The face of urology and nephrologycould change dramaticallyin the next decade. According tothe Association of American MedicalColleges, 26% of practicing nephrologistsand 7.2% of urologists werefemale in 2013. However, women currentlyaccount for 39% of nephrologyresidents and almost 23% of urologyresidents.

What does this mean for physicianpractices? Practices should plan aheadto create positive workforce changesaccommodating the needs of futurephysicians. 

A broader demographic in urology and nephrology 

Just 5 years ago, if a practice came toDan Jennings of The Medicus Firmlooking for a female urologist, he washard-pressed to find a candidate. Now,about 1 in every 5 or so responses hegets when advertising for urology positionsare from women. This is a goodthing, he said, particularly in communitieswith a lot of male physicians andan increasing number of female urologypatients. 

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It’s not a surprise to find that, onaverage, female physicians tend towork fewer hours than men. Studieshave shown that women doctors workapproximately 7 or 8 fewer hours aweek than their male counterparts. 

What groups should be awareof, however, is that flexing schedulesis not just for female providers.According to Cejka Search, 22% ofmale and 44% of female physiciansin 2011 worked part-time schedules.This trend is not likely to change,as the number of dual-career familiesincrease, more women enter thefield, older physicians cut back, andmore millennials enter the field,said Leslie Rickey, MD, FellowshipDirector, Female Pelvic Medicine andReconstructive Surgery, Yale School ofMedicine in New Haven, Conn., andpresident of the Society of Women inUrology. 

“It might be time to reconsider thenotion that more hours equal greaterdedication and a better physician,”Dr. Rickey said. “It doesn’t mean thatsome degree of ‘scheduled predictability’that allows doctors to dedicatetime to their families or outside activitiesimplies that a physician is any lesscommitted to optimal patient care.” 

Making changes in your practice 

As more women enter the fields, practicesmay need to be more flexible.Martin Osinski, owner of the recruitingfirm NephrologyUSA, said it willlikely be bigger offices that are ableto make changes. In these groups, hehas seen part-time schedules, reducedcall loads, or hiring solely for dialysisrounding or office visits. 

Jennings said women are movingto urology because there tends to befewer emergency surgeries. For thisreason, some groups may allow peopleto schedule surgeries only 2 to 3 days aweek in the mornings. 

Dillon said it will likely be groupshaving a hard time getting candidatesthat will have to be most willing tobend. He has seen small hospitals inrural areas ship evening and weekendsurgeries to other places so their physiciansdon’t have to come in. Somegroups might be amenable to splittingschedules and letting 2 women workhalf time to fill one full time equivalentposition. 

“If someone wants to take some callbut only every other week, officeswill have to make an adjustment incompensation somehow,” Dillonsaid. “They are going to have to becreative.” 

Dr. Rickey said that one of the mostimportant aspects of integratingwomen into the practice is dealing withmaternity leave. 

“There are still many women whostruggle with childbearing and whento do it and how it will look in practice,”she said. 

Practices need to deal with it proactively,she said. Time off and effectivecompensation should be built into acontract so the physician doesn’t haveto ask for it when the time comes. Oneoption may be to navigate the issuethrough the use of short-term disability.This way, the physician gets compensatedand other doctors don’t have tofeel like they are paying for their break. 

Moving up the ladder 

A physician’s ultimate goal is tobecome a partner. Unfortunately,this doesn’t exactly jibe with flexiblescheduling. 

A solution to this is to allow womento remain as employees and avoidcall or work fewer hours. Dillon saidpeople often won’t buy in as a partnerif they are only receiving part-timepay. Some practices let women “takea portion of partner.” They can workone-third or one-half of the call otherdoctors work and only pay in and reapthe rewards of an equal amount ofpartnership. 

“Medicine has changed and doctorswho are coming up in this day are notgoing to work like their dad or grandfatherdid,” Dillon said. 

To have women in partnership takesa pathway that is not always available.Dr. Rickey said she has had a host of“wonderful male mentors” during hercareer, but contends it will be increasinglyimportant as more women enterthe field to have tenured females inthese roles. 

“If you look around and don’t seepeople that look like you in those positions,you can’t see yourself there,”she said. “It is harder to relate and seeyourself in those roles.” 

Of the 126 urology residency programsin the nation, Dr. Rickey said sheknows of 3 that have women as departmentchairs, hardly reflective of the10% of women practicing in the field.