Effect of Gender on Practice Patterns of Andrology Fellowship Graduates

Abstract

ABSTRACT Introduction Women in urology are more likely than their male counterparts to treat a majority female patient population, despite training in non-urogynecologic fellowships. Female urology is accordingly one of the most popular fellowship training choices for female urology residents, while less is known about the traditionally male-dominated subspecialties. Objective We sought to evaluate the current landscape of male reproductive and sexual medicine fellowships as well as characteristics of past andrology fellows and post-fellowship career paths. Methods The websites of the American Urological Association (AUA), Society for the Study of Male Reproduction (SSMR), and Sexual Medicine Society of North America (SMSNA) were reviewed for sponsored fellowships. Program coordinators and institutional websites were queried for information including length of training, curriculum, faculty, current and past fellows. A Google search was performed for each institution in combination with the keywords “male reproduction”, “sexual medicine”, “male infertility”, “prosthetics” and “fellowship” to identify former fellows not listed on institutional websites. Medical school, residency program, current employment, and conditions treated as advertised online were noted. Descriptive statistics and t-tests were used to compare outcomes by gender. P values <0.05 were considered statistically significant. Results The SMSNA endorsed 73% of programs (29/40), and SSMR 48% (19/40) while only 45% of all programs (18/40) participated in the 2021 AUA match. Median length of training was 1 year. Median number of fellowship faculty was 2. Only 20% (8/40) programs had any female andrology faculty. The earliest reported fellows dated back to 1982. From 1982-2021, 324 andrology fellows were identified, 53 of whom were female (16.4%). Of the fellows identified, 43.2% (140/324) were currently working in in an academic position, with 54.5% of women pursuing academia versus 45.5% of men (p=0.39). Men and women were equally likely to advertise an exclusive andrology practice, 65.4 and 61.4%, respectively (p=0.78) versus also seeing general urology indications. We assessed for a change in the proportion of female versus male fellows over time by comparing fellows who began training prior to 2010, and those who began training in 2010 or later. The number of andrology fellows increased from 111 to 213 (91.9%), with an increase in the proportion of female fellows from 8.1% to 20.7%, p=0.0038. Conclusions Less than half of andrology fellowships participate in the AUA match and over a quarter are not endorsed by the SMSNA. Only 1 in 5 fellowship programs had a female faculty member. Male andrology fellows were and remained in the majority over time. Despite this, female andrologists were equally likely to pursue academic careers. National urology and andrology societies have taken steps towards standardizing andrology fellowship training however much of the information is not easily available for residents to view. The limited information on fellowship graduates somewhat restricts interpretation of gender-based differences in practice environment. However, we found there was no negative impact in female andrologists’ ability to practice andrology or enter academic careers despite being in a male-dominated subspecialty. While encouraging, further work is needed by andrology societies to make program information accessible to all trainees and standardize the application process. Disclosure No