FROM THE SECRETARY The Ongoing Celebration of Diversity at the AUA

John D. Denstedt, MD, FRCSC, FACS, FCAHS; Tracy M. Downs, MD, FACS
As Secretary of the AUA and Editor-in-Chief of AUANews, it is my privilege to introduce the second focus issue, “Celebrating Diversity with the AUA,” on which I collaborated closely with Tracy M. Downs, MD, who chaired the AUA’s Diversity & Inclusion (D&I) Task Force. We are thrilled to share with you this vitally important content, which we know will enrich the future of our urological community.

Society of Women in Urology Initiatives

Jannah H. Thompson, MD, FPMRS
The mission of the Society of Women in Urology (SWIU) is to support the professional development and career advancement of women urologists and urological researchers through education, advocacy and mentorship. SWIU, formerly known as “Women in Urology,” began informally at the 1980 AUA meeting in San Francisco with 5 women urologists and continued informally until 1992, when the group created an executive board and bylaws. SWIU now has more than 1,200 members, including approximately 300 board-certified female urologists, female researchers, urology residents and fellows, and postresidency, pre-board-certified women (fig. 1).

Closing the Gender Gap in Urology

Megan Prunty, MD; Laura Bukavina, MD, MPH
The proportion of female medical students in the United States is increasing, and for the last 2 years women have comprised the majority of all medical students. Coinciding with the increase in female medical students, the proportion of female urology trainees has also steadily increased. Despite this, women remain a minority of urology trainees and staff.

The Legacy of the R. Frank Jones Urological Society

Linda L. McIntire, MD
In Rev. Dr. Martin Luther King, Jr.’s sermon, “The Death of Evil upon the Seashore” given at the Cathedral of St. John the Divine in New York City on May 17, 1956, Dr. King stated, “Change does not roll in on the wheels of inevitability, but comes through continuous struggle.” It is with this sentiment that Richard Francis (R. Frank) Jones, MD worked tirelessly to increase the numbers of African American urologists.

We've Got a Long Way to Go, and a Short Time to Get There

D. Robert Siemens, MD, FRCSC
For most readers of this special edition of AUANews, a focus on diversity, equity and inclusion (DEI) has become an important part of our clinical, educational and/or leadership roles.

The Middle East Female Urologist: How Far Have We Come Today?

Reem Albareeq, MD, AFRSCI, CABU; Batool M. Turki, MD
Female urologists have steadily increased in the urology workplace, representing 10.3% of the workforce in 2020. Urology has long been a male-dominated specialty. With the greater demands from female patients to be treated by the same gender and greater interest from females to enter this field, we can see a change in the numbers of female urologists.

Racial Differences in Prostate Cancer Treatment

Olutiwa A. Akinsola, MD; Kelvin A. Moses, MD, PhD, FACS
Racial disparities exist in every facet of our society, and medicine is far from an exception. Within oncology, we have seen that Black Americans have the highest death rate and shortest survival of any racial/ethnic group in the United States for nearly all cancers. Dr. LaSalle Leffall was one of the first to highlight this when he published the seminal paper “Alarming Increase in Cancer Mortality in the US Black Population” in 1973, in which he hypothesized that environmental factors, and not race, were likely the cause of this difference. It is not the genetic differences between races that drive different health outcomes, but the impact of the social and environmental constructs of race on our society.

Women in Urology in India

Anita Patel, MCh, DNBE, FRCS
The year 1883 will always remain special to all Indian female doctors as this was when Dr. Anandibai Joshi became the first Indian woman to be fully trained in the science of Western medicine. India has come a long way since then, and today almost 50% of medical admissions are secured by girls. However, female surgeons still remain rare and female urologists even rarer.

Orchid and Its Impact on Women Urologists in Brazil

Maria Claudio Bicudo, MD, PhD
Historically, urology has been a male-dominated surgical specialty. In 2020, according to the Sociedade Brasileira de Urologia (SBU) database, there were 4,621 male and 125 female board-certified urologists (37:1 male-to-female ratio). Currently, among residents in urology, there are 53 women out of a total of 542 residents. We have reached this new trend due to efforts from SBU leadership and positive influences from world leaders including the AUA.

Social Media as a Platform for Diversity, Equity and Inclusion

Brandee Branche, MD; Kristian Black, MS, MD; Meidee Goh, MD; Juan Andino, MBA, MD; Khurshid R Ghani, MBChB, MS, FRCS
In the corporate world, it is increasingly clear that organizations with a diverse and inclusive workforce have improved levels of performance and innovation.1 Health care is no different. Studies have shown that increasing the diversity, equity and inclusion (DEI) of employees within health care is associated with improved patient outcomes, reductions in health disparities and potential health care cost savings.2

A Translational Health Services Research Approach to Racial Inequities in Prostate Cancer

Yaw A. Nyame, MD, MS, MBA
The Surveillance, Epidemiology, and End Result cancer registry has demonstrated a consistent and markedly higher rate of prostate cancer mortality among Black men in the U.S. since the 1970s. Black men are 80% more likely to be diagnosed with prostate cancer in the U.S. and twice as likely to die from prostate cancer as their non-Black male counterparts.This represents the widest racial inequity in cancer-related death in the U.S. Despite markedly higher rates of incidence and death, the lack of recommendations to guide care among Black men has often been justified by a lack of level 1 evidence to support a targeted intervention.

Recent Initiatives for LGBTQ+ Health Care in Urology

Tomas L. Griebling, MD, MPH
Sexual orientation and gender identity are core elements of the human experience. Historically, people identifying as sexual minorities have broadly experienced inequities in health care and employment. Changes in social norms and cultural climate have led to an increased awareness of these issues and advocacy work. There has recently been an increased wave of interest in diversity, equity and inclusion (DEI) in almost all facets of health care including our specialty of urology.

Diversity Isn't Enough: Strategies to Maximize Board Diversity

Princess Currence, DSW, MSW
Research shows that board diversity matters. Organizations that have strong cognitive and demographic diversity are more effective, make better decisions2 and are more innovative. But diversity is not enough. Boards cannot rely on diversity alone to guarantee a better performing board; rather, boards must develop a real culture of inclusivity, along with diversity.

Tackling Faculty Diversity in Urology

Maria Uloko, MD; Leah Ibrahim Puri, BS; Juan Javier-DesLoges, MD, MS; Jennifer T. Anger, MD, MPH
A recent study by Simons et al showed that from 2007 to 2020 the proportion of underrepresented minority (URM) residency applicants increased slightly, but the proportion of URM urology residents remained unchanged. Furthermore, the representation of these diverse groups was low at the faculty level. The study indicated that there was a “leaky pipeline,” and this was further evidenced by a stepwise decrease in the proportion of URM members represented at each stage of the educational pipeline from college to faculty (p <0.0001).

Representation in Medicine: The Causes and Costs of Failure

Danly Omil-Lima, MD; Gabriela Gonzalez, MD, MPH; Itunu Arojo, MD; Yahir Santiago-Lastra, MD; Randy Vince, Jr., MD, MS
The Association of American Medical Colleges and other professional organizations such as the AUA have formally committed to increasing diversity in medical training in order to promote a workforce that reasonably resembles the racial, ethnic and gender profiles of the patient populations we serve. However, despite decades-long efforts, significant progress is still lacking, begging several important questions: Why do we struggle to recruit, train, retain and promote underrepresented physicians in academic medicine? And at what cost? Is diversity in medicine truly important enough to demand our continued, unified commitment to this goal?

Trends of Hispanic Representation in Urology: A Bronx Story

Pedro P. Maria, DO; Jonathan Davila, MD
As of the 2020 AUA Census, there has been continuous annual growth in the number of practicing urologists across our nation. This has also included an encouraging growing population of women and urologists who self-identify as African American/Black. Despite these inspiring developing trends, the number of urologists self-identifying as Hispanic has remained unchanged.

The American Board of Urology: Striving for Inclusive Excellence

Cheryl T. Lee, MD; Martha Terris, MD; Christopher Amling, MD; David Bock, MD; J. Brantley Thrasher, MD, FACS; Eila Skinner, MD
The mission of the American Board of Urology (ABU) is to act for the benefit of the public by establishing and maintaining standards of certification for urologists and working with certified urologists to achieve lifelong learning to ensure the delivery of high-quality, safe and ethical urological care. Unwritten within this mission is the ABU’s commitment to fostering and sustaining a diverse workforce to fully serve every individual with a urological condition. As part of its strategic goals, the ABU has committed itself to inclusive excellence by integrating diversity, equity and inclusion into the fabric of its organizational structure in pursuit of certifying urologists capable of achieving real health equity in our field.

Building Inclusive Medical Practices: Caring for Our LGBTQIA+ Patients

Polina Reyblat, MD
Of all U.S. adults, 5.6%–or over 18 million people–identify as part of the LGBTQIA+ community. This has increased from 4.6% in 2017 reports. A total of 0.6% of U.S. adults consider themselves transgender, based on the 2020 Gallup survey. Because the U.S. Census does not ask about gender identity, these numbers are an estimate based on surveys and interviews. Additionally, the number of nonbinary LGBTQIA+ adults in the U.S. is currently estimated to be 1.2 million people from the recently released Williams Institute survey.

LatinX in Urology

Kassandra E. Zaila Ardines, MD; Jessica Delgado, MD, MS
According to United States (U.S.) census projections, by 2030 our nation will reach a transformative demographic turning point with the population becoming more ethnically and racially diverse than ever in the nation’s history. In the last decade, Latinos accounted for more than 50% of growth for the total U.S. population.

Introducing Medical Students to Diversity Initiatives within Urology

Marisa Clifton, MD, FACS; Shenelle Wilson, MD, FPMRS
Diversity, equity and inclusion (DEI) in medicine has gained significant momentum over the past several years and has underscored the acute need for expansion of DEI within the field of urology. Historically, the AUA Medical Student Education Committee hosts twice-yearly webinars geared specifically to medical students as they consider pursuing urological residency. Recognizing that today’s learners have a significant interest in diversifying the workforce and providing comprehensive care, the AUA Medical Student Education Committee hosted the “Diversity in Urology: Initiatives and Opportunities” webinar in March 2021.

Equity and Diversity in Surgical Training

Amanda E. Hird, MD, MSc, FRCSC
The lack of diversity in medicine and surgery has been an ongoing discussion for several decades. Even with roughly equivalent recruitment of female and male applicants at the medical school level, structural inequities as well as system-level and implicit biases continue to limit enrollment of underrepresented minority individuals.

You Fit in Here: Representation by Young Urologists Committee

Justin Han, MD; Seth A. Cohen, MD, FACS; Katie Murray, DO, MS, FACS; Jay Simhan, MD, FACS; Sammy E. Elsamra, MD, FACS
“Do I Fit in Here?” is a question that often enters the minds of medical trainees as they seek out their chosen future profession. For many women, racial and sexual/gender minorities, the answer may not be reflected within the urology workforce and organized urological societies such as the AUA.

FROM THE RESIDENTS AND FELLOWS COMMITTEE Growing Diverse Leaders: Diversity, Equity and Inclusion Efforts from the Residents and Fellows Committee

Michael Ernst, MD; Ruchika Talwar, MD
The Residents and Fellows Committee of the American Urological Association has represented the voices of trainee members since its inception in 2002. Over the past 20 years, our committee has grown to include not just members from each geographical AUA section, but also representatives from Canada and Mexico, as well as liasons from the American College of Surgeons, Residency Review Committee and the American Medical Association. Our aim is to advance the needs and concerns of all residents and fellows. As such, over the past year our committee has been involved with multiple efforts to increase diversity, accessibility and inclusion in urological training.

Diversity and Inclusion at the William P. Didusch Center for Urologic History

Ronald Rabinowitz, MD, FAAP, FACS
Over the past 15 years, AUA historians, curators, archivists, the History Committee and AUA staff have worked to build awareness of racism, sexism and ageism in the history of medicine. Diversity and inclusion have increased in history exhibits, membership on the History Committee and work groups, and in the History Forum Abstract Review Committee. Historians know that the best history includes many perspectives.

PRACTICE TIPS AND TRICKS Understanding Cultural Diversity

Neil H. Baum, MD
I recently came across a patient who asked about a capsule that I prescribed and asked if the medication came in a tablet form. Further inquiry revealed that the gelatin capsule was of porcine (pig) origin and his Muslim faith proscribed any products derived from pigs especially if there were alternatives. This conversation alerted me to the cultural differences of different faiths or patients who have different dietary preferences. This article will focus on just medications and dietary differences of various cultures and religions.

Augmenting Parental Integration in a Urological Residency Program: Going beyond Minimum Leave Policies

Kyle M. Rose, MD, MS; Alexandra M.C. Carolan, MD; Aqsa A. Khan, MD
Medical students often ask current trainees during residency interviews: “Does anyone here have kids? Is it possible to be a parent and be a resident here?” As resident and fellow education continues to evolve, transparency of training program accommodations for parental leave has become a forefront issue. Greater than half of residents report delaying having children due to residency training.

Differences in Urology Residency Applications by Gender: What Are They? How Do We Fix Them?

Alysen Demzik, MD; Pauline Filippou, MD; Angela Smith, MD, MS, FACS
The gender gap within urology continues to be one of the largest in medicine, with women making up only 10% of practicing physicians and 16% of academic urologists. This gap widens further when examining leadership positions, where women hold only 3% of department/division chair positions and 8% of program director positions.

Improving Diversity, Equity and Inclusion in Urology Residency Recruitment

Kate H. Kraft, MD, FAAP, FACS; James Brown, MD; Raj S. Pruthi, MD, MHA, FACS
Diversity in the urological workforce is critical to our specialty reflecting the patients we serve. Although urology continues to be male dominated, the proportion of women in urology is growing. According to recent AUA Census and ACGME (Accreditation Council for Graduate Medical Education) data, 10.3% of practicing urologists and 28.5% of urology residents are female. Racial representation among urologists is more severely lacking, with only 2.1% of current practicing urologists identifying as Black/African American and 3.9% as Latinx/Hispanic. These proportions have remained stagnant over recent years, as has the percentage of urology residents currently underrepresented in medicine (URiM).

Mexican Urology and AUA: A Chronology of Successful Alliance for Mutual Benefit

Ismael Sedano Portillo, MD
The partnership between Mexican Urology and the AUA has been founded on the twin pillars of academic exchange and strengthening of mutual friendship bonds. Mexican Urology is represented by 2 national associations: the Sociedad Mexicana de Urología (SMU) and the Colegio Mexicano de Urología Nacional (CMUN).

Recognizing the Importance of Equity, Diversity and Inclusivity within the Canadian Urological Association

Ashley Cox, MD, MSc, FRCSC
As the voice of urology in Canada since 1945, the Canadian Urological Association (CUA) exists to promote the highest standard of urological care for Canadians and to advance the science of urology. Akin to most surgical fields, the demographics of the members of our national organization have changed significantly since 1945. With a mandate to represent all members, the CUA is dedicated to ensuring a culture of respect and fairness. In order to do so, the CUA recognizes the importance of promoting equity, diversity and inclusivity (EDI) at all levels within our organization.

Diversity, Equity and Inclusion Initiatives of the New England Section of the AUA

Vernon M. Pais, Jr., MD, MS
It is increasingly recognized that lack of diversity, equity and inclusion disenfranchises the very differences that make us whole as a profession and as a society. We also risk silencing voices, stifling growth and missing opportunities afforded by fresh perspectives. Across medical disciplines, there has been growing recognition of the urgent need for improved efforts to increase diversity, equity and inclusivity (DEI).

Initiatives from the New York Section on Diversity and Inclusion

Peter N. Schlegel, MD
The New York Section of the AUA has had a long emphasis on enhancing diversity and inclusion within its membership as well as leadership. The current New York Section Board is the most diverse group that we have had as leadership in the history of this longstanding section of the AUA. The leadership group is the result of a series of deliberate choices to better represent those who have traditionally been underrepresented in medicine.

AUA Northeastern Section Diversity, Equity and Inclusion Initiatives

Jodi K. Maranchie, MD, FACS
The AUA Northeastern Section (NSAUA) straddles the Canadian border, representing upstate New York, western Pennsylvania and Canada from Manitoba to the Atlantic coast, with membership hovering around 50% U.S. and 50% Canadian (see figure). This position offers unique opportunities and challenges. The smallest section at about 1,000 members, the NSAUA is home to 5 U.S. and 11 Canadian residency programs.

We Celebrate 100 Years of the South Central Section of the AUA with Diversity, Equity and Inclusion

Fernando J. Kim, MD, MBA, FACS
The South Central Section of the AUA (SCSAUA) is the most ethnically diverse section of the AUA, with approximately 1,500 members from 8 states and 7 countries including Arkansas, Colorado, Kansas, Missouri, Nebraska, New Mexico, Oklahoma, Texas, Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico and Nicaragua.

Equity and Diversity within the Western Section AUA

Siamak Daneshmand, MD; Jeannie DeSantis, MBA
The WSAUA organization at large relies on the 20 inclusive urological teaching institutions to guide us in recruiting new faculty and residents to include in programming and leadership roles. Whether at program meetings or board meetings, it has always been important to WSAUA leadership to include a wide spectrum of physician leaders from all teaching institutions with specific attention to include individuals from underrepresented backgrounds.

Mid-Atlantic Section's Diversity, Equity and Inclusion Initiatives

Thomas Guzzo, MD, MPH
As Secretary of the Mid-Atlantic Section of the American Urological Association (MA-AUA) it is an honor to highlight our section’s diversity, equity and inclusion initiatives. There is strong and committed support from our sectional leadership to maintain, grow and further expand diversity at the sectional level. We are proud of the diversity we have on our Board of Directors with regard to gender, race and practice setting, which allows for diverse perspectives and ideas that drive our section forward clinically, academically and educationally.

Finding the Work-Life Balance as a Dual-Physician Family

Jeffrey Campbell, MD, MPH, FRCSC
When planning a career in academic urology one of my mentors told me I needed to choose between being a researcher, a good clinician and an attentive contributor to my family. I was told, “You can only be great at 2 of the 3 because there just isn’t enough time in a day.” After really mulling over this concept, I realized that is totally inaccurate. In fact, the only way to be successful in any one of those roles is to be equally great at all three!

Changing Times: Diversity, Equity and Inclusion in the Southeastern Section of the AUA

S. Duke Herrell III, MD; Chad W. M. Ritenour, MD
Over the past several years, the societal work around diversity, equity and inclusion (DEI) has become both more prominent and more significant. While this work touches the practice of medicine, including urology, there still remain opportunities for truly understanding the meaning and importance of DEI. The Southeastern Section of the AUA (SESAUA) is committed to weaving DEI into all of the activities of the Section.

Increasing Diversity in the North Central Section: A Grass Roots Effort

Elizabeth B. Takacs, MD, FPMRS; Larissa Bresler, MD, DABMA
The section has been striving to increase diversity and inclusion for several years. In 2017 the NCS Board of Directors approved the creation of a Women in Urology (WIU) Committee, with the first chair attending the interim meeting in 2018 and bylaws being approved and updated at the annual meeting in the fall of 2018. The committee chairperson is a member of the NCS Board of Directors. The NCS Board recognizes that there continues to be a lack of diversity in the section leadership and is determined to rectify this.

JU Insight: Representation in Online Prostate Cancer Content Lacks Racial and Ethnic Diversity: Implications for Black and Latinx Men

Stacy Loeb; Hala T. Borno; Scarlett Gomez; Joseph Ravenell; Akya Myrie; Tatiana Sanchez Nolasco; Nataliya Byrne; Renee Cole; Kristian Black; Sabrina Stair; Joseph N. Macaluso; Dawn Walter; Katherine Siu; Charlotte Samuels; Ashkan Kazemi; Rob Crocker; Robert Sherman; Godfrey Wilson; Derek M. Griffith; Aisha T. Langford
Black men have the highest incidence and mortality from prostate cancer and lower quality of life compared to other U.S. racial groups. Additionally, more Latinx men are diagnosed with advanced disease, and fewer receive guideline-concordant care. As many men seek medical information online, high-quality information targeting diverse populations may mitigate disparities. We examined racial/ethnic representation and information quality in online prostate cancer content.

From the AUA Secretary: First Diversity and Inclusion Focus Issue of AUA News

John D. Denstedt, MD, FRCSC, FACS, FCAHS
Last year, the AUA Board of Directors unanimously approved the creation of the AUA Diversity and Inclusion (D&I) Task Force, which aims to identify specific and actionable steps for how the AUA can advocate for and foster a diverse and inclusive environment within the association, as well as the global urology community.

AUA Announces Diversity and Inclusion Task Force

Tracy M. Downs, MD, FACS
A lot has changed since the American Urological Association (AUA) was founded in 1902, and it has indeed advanced urology as a premier urological association, providing invaluable support to the urological community. The AUA’s mission is to promote the highest standards of urological clinical care through education, research and the formulation of health care policy.

The AUA Addresses Inequities in Research Opportunities

Arthur L. Burnett, MD, MBA
The year 2020 brought several extreme challenges to our communities, one of which was sharply increased attention to race-based disparities that exist in every aspect of our culture. As the AUA takes significant steps toward addressing and ultimately eliminating these disparities as they relate to urology, an important effort will be addressing racial, ethnic and gender disparities and underrepresentation in urologic research.

A Different Type of Inclusion and Diversity in Urological Research: Pediatric Device Development

Soo Jeong Kim, MD; Chester J. Koh, MD
Research is indisputably important in advancing the field of urology. There are numerous examples, from the work of Huggins and Hodges, which rendered hormonal therapy the standard treatment for patients with advanced prostate cancer, to the adoption of robotic assistance in minimally invasive urological surgery.

A Critical Overview of Urethral Complications in Transmasculine Surgery

Mang Chen, MD; Rachel Moses, MD
Transmasculine genital reconstructive surgeries (TMGRS) are often performed with urethral lengthening (UL) to allow for micturition through a glanular meatus. Unfortunately, urethral complications are common.

The Treatment of Stone Disease in the Aging Population: How Old Is Too Old for Stone Removal?

Alaina Garbens, MD; Jodi Antonelli, MD
Approximately 16% of Americans are elderly, which is traditionally defined as age 65 years or older. As life expectancy has increased, so has the percentage of elderly surgical patients, who now account for 40% of all patients undergoing surgery.

Public Policy Council: Black Swans & AUA Public Policy - Civicism and Volunteerism Across America

Eugene Rhee, MD, MBA
Black swan events were first introduced by Nassim Nicholas Taleb in his 2001 book Fooled By Randomness, describing unpredictable financial events with severe consequences and our tendency to inappropriately rationalize them with simplistic explanations after the fact.

From the Urology Care Foundation: Global...Diverse...Human...Your Urology Care Foundation

Harris M. Nagler, MD, FACS
Humanitarianism is the promotion of human welfare. The goals are noble yet are presented with many, and ever changing, barriers. Witness the impact of COVID-19 on the ability to complete humanitarian missions throughout the world.

Call to Action: Improving Our Latinx Urological Workforce

Alejandro Sanchez, MD; Yahir Santiago-Lastra, MD
A lot has changed since the American Urological Association (AUA) was founded in 1902, and it has indeed advanced urology as a premier urological association, providing invaluable support to the urological community. The AUA’s mission is to promote the highest standards of urological clinical care through education, research and the formulation of health care policy.

Promotion Equity for Women in Urology: A Path Forward

Sima P. Porten, MD, MPH; Benjamin N. Breyer, MD, MAS; Jennifer T. Anger, MD, MPH
The 2019 AUA Census reflected the growing number of women entering the field of urology, representing 9.9% of the workforce in 2019 (compared with 7.7% in 2015). Despite these encouraging trends, women remain underrepresented in senior faculty roles in urology, journal editorial leadership and in organized urologic societies.

LGBT+ Representation in Urology

R. Craig Sineath, MD, MPH; S. Scott Sparks, MD; Tomas L. Griebling, MD, MPH
Diversity and equity are timely and essential topics in all of medicine, including urology. Regarding lesbian, gay, bisexual, transgender, and other allied (LGBT+) urologists, our representation is difficult to quantify. While there is a small cadre of out LGBT+ urologists, even an estimate of the total number is impossible.

Ageism, Sexual Identity, and One Urologist's Personal Reflection on Diversity and Inclusion

Tomas L. Griebling, MD, MPH
I am honored to have been invited to serve as a member of the recently formed AUA Task Force on Diversity and Inclusion. This is an opportunity to provide serious analysis and work toward ongoing improvements on multiple fronts in our specialty. I also appreciate this opportunity to provide some brief personal reflections.

The Time is Now: Salary Equity for Women Urologists

Simone Thavaseelan, MD; Elizabeth Timbrook Brown, MD, MPH
While urology is a unique field, it is similar to every other specialty and economic sector where a salary gap exists between male and women urologists. In 2016, median salary among female urologists was $81,578 less than male urologists. After controlling for age, number of hours worked per week, practice setting and type, fellowship training, call frequency and ancillary income, being female was still predictive of lower income.

Creating a Gender-Affirming Environment for Urologic Care

Dorian Scull, PA-C; Paul H. Chung, MD; Daniel Dugi, MD; Geolani W. Dy, MD
Access to health care is not a privilege, but a basic right. Yet for many marginalized populations, and the transgender and non-binary (TGNB) community in particular, barriers to basic health care are pervasive. These include lack of knowledgeable and competent providers, experiences of prejudice, discrimination and trauma in health care settings, and cultural barriers.

ABMS Releases New Parental and Caregiver Leave Policy, ABU Responds

Rachel Greenberg, MD; Simone Thavaseelan, MD; Mary Beth Westerman, MD
The American Board of Medical Specialties (ABMS) establishes requirements for candidates to become eligible for Initial Certification. Effective July 1, 2021, a new parental leave policy will allow for a minimum of 6 weeks away from training for the purposes of parental, caregiver or medical leave at least once during training, while maintaining at least 2 weeks of vacation without extension of training.

Creating Systemic Change in GME

Byron Joyner, MD, MPA
As a country, we have experienced the most significant declaration of racial, political and social unrest since the 1950s and 1960s Civil Rights era, which led to the important catalyst for passing the Civil Rights Act of 1964 and the Voting Rights Act of 1965.

Hidden Voices: Firsthand Stories from Black Trainees about Systemic Racism in Urology

Randy A. Vince Jr, MD; Kristen R. Scarpato, MD; Adam P. Klausner, MD
Some in the field of urology may be deaf to the voices of Black trainees as they speak on their experiences of discrimination and injustice. The hidden voices of these Black men and women may have only been whispered or even silenced. In this article, we get the chance to hear them speak.

Medical Ethics and Urological Surgery

Giulia I. Lane, MD, MS; Shenelle N. Wilson, MD; Joel D. Howell, MD, PhD
The urological community has come together to promote diversity, equity and inclusion in our workforce in support of societal efforts to condemn systemic racism and bias. Like much of the history of medicine, the history of urology is stained by events in which medical professionals capitalized on systemic racism and bias to take advantage of the most vulnerable among us.

Structural Racism

Linda L. McIntire, MD
What is structural racism? According to the Aspen Institute’s (an organization committed to working with people to improve their communities) glossary of terms, structural racism is a system in which public policies, institutional practices, cultural representations and other norms work in various, often reinforcing ways to perpetuate racial group inequity.

Microagressions in Medicine

Fenwa Famakinwa Milhouse, MD; Denise Asafu-Adje, MD
In the wake of the gruesome murder of George Floyd and the disproportionate impact of COVID-19 on communities of color, America is facing a reckoning over race and the historical inequities that underrepresented minorities have endured. Our institution of medicine has been forced to look inward and evaluate its own role in perpetuating these inequities.

Increasing Diversity and Inclusion with Urologists for Equity

Shannon Cannon, MD; Geolani W. Dy, MD; Casey A. Seideman, MD
Urology, like other surgical specialties, has struggled to attract and retain underrepresented minorities (URMs) and women. The 2019 American Urological Association (AUA) Census reported that 10% of practicing urologists identified as women, 3.9% as Latinx and 2% as Black. Previous literature has highlighted the underrepresentation of female and minority groups in the field of urology.

Black Women in Urology

Efe Chantal Ghanney Simons, MD
Intersectionality, a term coined in 1989, encapsulates the compounding impact of multiple social identities.1 Black women in American society find themselves occupying a uniquely challenging position. In addition to being subject to many of the socioeconomic and political barriers faced by the African American community, they also experience the hurdles that women face when attempting to build a career in a male-dominated surgical specialty like urology.

The Canadian Perspective of Women in Urology

Leandra Stringer, MD
With the recent celebration of National Women Physicians Day, it is important to stop and reflect on the past and current presence of females within our great specialty of urology. The first female urologist in Canada was Dr. Christina Hill, who graduated from urology training at The University of Toronto and began practice in 1976.