Being female appears to affect urologists’ case mix

An increasing proportion of certifying and recertifying urologists are women, and they perform a disproportionate volume of female urology cases, researchers at Northwestern University in Chicago found.

In examining case log data for 37 CPT codes for common female urologic procedures, they found a significant increase since 2011 in the proportion of such procedures being performed by female urology subspecialists and women urologists, despite women remaining a minority of certifying urologists and female subspecialists. They presented their data at the 2015 AUA annual meeting and subsequently published these findings online in Neurourology and Urodynamics (Dec. 17, 2015).

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“I wondered, is being a woman in practice going to dictate my case volume load and the type of case mix I see, and whether doing a female urology subspecialty would change that as well,” said first author Joceline S. Liu, MD, a urology resident at Northwestern working with Stephanie J. Kielb, MD, and colleagues.

“We found that over the last decade, there has been a significant increase in the number of women urologists being certified and recertified,” Dr. Liu said. “Overall, the number has quadrupled in the last decade. For those women surgeons, they performed a disproportionate volume of female urologic cases.”

In her analysis, she examined surgical case volume characteristics in certifying urologists associated with common female urologic procedures. Six-month case log data of certifying and recertifying urologists (2003-2013) was obtained from the American Board of Urology.

“For urologists certified after 1985, recertification is necessary at 10-year intervals,” said Dr. Liu. Certification in female pelvic medicine and reconstructive surgery (FPMRS) was recently established in 2011. Senior candidates may apply for certification between 2011 and 2015.

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Case logs for 37 CPT codes were examined, focusing on five procedure groups in women ≥18 years of age: incontinence, prolapse, vesicovaginal fistula (VVF), ureteral reimplant, and revision/removal of mesh.

Among 4,802 urologists (442 female and 4,360 male) logging at least one female urology case, 43,949 incontinence, 30,983 prolapse, 451 VVF, 3,643 revisions of mesh, and 3,497 ureteral reimplant surgeries were identified.

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Greatest case volume in FPMRS applicants

From 2003-2010, subspecialists in female urology comprised 9.6% of all urologists logging a female urology index case. After initiation of the FPMRS certification process, subspecialists applying for FPMRS certification accounted for 13.1% of urologists logging a female urology case.

Female urology subspecialists performed a disproportionate volume of female urology cases, with the greatest case volume in FPMRS applicants. FPMRS accounted for 56.7% of all prolapse, 62.9% of VVF, 59.0% of mesh/graft revisions, and 41.9% of incontinence surgeries, all of which were greater than the percentage performed by subspecialists in female urology before 2011 (39.1%, 42.4%, 41.5%, and 21.6%, respectively (all p<.001).

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The number and proportion of women certifying in the female urology subspecialty have increased markedly, noted Dr. Liu, shifting from the minority (2.1% in 2004) to almost half of certifying female subspecialists (43.4% in 2013).

Some 90.8% logging at least one female CPT code were male, but women surgeons (9.2%) accounted for a disproportionate volume (22.6%) of cases.

“A rising proportion of certifying and recertifying urologists are women, performing a disproportionate volume of female urology cases,” said Dr. Liu. Women comprised 4.7% of certifying urologists in 2004 and performed 8.5% of prolapse and 2.8% of mesh/graft revisions. By 2013, women accounted for 38.2% of prolapse repairs and 35.4% of mesh/graft revisions (p<.001).