Urology isn't a medical field that's focused strictly on male patients. But because of the high percentage of men that go into the field as doctors, some physicians acknowledge that the male-centered assumption doesn't surprise them.
“They don’t realize that our specialty deals with the urinary tract as well,” said Dr. Stefanie Seixas-Mikelus, the new head of East Cooper Urology with the East Cooper Medical Group.
“Of course, women also have kidneys and bladders."
While in the U.S. the percentages of men and women in medical school are nearly equal, there are still certain fields of medicine that see noticeable gaps in terms of gender.
The American Urological Association reported that in 2018 women made up less than 10 percent of all urologists in the U.S. In South Carolina, the Association of American Medical Colleges reported fewer than 10 female urologists in 2016.
And in the Charleston area, Seixas-Mikelus is also one of the few women leading a urology practice.
“I definitely give credit to those ladies that paved the path," she said.
But urology isn't the only specialty with a wide gender gap. According to the American Medical Association, women make up more than 70 percent of all physicians in fields like pediatrics, obstetrics and gynecology, and immunology. And men make up over 70 percent in radiology, thoracic surgery, neurological surgery and orthopedic surgery. Studies also show that less than 30 percent of surgeons in the U.S. are women.
“There weren't many female urologists at the time of my training," Seixas-Mikelus said.
Seixas-Mikelus has been trained and works as a urologic oncology and robotic surgeon. In her experience, these were two focuses that didn't include a lot of women.
She said she even remembers going through training and having male attendings encourage her to consider more female-friendly specialties.
“It made me work harder and want to prove to them that women should be able to have the opportunity just like a male to pursue whichever career they wish," she said.
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One of her theories on the existence of these gender gaps is time flexibility. Seixas-Mikelus said some women might feel pressured to shy away from urology or surgery because of time commitments.
They are often required to work long hours, she explained. It is also fairly common for them to get called in the middle of the night to operate, she said.
“It’s very hard to go into a specialty like that," she said.
Dr. Heather McIntosh, an orthopedic surgeon with Roper St. Francis Physician Partners Orthopaedics, has found this to be a similar assumption made in orthopedics.
“For females, that’s a big consideration if they want a family," she said.
The American College of Surgeons reports that a general surgeon works an average of 50-60 hours a week, not including the time when they are available for call. And 40 percent of female surgeons have children.
Dr. Colleen Boylston, the owner of Sweetgrass Pediatrics, admits that work hours are sometimes a factor in her experience in pediatrics. At Sweetgrass, she said there are more than 20 female pediatricians and two male pediatricians.
“It allows flexibility," she said. “I actually employ many part-time pediatricians.”
She also acknowledges that not every pediatric practice is able to do that. Other theories for the gender gaps include stereotypes and exposure, McIntosh explained.
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Both McIntosh and Seixas-Mikelus explain that orthopedics and urology are not a common focus in medical training. So it does require additional information, they explained. In Seixas-Mikelus' case, she said she was introduced to urology as a child when her mother needed one.
She also got the opportunity to shadow a urologist during her training.
“It’s definitely not one of the core rotations in medical school," she said.
McIntosh explained that a common myth with orthopedics is that women are not strong enough to work with the musculoskeletal system. The typical stereotype for an orthopedic surgeon, she explained, is a tall muscular man.
Dr. Sara Van Nortwick, an assistant professor of pediatric orthopedic surgery at the Medical University of South Carolina, said in medical school she couldn’t even shadow an orthopedic surgeon because there were men in her class who wanted to do it.
She said her professors explained to her that the reason was that the men would actually end up pursuing the field.
“I think that was fairly unfair," she said. “I think a lot of it is misconceptions.”
McIntosh said that in reality, a lot of men were likely exposed to orthopedics through athletics.
In the 1960s and early '70s, women were often excluded from working with athletics, she explained. “So the exposure wasn’t there."
Over time, she said, policy developments have allowed for more women to get into athletics. And a recent survey by the Ruth Jackson Orthopaedic Society reports that 84 percent of female orthopedists played sports.
In terms of pediatrics, Dr. Matthew Davis, the chairman of the department of pediatrics at East Cooper Medical Center, explained that women are often seen as naturally nurturing. So this could explain why some women gravitate to pediatrics.
"It's a specialty that requires a certain amount of nurturing," he said.
But in general, many physicians highlight that the numbers are changing since more women are going into medical programs. In urology, 8.5 percent of doctors in the field were women in 2016, according to the American Urological Association. In 2018, that percentage was 9.2.
And in the 1970s, women made up less than one percent of orthopedic surgeons. Now, the American Medical Association reports more than 14 percent of surgeons are women.
McIntosh and Nortwick explained that the more women who enter specialties such as orthopedics, the more women there will be to mentor upcoming female medical students. Because of this, McIntosh said she expects to see even more improvements.
“You don’t have to be 7 feet tall and look like Arnold Schwarzenegger," she said.
Nortwick said “I think we need to appeal to everyone and not just a certain demographic."
In urology, studies have shown that female urologists tend to see a higher percentage of female patients in comparison to their male colleagues. So the push for more women is important, Seixas-Mikelus explained.
“What’s encouraging is that there are more females going into the field," she said. “There is a need."