Current Urology Reports

, 20:61 | Cite as

Strategies for Attracting Women and Underrepresented Minorities in Urology

  • Jessica C. DaiEmail author
  • Nnenaya Agochukwu-Mmonu
  • Adam B. Hittelman
Education (G Badalato, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Education


Purpose of Review

This article summarizes the current state of underrepresented minorities (URM) and women within urology. Specific strategies to promote the recruitment and retention of URM and women within urology are discussed.

Recent Findings

Minorities and women remain underrepresented within urology, a disparity that has roots as early as medical school and persists throughout residency and practice. This is likely due to implicit and explicit bias, lack of role models, and persistent disparities in compensation and promotion. Strategies to improve recruitment and retention of these individuals should focus on increasing early exposure to urology, opportunities for mentorship, and support in professional development. Creation of a supportive institutional culture, consideration of alternative career advancement paths, and intentional diversity-focused recruitment efforts are also critical.


Successful recruitment and retention of URM and women in urology requires specific, directed efforts to increase opportunities for exposure, mentorship, and career promotion at a programmatic, institutional, and national level.


Residency training Urology Recruitment Underrepresented minorities Women Diversity 



Underrepresented minority


American Urological Association


Society of Women in Urology


Compliance with Ethical Standards

Conflict of Interest

Jessica C. Dai, Nnenaya Agochukwu-Mmonu, and Adam B. Hittelman each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    “Underrepresented in Medicine Definition”. Association of American Medical Colleges. 2019. Available from: Accessed 1 Jun 2019.
  2. 2.
    Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. 2018. Report No.: 24787. Available from: Accessed 1 Jun 2019.
  3. 3.
    Oberlin DT, Vo AX, Bachrach L, Flury SC. The gender divide: the impact of surgeon gender on surgical practice patterns in urology. J Urol. 2016;196:1522–6.CrossRefGoogle Scholar
  4. 4.
    Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996 May 16;334(20):1305–10.CrossRefGoogle Scholar
  5. 5.
    Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff. 2002;21(5):90–102.CrossRefGoogle Scholar
  6. 6.
    Association of American Medical Colleges. Medical School Graduation Questionnaire 2018 All Schools Summary Report. 2018 [cited 2019 Mar 15]. Available from:
  7. 7.
    Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–84.CrossRefGoogle Scholar
  8. 8.
    Smedley BD, Stith Butler A, et al. Committee on institutional and policy-level strategies for increasing the diversity of the U.S. Health Care Workforce Board on Health Sciences Policy Brian D. Smedley. National Academies Press (US); 2004.Google Scholar
  9. 9.
    Haider AH, Scott VK, Rehman KAV, et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg. 2013;216(3):482–92.CrossRefGoogle Scholar
  10. 10.
    Bureau USC. Quick Facts, United States. 2019. Available from: Accessed 1 Jun 2019.
  11. 11.
    The State of Urology Workforce and Practice in the United States 2018. Linthicum, Maryland, U.S.A.; 2019.Google Scholar
  12. 12.
    • Shantharam G, Tran TY, McGee H, et al. Examining Trends in Underrepresented Minorities in Urology Residency. Urology. 2019;127:36–41 This reference highlights current disparities in the representation of URM in Urology, as compared to other specialties, and provides thoughtful discussion of some of the factors contributing to this. CrossRefGoogle Scholar
  13. 13.
    Association of American Medical Colleges. 2018 Matriculating Student Questionnaire [Internet]. 2018 [cited 2019 Mar 15]. Available from:
  14. 14.
    Halpern JA, Lee UJ, Wolff EM, Mittal S, Shoag JE, Lightner DJ, et al. Women in urology residency, 1978-2013: a critical look at gender representation in our specialty. Urology. 2016;92:20–5.CrossRefGoogle Scholar
  15. 15.
    Association of American Medical Colleges. 2018 [cited 2019 Jun 1]. Available from:
  16. 16.
    Data Resource Book, Academic Year 2017–2018. Accreditation Council for Graduate Medical Education. Chicago, IL; 2018 [cited 2019 Jun 1]. Available from:
  17. 17.
    Washington SL III, Baradaran N, Gaither TW, et al. Racial distribution of urology workforce in United States in comparison to general population. Transl Androl Urol. 2018;7(4):526–34.CrossRefGoogle Scholar
  18. 18.
    Grimsby GM, Wolter CE. The journey of women in urology: the perspective of a female urology resident. Urology. 2013;81(1):3–6.CrossRefGoogle Scholar
  19. 19.
    Nettey OS, Fuchs JS, Kielb SJ, Schaeffer EM. Gender representation in urologic subspecialties. Urology. 2018;114:66–70.CrossRefGoogle Scholar
  20. 20.
    American Urological Association. The State of Urology Workforce and Practice in the United States. Linthicum, Maryland, U.S.A.; 2017.Google Scholar
  21. 21.
    • Gaither TW, Awad MA, Breyer BN, et al. Gender and racial disparities in early urology exposures during medical school. Urol Pract. 2019;6(2):129–34 This reference examines early factors during medical school that may contribute to gender and racial disparities among urology trainees. CrossRefGoogle Scholar
  22. 22.
    Yang Y, Li J, Wu X, Wang J, Li W, Zhu Y, et al. Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ Open. 2019;9(3):e022097.CrossRefGoogle Scholar
  23. 23.
    Kim S, Farrokhyar F, Braga LH. Survey on the perception of urology as a specialty by medical students. Can Urol Assoc J. 2016;10(9–10):349.CrossRefGoogle Scholar
  24. 24.
    Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS, Power DV, et al. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med. 2007;167(19):2103.CrossRefGoogle Scholar
  25. 25.
    Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA Netw Open. 2018;1(5):e182723 Available from: .2723.CrossRefGoogle Scholar
  26. 26.
    Meyerson SL, Sternbach JM, Zwischenberger JB, et al. The effect of gender on resident autonomy in the operating room. J Surg Educ. 2017;4(6):e111–8.CrossRefGoogle Scholar
  27. 27.
    Salles A, Mueller CM, Cohen GL. Exploring the relationship between stereotype perception and residents’ well-being. J Am Coll Surg. 2016;222(1):52–8.CrossRefGoogle Scholar
  28. 28.
    Vemulakonda VM, Sorensen MD, Joyner BD. The current state of diversity and multicultural training in urology residency programs. J Urol. 2008;180:668–72.CrossRefGoogle Scholar
  29. 29.
    Abelson JS, Symer MM, Yeo HL, Butler PD, Dolan PT, Moo TA, et al. Surgical time out: our counts are still short on racial diversity in academic surgery. Am J Surg. 2018;215(4):542–8.CrossRefGoogle Scholar
  30. 30.
    Palepu A, Carr PL, Friedman RH, Ash AS, Moskowitz MA. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000;75(2):157–60.CrossRefGoogle Scholar
  31. 31.
    Fang D, Moy E, Colburn L, et al. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284(9):1085–92.CrossRefGoogle Scholar
  32. 32.
    Mayer EN, Lenherr SM, Hanson HA, Jessop TC, Lowrance WT. Gender differences in publication productivity among academic urologists in the United States. Urology. 2017;103:39–46.CrossRefGoogle Scholar
  33. 33.
    Han J, Stillings S, Hamann H, Terry R, Moy L. Gender and subspecialty of urology faculty in department-based leadership roles. Urology. 2017;110:36–9.CrossRefGoogle Scholar
  34. 34.
    Spencer ES, Deal AM, Pruthi NR, Gonzalez CM, Kirby EW, Langston J, et al. Gender differences in compensation, job satisfaction and other practice patterns in urology. J Urol. 2016;195(2):450–5.CrossRefGoogle Scholar
  35. 35.
    Rotker K, Iosifescu S, Baird G, et al. What’s gender got to do with it: difference in the proportion of traditionally female cases performed by general urologists of each gender. Urology [Internet]. 2018 Jun [cited 2019 Mar 15];116:35–40. Available from:
  36. 36.
    Snyder RA, Bills JL, Phillips SE, Tarpley MJ, Tarpley JL. Specific interventions to increase women’s interest in surgery. J Am Coll Surg. 2008;207:942–947.e8.CrossRefGoogle Scholar
  37. 37.
    Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018.Google Scholar
  38. 38.
    Itum DS, Oltmann SC, Choti MA, Piper HG. Access to paid parental leave for academic surgeons. J Surg Res. 2019;233:144–8.CrossRefGoogle Scholar
  39. 39.
    Kutikov A, Bonslaver J, Casey JT, et al. The gatekeeper disparity--why do some medical schools send more medical students into urology? J Urol. 2011;185(2):647–52 Available from: Accessed 1 Jun 2019.
  40. 40.
    Parks ML, Chambers MC, Mason, et al. Can a strategic pipeline initiative increase the number of women and underrepresented minorities in orthopaedic surgery? Clin Orthop Relat Res. 2016;474(9):1979–85.CrossRefGoogle Scholar
  41. 41.
    Tunson J, Boatright D, Oberfoell S, Bakes K, Angerhofer C, Lowenstein S, et al. Increasing resident diversity in an emergency medicine residency program: a pilot intervention with three principal strategies. Acad Med. 2016;91(7):958–61.CrossRefGoogle Scholar
  42. 42.
    •• Butler PD, Aarons CB, Ahn J, et al. Leading from the front: an approach to increasing racial and ethnic diversity in surgical training programs. Ann Surg. 2019;269(6):1012–5 This references provides evidence for the role institutional-level programmatic efforts to increase diversity during recruitment of surgical residents and offers a framework that may be adopted by other training programs. CrossRefGoogle Scholar
  43. 43.
    Sambunjak D, Straus SE, Marušić A. Mentoring in academic medicine: a systematic review. J Am Med Assoc. 2006;296:1103–15.CrossRefGoogle Scholar
  44. 44.
    Butler PD, Britt LD, Green ML, et al. The diverse surgeons initiative: an effective method for increasing the number of under-represented minorities in academic surgery. J Am Coll Surg. 2010;211(4):561–6.CrossRefGoogle Scholar
  45. 45.
    Butler PD, Britt LD, Richard CE, Chang B, Serletti JM, Green ML Jr, et al. The diverse surgeons’ initiative: longitudinal assessment of a successful national program. J Am Coll Surg. 2015;220(3):362–9.CrossRefGoogle Scholar
  46. 46.
    Peek ME, Kim KE, Johnson JK, Vela MB. URM candidates are encouraged to apply. Acad Med. 2013;88(3):405–12.CrossRefGoogle Scholar
  47. 47.
    Moody J. Faculty diversity: problems and solutions: Routledge; 2004.Google Scholar
  48. 48.
    •• Carnes M, Devine PG, Baier Manwell LB, et al. The Effect of an Intervention to Break the Gender Bias Habit for Faculty at One Institution. Acad Med. 2015;90(2):221–30 This references highlights the long-term impact of a brief intervention to reduce bias within STEM departments on departmental hiring practices and provides evidence for the benefit of such programs. It also provides an example of a structured intervention that could be carried out at other institutions. CrossRefGoogle Scholar
  49. 49.
    Devine PG, Forscher PS, Cox WTL, et al. A gender Bias habit-breaking intervention led to increased hiring of female faculty in STEMM departments. J Exp Soc Psychol. 2017;73:211–5.CrossRefGoogle Scholar
  50. 50.
    Lerner LB, Baltrushes RJ, Stolzmann KL, Garshick E. Satisfaction of women urologists with maternity leave and childbirth timing. J Urol. 2010;183:282–6.CrossRefGoogle Scholar
  51. 51.
    Antonoff M. Opportunities for academic achievement during parental leave: the Society of Thoracic Surgeons sets the standard. Ann Thorac Surg. 2018;16(2):321–3.CrossRefGoogle Scholar
  52. 52.
    Stein SL. The changing face of surgery today: it is not a women’s issue, It’s a Work Force Issue. Ann Surg. 2017.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jessica C. Dai
    • 1
    Email author
  • Nnenaya Agochukwu-Mmonu
    • 2
  • Adam B. Hittelman
    • 3
  1. 1.Department of UrologyUniversity of WashingtonSeattleUSA
  2. 2.Department of UrologyUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of UrologyYale School of MedicineNew HavenUSA

Personalised recommendations