, with some evidence being presented that groups with more varied leadership styles perform better, on multiple measures of success. Finally, evidence was presented to suggest that there are benefits to patient outcomes from increased female representation within both the general workforce of a specialty and within its leadership positions. All the articles explored potential solutions to these problems, which include improved education to minimise subconscious bias and eliminate gender-based discrimination, enhanced mentorship and sponsorship during a surgical career and active intervention to support women who wish to combine the professional career with a fulfilling home life, both during their training and then into their subsequent consultant career. The Journal of Urology, which is the flagship journal of the American Urological Association, recently announced the appointment of its new editor. Dr Robert Siemens will initially undertake the role of Incoming Editor from January 2021, working alongside the current editor Dr Joseph A Smith. He will take over the role of Editor-in-Chief from January 2022. He will be the first Canadian Editor of the Journal of Urology. Dr Siemens undertook both undergraduate and postgraduate training at Queens University School of Medicine, Ontario and he also the undertook a fellowship in Oncology at The University of Iowa. He is the current Professor of Urology at Queens University with additional appointments in the departments of Oncology, Biomedical and Molecular sciences as well as at the Queens Cancer Research Institute. He has previously served as the Editor-in-Chief of the Canadian Urological Association Journal. World News is written by Ian Eardley

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