Despite the male dominance in Japanese urology, female representation has been rapidly increasing in recent years. However, female role models are scarce. Understanding the extent of leadership motivation among female urologists by career stage and its relationship to role-model exposure can inform targeted interventions to strengthen the leadership pipeline. Over Forty Female Urologists ConsortiumUROlogy (OFFUCURO), established in 2024, supports long-term career development for female urologists through peer networking and mentorship. As of August 2025, it includes 114 members (women and men), representing approximately 10% of the Japanese Urological Association (JUA) -registered female urologists. We conducted a cross-sectional, web-based survey of OFFUCURO members (n = 114) from August 29 to September 11, 2025. Participation was voluntary and anonymous, and informed consent was obtained electronically. The questionnaire used the validated Japanese wording of the original 27-item Motivation to Lead (MTL) scale 1, 2. Items were rated on a 5-point scale, and reverse-worded items were standard reverse-coded. The scale comprises three subscales—affective-identity (AI-MTL), non-calculative (NC-MTL), and social-normative (SN-MTL). We compared women aged < 40 years, women aged ≥ 40 years, and men using Kruskal–Wallis tests with Steel–Dwass post hoc tests, performed using EZR software. We also assessed role models and work–family balance concerns. Of the 62 respondents (response rate, 54. 4%), 61 were analyzed after excluding one respondent because of missing information on sex (women, 50; men, 11). All male respondents were aged ≥ 40 years. Among women, 18 (36. 0%) were < 40 years old and 32 (64. 0%) were ≥ 40 years old. Role-model exposure differed by age group; younger women cited male/mixed role models more often, whereas women aged ≥ 40 years cited female/mixed role models. Work–family balance concerns were reported by 14/18 (77. 8%) women aged < 40 years, 16/32 (50. 0%) women aged ≥ 40 years, and 5/11 (45. 5%) men aged ≥ 40 years. Figure 1 shows MTL comparisons. Kruskal–Wallis tests indicated overall differences for AI-MTL (p = 0. 039) and NC-MTL (p = 0. 0037), but not for SN-MTL (p = 0. 159). In the Steel–Dwass tests, NC-MTL was lower in women aged < 40 years than in those aged ≥ 40 years (adjusted p = 0. 0043) and men (adjusted p = 0. 039). AI-MTL showed a trend toward higher scores in women ≥ 40 years than in those aged < 40 years (p = 0. 062). These patterns are consistent with the practice-relevant interpretation. Early career clinicians face tighter schedules, fewer support resources, and multiple transitions; leadership costs feel larger and benefits are less certain, especially when work–family balance is salient 3, 4. By mid-career, work routines often stabilize, family responsibilities shift, and greater autonomy reduces perceived leadership “costs, ” aligning with higher NC-MTL in women aged ≥ 40 years. Affective-identity may also strengthen as experience accumulates, consistent with the trend toward higher AI-MTL after 40 years. However, alternative explanations merit consideration. The observed differences may reflect cohort effects (women aged ≥ 40 years entered careers when female role models were scarce 5, whereas younger women have had greater exposure through the JUA and community initiatives such as OFFUCURO) or survivorship bias (women aged ≥ 40 years remaining in urology may have higher baseline motivation). Longitudinal data are needed to disentangle these mechanisms. The JUA has implemented concrete visibility and access measures, such as curated lists of qualified women chairs and designated women's seats among delegates and Board members. These initiatives successfully engage women aged ≥ 40 years showing higher leadership motivation; however, whether these measures increased motivation or attracted already-motivated individuals is unclear. Regardless, sustaining and expanding these initiatives is important to foster leadership aspiration among younger women. For early-career clinicians, proactive engagement in national/regional meetings and cross-institutional communities is important to broaden networks beyond one's hospital and increase exposure to leaders 6, 7. This study has several limitations. First, we used convenience sampling with a modest sample size, limiting statistical power and generalizability. OFFUCURO members may represent a self-selected group with higher interest in networking compared to all Japanese female urologists. Non-response and selection biases may affect results. Second, all male respondents were ≥ 40 years old and in senior roles, precluding assessment of whether age-related patterns are sex-specific or universal. Third, the cross-sectional design precludes causal inference because we cannot distinguish age effects from cohort effects or selection effects. Fourth, we used the 27-item MTL instead of the Japanese 11-item short form; future replications should include short-form sensitivity analyses. Sachiyo Nishida: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing. Chie Matsushita: investigation, writing – review and editing. Yasuyo Yamamoto: investigation, writing – review and editing. Tomoko Kobayashi: investigation, writing – review and editing. Maki Kawasaki: investigation, writing – review and editing, supervision. Hitomi Sasaki: investigation, writing – review and editing. We would like to thank the OFFUCURO members for their participation and sincerely thank Professor USUI Emiko (Institute of Economic Research, Hitotsubashi University) for her expert advice. The authors used ChatGPT (OpenAI) to assist with initial English phrasing. The tool was used only for language assistance; data analysis, interpretation, and all decisions regarding content were made by the authors. All text was reviewed and edited by the authors, who accept full responsibility for the final manuscript. The study was approved by the institutional review board of Sapporo Medical University (Approval No. 7-1-23). The web-based survey was voluntary and anonymous; electronic informed consent was obtained from all respondents. The authors declare no conflicts of interest. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48: 452–458.
Nishida et al. (Thu,) studied this question.