Pulse
Trailblazers
A rarity in urology not long ago, women are going into the specialty in gradually increasing numbers.
When the group Women in Urology was formed at the 1980 annual meeting of the American Urological Association (AUA), its membership roster consisted of five women who met informally over breakfast to share their experiences and frustrations.
By the mid 1990s, women were still so scarce among the ranks of attendees that the few who were there turned heads, recalls Suzette E. Sutherland, M.D., now a partner in Twin Cities-based Metro Urology and an adjunct associate professor of urology at the University of Minnesota. “I was there with another woman who was also a resident at that time,” Sutherland says. “It was a very conservative, male-dominated crowd, and we definitely stood out amongst the traditional dark suits and ties.”
Fast forward to today and the picture has changed significantly. “Now you walk into the AUA and there are so many women all over,” Sutherland says. The evidence is more than anecdotal. Women in Urology, now known as the Society for Women in Urology, has grown into a robust organization with more than 300 members including nearly 200 board-certified women urologists. And this year, women make up 28 percent of the incoming urology residents, says Deborah J. Lightner, M.D., an associate professor of urology at Mayo Clinic. “We basically reached the tipping point. Nobody says anymore, ‘Oh, but she’s a woman.’”
That’s not to say that all things are equal among the specialists once considered the male equivalent of OB/GYNs. Women still make up just a fraction of the board-certified urologists in the United States, and women urologists struggle to achieve the same level of financial and career success as their male counterparts, says Lightner, lead author of a 2005 study on the status of women in urology.
Lightner is in a unique position to understand just how profound the change has been, however. A practicing urologist for 25 years, she’s been a trailblazer in the field. Among her list of firsts, she was the first woman trained in urology at Yale, the first woman urology fellow at the University of Minnesota, the first woman urologist practicing in the Twin Cities, and the first woman urologist on staff at Mayo Clinic.
She was also one of just eight women in her medical school class of 85 students at Vanderbilt University and the only woman to go into surgery. Originally, Lightner intended to specialize in orthopedics, but that field was even more male-dominated. “[Urology] was a little friendlier than orthopedics was at the time,” she says.
Surgeons First
Lightner says she was drawn to urology first and foremost because she loved doing surgery, and urology offered her the opportunity to do a variety of procedures. “From my point of view, it’s because I like a combination of endoscopic and robotic and laparoscopic [procedures], and you do a tremendous amount of that,” she says.
Sutherland was attracted by the surgical aspect as well as the variety of the work. “Medical life is not a piece of cake. It takes a toll on you and it takes a toll on your family,” she says. “And a surgical life, even more so. If you don’t get goose bumps going into the OR, it’s probably not worth it in the long run.”
However, urology can be a great specialty from a lifestyle standpoint, both women say. Unlike some other surgical specialties, there are few emergency procedures. That means fairly regular hours and time for family. And, as a group, urologists have the reputation of being more fun-loving than some of their surgical counterparts.
That was one of the draws for Nissrine Nakib, M.D., an associate professor of urology at the University of Minnesota who specializes in female urology. “There are always generalizations about certain fields,” Nakib says, “and the general consensus about people in urology is they have a good sense of humor about things and they’re relatively easy-going.”
As a medical student, Nakib says she had a difficult time deciding on a surgical specialty. Her father was a cardiac surgeon, but like many surgeons of his time, he did a little of everything. Eventually, her advisor suggested urology. “I almost laughed,” she recalls. “I thought, What am I going to do in urology? That’s for men.”
But the more she looked into it, the more interested she became, especially in the subspecialty of female urology, which focuses on maladies such as interstitial cystitis, pelvic pain, and pelvic floor disorder. Male urology is more focused on oncological illnesses such as prostate cancer. “I see the appreciation among women when they come to me and they get a sympathetic ear. They feel that maybe I can relate to them better,” Nakib says. “Not necessarily that I would be able to, but that’s the impression that they get, and I’m glad I’m able to make them feel that way.”
Women urologists are quick to point out that their biology doesn’t give them any special expertise when it comes to treating women—no more than male urologists have when treating men. Many urologists treat patients of both sexes. But they say that with more women going into urology, there has been a greater emphasis on researching conditions that affect women, including a variety of pelvic disorders. The headway that has been made in treating those kinds of problems is a direct reflection of more women getting into the field, says Sutherland, who specializes in female urology at Metro Urology’s Center for Continence Care and Female Urology and Center for Pelvic Floor Disorders.
Women urologists have been more interested in finding out why these conditions develop and how to prevent them, rather than just treating them, she says. That interest hasn’t necessarily translated into a flow of research dollars, however. At least in part, that is because of the way federal funding is allocated, Lightner explains. The National Cancer Institute funds urologic oncology research, which includes prostate cancer. The National Institute for Diabetes, Digestive, and Kidney Disorders funds research into benign diseases, which puts women’s urologic disorders in competition for funding with other diseases such as diabetes and kidney disease.
Still Playing Catch-Up
Despite the increasing number of women in urology, women urologists still have some hurdles to overcome, especially in academia. Women urologists, like women in other male-dominated medical specialties, often become more isolated and marginalized as they climb the academic ranks. The scenario is common enough in academic medicine that it has a name: “Jennifer Fever.” Drawn from a book by Barbara Gordon entitled Jennifer Fever: Older Men/Younger Women, the term refers to the tendency of senior male faculty to show professional interest in younger women residents and faculty (Jennifers) to the point they overlook their more experienced female colleagues (Janets).
An editorial in the November 3, 2007, issue of the Journal of Women’s Health on this topic points out that when the need for more women in academic medicine is brought up, senior male faculty tend to focus on students, residents, fellows, or very junior faculty, passing over senior women faculty. The editors noted, “… when women advance to more senior levels—Janets, if you will—where they have competence, experience, opinions they may wish to voice, and a legitimate claim over institutional resources, they are abandoned.” The senior women are passed over for promotions, relegated to positions where they are in charge of “women’s issues,” or assigned organizational tasks.
“Overwhelmingly, women in academic medicine have not been as successful,” Lightner says. The study she co-authored showed that while women urologists are represented in greater numbers in academia than men (16 percent of urologists versus 13 percent, respectively) and achieve higher academic rank than women in other medical specialties (38 percent reached the rank of associate professor versus 19 percent for women in other specialties), they are rarely promoted above the rank of associate professor. Only two women chair urology departments in the United States. Lack of support is one of the biggest reasons women leave academia, Lightner says.
Things are changing for women urologists in academia and in practice, however, and they will continue to change as more women enter the field. Sutherland is the first woman to serve on the board of the Minnesota Urologic Society in its 50-year history, which puts her in line to become its president in 2012.
Women urologists are also very aware of the need to mentor other women in the field. Sutherland believes women often are hardest on themselves and each other. She says she tries not to perpetuate the attitude “I went through it, so you have to go through it too.” Rather, she finds it important to foster supportive relationships. “It’s more like, I went through that, and parts of it were hell, so what can I do now to make your experience better?”—J. Trout Lowen