If surgery is often seen as a male-dominated medical specialty, the stereotype goes double for the field of urology, with its focus on male concerns including erectile dysfunction, prostate issues, and vasectomies. A 2020 study from the American Urological Association, for example, found that women accounted for just 10.3% of all practicing urologists in the U.S.
Things are changing, though, as women pursuing careers in urology join the ranks of urology fellows at medical schools across the country. That includes the Department of Surgery at the University of Colorado School of Medicine, where three of the four current urology fellows — pediatric urology fellows Kristen Meier, MD, and Kelly Harris, MD, and reconstructive urology fellow Margaret Higgins, MD — are female.
We sat down with all three to talk about what drew them to the field and the unique challenges of being a woman in urology.
What drew you to the field of urology?
Higgins: In medical school, I got involved in women’s health issues pretty early on. I thought maybe I would do OB/GYN, because in medical school, one of the first pivot points you have to decide on is medicine or surgery. I tried very hard to not like surgery, because I knew what that lifestyle entails, but unfortunately, that is where I found the greatest happiness. We did four weeks of general surgery, then we had another month of a surgical subspecialty where you ranked what your choices are. I got my third choice, so I got put into urology. And it was on that rotation that I became enamored with the field. I loved the breadth of the specialty. You could do clinic procedures, then massive intra-abdominal surgeries, see male patients and female patients, adults and kids. It's a full scope, all confined to a narrow anatomical consideration.
Meier: Coming into medical school, I thought I would end up in pediatrics or something surgical. In the third and fourth years (our clinical years), I really enjoyed my surgery rotation, especially being in the OR, though I felt I wanted more patient continuity and the ability to develop long-standing patient relationships. After doing more digging through surgical subspecialties, it seemed like you could get a great mix of clinic, office-based procedures, and the breadth of OR cases with urology. I ended up spending some free time shadowing a few urologists, and it was very clear that I had found people of a similar personality, which was very important to me. As a urologist, you are dealing with very personal (and sometimes embarrassing) topics, so ideally you need a mix of empathy, humility, and humor to help your patients feel comfortable and understood.
Harris: I knew I wanted to go to medical school since I was in high school. That’s when I started shadowing OB/GYNs. We had some family friends who were in this field, and I thought I was going to be a women’s health doctor. Then when I was in college, I was part of a shadowing program where we spent time with urologists. I remember sitting in the parking lot on my first day, thinking, “This is going to be terrible.” But the week that I was with them, I fell in love with the specialty. I realized that I still could take care of women, but also men and children. I could still have the satisfaction of being a part of an intimate field of medicine. We talk with patients about things they hesitate to talk to anyone about. The more I interacted with urologists in medical school, through both research and clinical activities, it became very clear that that was my path.
What is it like being a female in urology? Is it something you think about?
Higgins: I think orthopedics still has the lowest rate of females in the specialty. And I know neurosurgery has a male dominance as well. But it’s gotten a lot better. I had a mentor at the University of Kentucky who knew her exact number, like she was the 54th female in urology or something like that. I am in awe of the true pioneers of the field who paved the way for generations of women behind them. When applying to urology, I thought more about how competitive the field was and my long-shot application rather than being a female entering a male-dominated field. I see female patients all the time who get very excited to see a female urologist. They’re like, “Oh my gosh, this is so great, I’ve had to see males for so long.” So that’s nice.
Meier: When people think about urology, the male issues often come to mind first. But most everyone has kidneys and a bladder, and half the population has female organs, so it makes sense that they may want to see a urologist who looks like them. Some people want a female provider for the opposite reason. We sometimes have male patients who say, “I feel more comfortable discussing this with a female.” There definitely are patients who for whatever reason may not want to see you because you are female, I think often in part due to the sensitive nature of their medical problem. Ultimately that is their choice, and when possible, you try your best to respect that and not let it bother you. Nevertheless, there are plenty of patients who are relieved and happy because previously they didn’t have the option to see a female urologist. It’s not something I think about daily, but I do think having more female urologists creates more welcome options for patients and diversity in a field that has traditionally been dominated by males.
Harris: I remember the first time I told my family that I was going into urology, and they had no idea why I would be interested in it. There’s definitely an assumption that it’s a man’s field. There have been plenty of times that patients have said they don’t want to see me because I’m a woman. As a trainee it can be difficult, because maybe they made an appointment with our attending, who’s a man, and they weren’t expecting to see a woman. Or I’ve seen patients who are consults in the hospital where I’m the only urologist around, and I have to see them. That can be difficult to navigate. Women have definitely made significant strides, not just in urology, but in medicine, and certainly in surgery in general. It’s a very different landscape than it was even 20 years ago. But there are still little moments of being very aware of your gender in a field.
What do you like most about the specialty and your specific fellowship?
Higgins: I’m in the genitourinary reconstruction fellowship, and I love the combination of male and female reconstruction. I like a lot of female urology and female reconstruction, but as a female in urology, you end up getting a lot of female patients shunted to you. A lot of that is just because of patient preference. A lot of female patients like seeing female providers. But knowing that and knowing that I wanted a broader practice, I chose to do a fellowship that focuses on male reconstruction so I have that expertise to broaden my practice.
Meier: Though it was hard to steer away from adult urology, I was always interested in working with kids. My mother’s an elementary school teacher, so I had a lot of exposure with education early on and spent many summers in camp counselor and mentorship roles. Not only are we teaching patients, but many pediatric urology positions are within academic urology, which allows us to work with young trainees who we can help educate and mentor. I think the coolest thing about pediatric urology is that you can make a difference early on that will hopefully change someone’s life trajectory in a positive way. We like to think we’re helping put our patients on the path to success. These types of changes don’t just have to happen at a local level, either; there are many possibilities within urology to participate in global health work and the global surgical community, which is another major interest of mine.
Harris: When I was looking for fellowship programs, I was interested in training with somebody who had extensive transitional urology experience. That’s kind of a sub-sub-specialty within urology where we take care of adolescents and young adults with congenital urologic issues. Having an attending here who specializes in that (Daniel Wood, PhD, MBBS) was a big draw. When I interviewed here, the culture and the general dynamic of the program, the way that we’re treated as fellows, the overall breadth of diversity that we see here, was very appealing to me. Since college, I’ve been interested in the embryology of the reproductive system and the way that it relates to not just biological sex, but lived gender. I’ve always found that to be a really interesting intersection of medicine and society and psychosocial issues. What first got me interested in pediatric urology was that we deal with these types of issues every day. That was one of the big things that piqued my interest very early on.
Photo, from left: Kristin Meier, MD; Margaret Higgins, MD; Kelly Harris, MD
October 17, 2023