The Field is Changing: Perspectives from Three Miller School Female Urologists
Three Miller School of Medicine female faculty members and UHealth urologists say the field is becoming more welcoming to women.
They’ve heard the jokes. They’ve witnessed the surprised looks of patients. But the three female urologists in the University of Miami Health System have never doubted their choice of career. In fact, their experience in the clinic and the operating room has only strengthened their commitment.
“I really like to follow patients long term. In urology, even as a surgical subspecialty, I can do that,” said Katherine Amin, M.D., an assistant professor of urology at the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine. “I get to build a relationship with my patients and see them year after year.”
UHealth’s two other women urologists echo that sentiment. All of them leaned towards a surgical field, but few surgical disciplines allow for both continuing patient relationships and a reasonable work-life balance. Raveen Syan, M.D., an assistant professor of clinical urology at the Miller School, knew early on that she wanted to work with her hands. At one point, she considered trauma.
“It really didn’t fit with what I wanted both within and outside of work,” she explained. “I wanted a family and I also wanted to do a broad range of surgeries.”
For Laura Horodyski, M.D., an assistant professor of urology at the Miller School, there was never a question of specialty. She felt at home in the operating room and found a “very welcoming” group among fellow urologists, most of them men. To confirm her decision, the only female urologist she met during medical training “was very happy and seemed to really enjoy her work.”
Trends in Urology Physician Demographics
Women in urology is a relatively recent development. As with orthopedic and thoracic surgery, urology has long been a male-dominated field. The belief was that men wanted to be treated by other men. But only some urology issues (think erectile dysfunction, testicular problems and prostate cancer) are unique to men, Dr. Horodyski said. Many urologic problems, from kidney stones to bladder cancer, can affect both men and women.
As more women attend medical schools, attitudes and numbers are changing. According to the 2023 annual census of the American Urological Association (AUA), 11.8% of urologists are female. That’s up from 7.7% in 2014. Desai Sethi Urology Institute is committed to diversity within the department and boasts 14.28% female providers, surpassing the national average.
The increase is even more noticeable when the gender makeup of urologists is teased out by age. Among urologists who are 45 or younger, 24.06% of the urologists are women. Only 5.9% of U.S. urologists between the ages of 55 and 64 are women. And in the 65-plus set, it’s a miniscule 1.2%.
Drs. Amin, Syan and Horodyski have witnessed the slow but steady uphill climb. Dr. Horodyski began medical school in 2013 and her residency at UHealth in 2017. Aside from the aforementioned woman urologist, she didn’t meet any other women in the field.
As a student, Dr. Amin didn’t encounter a single female attending urologist. By her residency, she knew only one.
“By then I could see the small changes in the student pipeline,” she said.
Experience and Ability Matter
This student pipeline trend is evident among UHealth urology residents, as well. About one-fourth to one-third of trainees at the Miller School are now women, Dr. Horodyski said, adding that working with female attending physicians in the field has helped attract more women.
“Having an informal mentorship [with these medical students] has made a difference,” she said. “Just spending time in the OR with them and giving them advice provides reassurance.”
A 2020 study bears that out. The percentage of women urology faculty members is strongly correlated with the number of women who apply for a urology residency. Already residency match figures are changing. The 2023 AUA census shows that 85% of the women who applied to a urology residency program in 2024 were matched, up from 75% in 2018.
Connecting with an attending physician who can make sense of professional and personal concerns can make a difference because it’s usually during the years of residency that female urologists face the first obstacles of their career specialty. All three UHealth urologists recount stories of patients initially confused by a hospital visit from a woman urologist.
During Dr. Horodyski’s training, clinic patients seeing her for the first time were surprised to have a woman at bedside. They invariably thought she was a nurse.
“Though I would introduce myself [as a doctor], they would get a call from their family and they would say, ‘Oh, the nurse is here with me,’” she recalled, laughing.
She’s also heard stories from other female surgeons complaining about treatment in the O.R., where “there can be some gender bias. They’re sometimes not listened to.”
But in her seven years of practice, she noted that attitudes are changing as more women enter all fields of medicine. Women accounted for 54.6% of medical school students in the 2023-24 academic year, according to the Association of American Medical Colleges.
The Patient Perspective
Much depends on one’s urologic subspecialty, of course. Many women urologists gravitate to female urologic issues. Dr. Amin sees mostly women in her practice because she specializes in pelvic floor reconstruction, pelvic organ prolapse, urinary incontinence, female sexual health and robotic surgery.
“They are so grateful to see a woman,” she said. “My experience has been that most women like to see another woman, regardless of diagnosis.”
But in the long run, gender seems to matter less than expertise and sensitivity.
“When discussing sensitive issues, you have to make a patient comfortable and I feel I do that. It’s about reading the room,” said Dr. Horodyski, whose specialties include erectile dysfunction and Peyronie’s disease. About 70 percent of her patients are men.
Dr. Syan also sees more male patients.
“We are definitely seeing a shift,” she said. “Patients’ perceptions are changing. They want someone who is caring and a good listener.”
Working with Other Women Urologists
Geography, too, plays an important role in the number of women medical students who seek residential matches in urology. Dr. Syan’s experience serves as an example. Unlike her two colleagues, Dr. Syan met several women urologists during medical school in Los Angeles and residency in New York City. The vice chair of urology at the University of Southern California, as well as three of the urology faculty, were women when she attended. At New York University, 33% of the residents and four of the faculty were women. In addition, her older sister went into the field.
“Women are drawn to urology when they see other women urologists,” Dr. Syan said, “and there definitely is a geographical difference in where women urologists are working.”
This is true of male urologists, too. The majority of counties in the U.S. do not have a practicing urologist, male or female, and an astounding 90 percent of urologists practice in metropolitan regions with a population of 50,000 or more, according to the AUA census.
In addition, fewer women work in private practice (33.5%) when compared to their male colleagues (51.9%). They also tend to be associated with medical schools or academic medical centers, which are usually established in large cities.
Barriers to Success
Even as their participation in the field grows, women urologists say they face both expected and unexpected barriers. An editorial published in the journal Nature Reviews Urology in 2023 noted that gender stereotypes persist, hampering recruitment and retainment. Women in urology “reported increased dissatisfaction regarding work–life balance, reduced time for personal and family life owing to work schedule, and increased burnout rate compared with their male counterparts. The rate of academic promotions and career progression for women urologists is lower than that of male colleagues, and women urologists were shown to be paid less than men.”
Some challenges also have to do with a physician’s own preferences. There are simply some family responsibilities only a woman can meet, said Dr. Syan. When she was breastfeeding her son, she didn’t always have time to pump in a private setting. Instead, she sometimes wore the contraption under her clothing and lab coat while working. Patients and staff were very accepting.
“My male colleagues didn’t have to do that,” she said. “We have ‘mom guilt’ that is created by our community, our children and, unfortunately, ourselves.”
The physical demands on a woman’s body are also different. While pregnant, she discovered that the console bar for robotic surgery would cut into her belly, making performing these procedures “horribly uncomfortable.”
“Passing the Torch”
Those experiences, however, can inform the next generation of woman urologists. Like Dr. Syan, Dr. Amin feels it’s important “to pass on the torch” to female urology residents. But it’s also essential to be honest with them about the unique challenges women physicians face, especially when they start a family.
“When I speak to the medical students, I’m very open with them,” she said. “I talk to them about work/life balance. I’m a mother, a wife and a doctor and that means I wear all three hats.”
One of the advantages of working in urology, she added, is that “there’s flexibility to shape your practice with clinical and surgical responsibilities, including small and big procedures.
What’s more, there’s a lot of camaraderie and support within academic urology.
UHealth’s women urologists belong to the Society of Women in Urology (SWIU), a national group that helps women advance in the field. It has more than 950 members, including academic and private-practice surgeons, researchers, fellows, residents and medical students.
Other medical organizations, such as the Association of American Medical Colleges (AAMC), provide toolkits addressing pregnancy, family leave, work productivity and potential discrimination to help female physicians navigate their unique situations during pregnancy and early child-rearing.
“The field is changing and there’s a lot of room for women here,” said Dr. Horodyski. “But at the end of the day, the question is, do you have a passion for the field? That’s what it’s about. You have to love what you do.”
Tags: Department of Urology, Desai Sethi Urology Institute, diversity, Dr. Katherine Amin, Dr. Laura Horodyski, Dr. Raveen Syan, inclusion