Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective :
Minimally invasive laparoscopic/robotic surgery (MIS) has transformed urology over the last two decades. In the same time, there has been a rapid rise of women in urology, but evidence shows women are less likely to specialize in MIS. We aim to characterize and evaluate temporal gender-based trends for MIS surgeons relative to specialty, practice type, and case-mix.
We retrospectively reviewed a de-identified dataset from the American Board of Urology including 6-month operative logs submitted for board certification or re-certification from 2005-2015. We excluded pediatric urologists and assessed MIS case volume and case mix according to gender, accounting for specialty, practice type, region, and log year. Chi-squared analysis and t-tests were used for univariate analysis. These results were then used to fit multivariable regression models.
6800 urologists submitted 7675 six-month operative logs. Women represented 8.7% of the total population, and 11.4% of academic providers. There was no significant difference in the number of women who logged any MIS case (p=0.5) but they logged significantly fewer mean cases than men (5.1 cases vs. 13.6), even in an adjusted model. Women accounted for only 4.8% of surgeons who logged 1+ MIS case/month and just 2.2% of those who logged 1+ MIS case/week. This remained significant when accounting for specialty, practice type, region, and certification year (Table 1). Female MIS surgeons were less likely to be oncologists (p=0.02) or in endourology/laparoscopy, more likely to be female pelvic medicine specialists and more likely to have a full-time academic practice (p=0.002). After 2005 there was a significant trend towards increasing female MIS surgeons over time, stabilizing in 2013. Among surgeons who logged 1+ case/month, women performed 20% more renal cases and 29.5% fewer prostatectomies compared to men.
Women are significantly under-represented amongst surgeons who perform at least 1 MIS case/month, even when controlling for confounders. Oncology and endourology/laparoscopy have the fewest female MIS surgeons and MIS case-mix varies by gender. These trends have substantially improved over time, but overall numbers of female MIS surgeons remain low. Further investigation is warranted to determine factors involved in gender disparities related to the performance of MIS in urology.
Jennifer Robles– Urology Fellow, Vanderbilt University Medical Center, Nashville, Tennessee
Ryan Terlecki– Wake Forest Baptist Health, Winston-Salem, North Carolina
Brant Inman– Associate Professor of Urologic Oncology; Vice Chief of Urology, Duke University Medical Center, Durham, North Carolina
Nicole Miller– Associate Professor of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
Vanderbilt University Medical Center
Jennifer Robles, M.D. completed a Urologic Surgery residency at Washington University in Saint Louis in 2016 and is currently an Endourology and Laparoscopic/Robotic Surgery Fellow at Vanderbilt University. She is also a VA Quality Scholar and is completing a fellowship in Quality Improvement, including a Master's in Public Health. Her interests are in surgical quality improvement, particularly using implementation science and clinical informatics to improve the efficiency and quality of surgical care delivery.
Associate Professor of Urologic Oncology; Vice Chief of Urology
Duke University Medical Center
Durham, North Carolina