There is both cause for concern and reason for celebration when surveying the landscape of women in urology.

On one hand, women remain underrepresented in the field. The gender gap, however, has been narrowing and research suggests it will continue to do so.

Only 10 percent of practicing urologists today are women. In 1995, however, that number was just 1.2 percent. Urology, meanwhile, retains one of the lowest representations of practicing female physicians despite decades of progress. Orthopedic surgery (11 percent), plastic surgery (16 percent) and otolaryngology (22 percent) trail urology as surgical subspecialties with the lowest percent of women practicing.

That’s according to a December 2020 study which examined the current state of women in academic urology. The research aimed to determine a correlation between female applicant matches and the proportion of female faculty or residents at an institution and became the first study to compare gender differences across American Urological Association (AUA) regions.

The 2020 AUA Match filled 353 residency slots, including 105 by women (30 percent). Female applicants matched at a rate of 86 percent, exceeding the rate of male applicants (77 percent) for the first time since 2014.

Across all institutions with urology residency programs, women accounted for 27 percent of residents and 16 percent of full-time faculty. The number of female residents has increased from the previous year in four of the past five years.

Women are still underrepresented in leadership roles in academic urology, with 23 (16.2 percent) female program directors and six (4.2 percent) department and/or division chairs.

Eleven percent of academic urologists are women and they are promoted at slower rates than their male counterparts. Female medical students have reported that access to mentors of the same gender factors into their decisions to study a particular specialty. With more practicing female urologists choosing academic practice, it creates added access to mentors for medical students and residents.

While there is a positive association between the proportion of existing female residents and female faculty, more research is needed to examine contributing factors, according to the study.

In the 2019-20 academic year, women made up 50.5 percent of all medical school enrollees — the first time they were the majority.

The median age of a practicing urologist is 55, and 30 percent are 65 or older. According to the 2019 AUA census, 22.2 percent of female urologists are under age 45.

“With the current trend of nearly 30 percent of trainees either entering or currently in residency being female, the gender gap will continue to narrow,” the authors write.

A similar study from September 2020 found the proportion of female first- and senior-authored peer-reviewed manuscripts in five prominent urology journals is significantly higher than the proportion of women in urology.

“More of our senior authors were women than we had anticipated,” Dr. Kathleen Kieran, the study’s author, said on the Speaking of Urology podcast. “We were delighted to see this. We were especially surprised to see that this difference was most pronounced in terms of journals that had double-blinded peer review. … That really tells us, at least within our specialty, that this is solid research that stands on its own and is appreciated by our colleagues."