Urogynecology Visit Type: Does Gender Concordance Make a Difference?

INTRODUCTION: Prior research has demonstrated variations in health care delivery, patient outcomes, and revenue generation based on physician gender. However, it is unknown whether there are differences in conditions seen or procedures performed based on surgeon gender in the field of urogynecology. OBJECTIVE: The objective of this study was to describe the initial visit diagnoses evaluated by urogynecologic surgeons in an ambulatory setting and determine whether there may be a difference in surgical versus nonsurgical conditions evaluated by surgeons of different genders. METHODS: We conducted a multicenter retrospective review of new patient billing data from 10/1/2023 to 9/30/2024. We included urogynecology practices with both women and men board-eligible or -certified urogynecologic surgeons in practice for at least 1 year. Urogynecologic surgeons in practice 1 month during the study period were excluded. Number of new patients and primary ICD-10 diagnosis code for each new patient visit were recorded. Visit diagnoses were inclusive of all conditions reported and separated into surgical and nonsurgical conditions by potential for surgical intervention. Surgeon demographic and occupational data were collected and summarized using descriptive statistics. Comparisons between the frequency of diagnoses seen and surgeon gender were assessed with 2-sample tests of proportions and Fisher exact tests. RESULTS: Data from 12 urogynecologic surgeons, 6 women and 6 men, at 4 institutions were included. Median surgeon age was 52 years (IQR 41.5–60), and median practice duration was 17.5 years (IQR 7–29). Most surgeons (91.7%) were board certified, and all surgeons practiced at an academic (66.7%) or academic-affiliated institution (33.3%). 33.3% of surgeons were assistant professors, 41.7% associate professors, and 25% professors. Median block time per surgeon was 5 days per month (IQR 4–5.75). There were no gender differences in demographic variables, block time, or full-time employment; however, women surgeons had less clinical FTE than men surgeons (median 0.725, IQR 0.6–0.8 vs 0.875, IQR 0.8–1, respectively, p=0.022). Median number of new patient visits was 342.5 (IQR 229–501.5) which did not differ by surgeon gender (p=0.937). However, women surgeons evaluated a greater proportion of patients with nonsurgical diagnoses (52.9% vs 48.8%, p=0.007) and fewer patients with surgical diagnoses (47.1% vs 51.2%, p=0.007) compared to men surgeons (Table 1). Surgeons performed a median of 172.5 surgeries during the study period (IQR 131.5, 189.5) with no gender differences (p=0.310). After adjusting for clinical FTE and block time, there was no difference in the volume of new patients evaluated by men and women surgeons. CONCLUSIONS: Women urogynecologic surgeons saw more patients with nonsurgical conditions and fewer patients with surgical conditions than men surgeons, although there was no gender-based difference in the number of new patients evaluated or surgeries performed. Women surgeons had lower clinical FTE compared to men surgeons despite having similar rates of full-time employment. These findings identify potential gender bias in urogynecology that may be detrimental to women surgeons in practice with men. More research is needed to examine the influence of surgeon gender in surgical management of urogynecologic conditions.Table 1