Dr. Suzette Sutherland
Appearances
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
This week on the Backtable podcast.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And then I guess to take it to another direction a little bit, these patients that have mixed, you know, low and high grade histology or uncommon variants, does it help to determine, you know, is it picked up by the uncommon variants as well so it can help to determine these more really high, high risk patients? Yes.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Furthermore, patient compliance can often be an issue, with only 23% of patients coming back for re-resection. It's therefore all the more important to ensure a complete TURBT The first time, right from the start. Listen to this podcast interview with Dr. Suzanne Merrow, who discusses the benefits of blue light cystoscopy to enhance visualization and ensure a high quality TURBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah. Can you refresh my memory? Is there a certain percentage? If it's mixed, is there a certain percentage of high grade to put them into the high grade category, like 5% or is it any high grade?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Well, I mean, that's obviously a very important junction then whether a patient is deemed intermediate versus high, getting intravesical chemotherapy or intravesical BCG, and the risks associated with the intravesical therapy, right?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
That clinical decision, taking out, you know, all of the objective things and looking at the patient, having the patient help make that decision, what they're willing to do, it's not easy, right? And so, The more we have on the diagnostic end of things to point our fingers towards a high risk situation to tell us to do the intravascular therapy.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
I mean, it obviously makes our job somewhat easier to some degree, right? Because that decision making process is out of it, the judgment part. But also, I think for the patient to accept that. doing intravesical therapy. It's not an easy thing. You do this all the time, right?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
This isn't my specialty, but I do have some bladder cancer patients that are women in my practice, and it's never an easy thing for those women to undergo that and some of the hardships associated with the symptoms thereafter and so on and so forth that they go through, right? So this really would help, you know, make that diagnosis. I found some information on the sensitivity.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
the accuracy, right? Looking at what's seen through the eye and then what's seen histologically. And with white light, the accuracy is 76% compared to blue light, 91%. And then combination, white plus blue, 98.5%. Now, clearly that comes from, I'm sure, one conglomerate study of looking at things. But still, the difference there is really poignant.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And why do you say that? Is that more for our learning purposes? So then we can go back and say, this is what it looked like in white, and now I see it on blue. So ergo, next time I'm going to know that white light, little distal I didn't think was important, is important, or is there more to it?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Because if we think real practically, when we, you know, you put the cyst view in, it They sit there for an hour and it colors the bladder. We'll get into the workflow in a minute, but it colors the bladder. So when you take them to the OR there and put in the scope, it's already all colored. You've lost your white, your absolute white light.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
I'm your host today, Dr. Suzette Sutherland, and I'm super excited to have Dr. Suzanne Merrill here today to talk to us about diagnostic aspects of bladder cancer and how to enhance that, specifically with a newer type of technology called blue light cystoscopy. Thanks for being here with us today, Dr. Merrill. It's my pleasure. Thanks for having me, Suzette.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Or do you mean, well, I guess, no, you can still see everything looks still the same on white light or are there differences on white light with the SysView in?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Okay. That was really the big question. I think sometimes I hear people wonder if it ruins your ability to get a good white light look, but you're saying no, you still get a good white light look and then you turn on the blue light imaging and you get your blue light. Right. Yes. Got it. So let's talk about the workflow a little bit.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Sometimes people think there's too much fuss and muss and can I really do this? And I'm at an institution where it's done quite easily. I think it's just important to get a good workflow going. to be able to do this efficiently and have some trained staff that understand the importance of what you're doing.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So why don't you walk us through what you do when you have a handful of cases maybe stacked or how you make it work for you?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, let me tell you a little bit about Dr. Suzanne Merrill. She is trained at Duke University for her urology residency and then did a GU oncology fellowship at Mayo Clinic in 2015. She's now 10 years out of fellowship, so she has a lot of experience under her belt. She started on faculty at Penn State Hershey Medical Center. where she was program director there too for the urology residents.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So that was a question I had just to make sure. So there's no other company that makes equipment that will be compatible for this. It's Storz.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
It is interesting. Are there, you know, and it's part of the AUA guidelines and in such a strong way that there aren't more companies that have come down the pike to try and do the same thing, whether it's Olympus or other, you know, there are other imaging companies, right, that do optics. Are there newer ones coming down the pike that you're aware of? No, that kind of fits with this technology.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah. And I'm sure as more time goes on, the quality of the imaging will only improve even more. I mean, that's where the technology is going and should go to enhance detection. So back to our workflow, I think we were stacking them in the front end, having your nurses educated, knowing so, you know, the nurse knows what to put in when and timing it and so on and so forth.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
You mentioned if somebody can hold their bladder a sufficient amount of time, it's just an in and out catheter to put the CIS view in. But if you have somebody who says, no, I can't, then what do you do?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And it's helpful to put that in your standing orders and the algorithm so you don't get a phone call first thing in the morning always about it, right? You got it. It's an either or and the nurse decides which one to do. Right. So after your TURBT and the OR, you're done. You already said you cycle it through, then you do your TURBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And now since about a few years, since 2021, she's in Colorado at Colorado Urology, which is under a bigger umbrella of United Urology and specializing in GU oncology and also considered a regional bladder cancer specialist. So she really knows what she's talking about here today. And I'm so happy that she's here to share that with us today. Well, thank you. So let's just get started.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Is there any post-op things that are additional because they did the cyst view?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah. In what time span was that? Recommendation is about six weeks. And then, you know, let's talk a little bit about, too, upward migration of staging and the numbers around that and how blue light has, you know, sort of opened our eyes. We've had a little bit of this discussion, too, but not as much about just really that patients that have low risk
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And then suddenly, because of blue light, you're able to get a better visualization, better resection, so on and so forth. Then you found that, you know, there are studies out there showing that, oops, they really seen a trend of upward migration, right? Of more high grade patients out there. Isn't that true? With the use of blue light, as we've looked over the last handful of years or so.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah. So a lot of this, of course, is very helpful for patients that have non-muscle invasive, right, superficial intervesicles. Is there some data to show with the use of blue light, it's really helped us to identify the muscle invasive patients as well? Like upstaging to that level or is that... You know, usually those are patients that have a little bit more burden in them.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
They also, their tumors can look a little aggressive even on white light. They've got, you know, and so sometimes we have more of a hunch of that than we do when people just have very small CIS areas or things like that. But I just wonder if the data also shows it's been helping us to identify patients to move them from the non-muscle invasive into the muscle invasive category. Yeah.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Like, first of all, just a couple of, you know, good fun facts, I suppose, not so fun. But, you know, we know bladder cancer, it seems like it's getting even more common today than it was even when I was training. It's quite common, more so in men than women. Tell us the statistics around the epidemiology today.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, that's really amazing. Those numbers are alarming. So I'm thankful that we have something like Blue Light to help us along and look forward to see what's developed even more in the future. There is something else that we can touch quickly just because it is in the AUA SUO guidelines, another form of enhancing detection, but narrowband detection.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
imaging or do you have much experience with this? They say you could recommend it to patients. My understanding is there's not a ton of data out there, but it's something maybe to look for in the future to see if there's more enhancement that develops. What can you tell us about that?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Is it really that there aren't many studies out there yet because it's too new? Or is it really that there's enough data just when we look at the data, there doesn't seem to be much benefit? I think it's the latter. I think it's the latter because it's been around for quite some time. Well, it's good to touch on it. It is in the guidelines.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And so I know people think about that now and which one should I do? And as you say, I've been exposed to that as well with Olympus and it is a lot easier, right? But we also have to recognize if it's limited with respect to what it can provide us, then there might be a reason to do the extra steps of the blue light, needless to say. Yeah. Good. Exactly.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Well, I think this has been a very healthy discussion about non-muscle invasive bladder cancer and the management thereof and enhancing our diagnostics and helping us to determine what algorithm to use to treat, right? Risk, low risk, intermediate risk, high risk. Well, great. Well, this has really been so informative. Very, very helpful.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Again, Dr. Suzanne Merrow from Colorado Urology, really an expert in urology. GU Oncology in general. She has more than just bladder cancer, but has really become a regional expert in her area for bladder cancer. And we're so happy that you were here with us today to share your expertise with us. Thank you so much. You're so welcome. It was my pleasure.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So once again, thank you for joining us on Backtable Urology. We strive to be your source of information for all things urology. Again, I'm Suzette Sutherland signing off. See you next time.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Right. So we know when we talk to patients about cancer, oftentimes I say the C word before I say the word, right? Because it's so frightening, right? And we as physicians and surgeons know that one person's cancer isn't another person's cancer, especially when we're talking about different organs, right?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But even the case when you're talking about bladder cancer, and we know the earlier you find it, it's totally treatable, right? And when it's late in the diagnosis, it's a whole nother issue for the patients, right? So that's another thing that we're talking about here today, how we can do a better job at detection early. and utilizing some of the newer tools that we have.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Let's look at the AUA guidelines really quickly, right? For the risk stratification, we know it's determined low risk, intermediate high risk, and the things that come into play for that, much of it histological things, and that's where our technology can help us. Can you briefly kind of go into a little bit of the main points that go into our risk stratification today?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah. So it's oh so important to really know the accurate histology, right? At the time of biopsy, at the time of look-see, right? When we take them for a look, cystoscopically, whether it's in the office or in the OR, we want to be really confident that we know what we're seeing, that when we see nothing, as an example, that we really are seeing nothing.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So tell us about the blue light cystoscopy, the cyst view, and how that works and how that enhances our visualization. Yes.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
I've had the opportunity to use this myself and was really astounded at what I saw on white light versus what I then was able to see on blue light. And so it really was an eye opener. The first time I used it was several years ago, but it really was an eye opener.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And I'm a firm believer that it helps with diagnostics at this point and really that, you know, it should be used if possible on almost all patients. What are your thoughts on that? when it should be used? Or is there a time when it shouldn't be used?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Welcome to the Backtable podcast, your source for all things urology. You can find all previous episodes of our podcasts on Apple Podcasts, Spotify, and at backtable.com. We all know that TURBT procedure is critical in the care of patients with non-muscle invasive bladder cancer.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So that's a huge number, right? One third of the patients. And we're talking about something as serious as CIS. Exactly.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Unfortunately, there's data that shows that carcinoma in situ, or CIS, was missed on TURBT more than 45% of the time on subsequent radical cystectomy cases. And 86% of residual tumors have been found at the original resection site. With this, it's clear that enhanced visualization is of utmost importance and will be a significant benefit during TURBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
It is amazing having trained in the era before blue light and how we thought we were doing such a good job with our two RBTs. And now with the blue light, you see the residual tumor, as you said, that you miss. I mean, I didn't know until doing a little more research myself in anticipation of this podcast how high that number was.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And when you look at the recurrence rates or the residual tumor rate, I mean, as you said, sometimes this can be up to two thirds in some reports, but even how much of T1 disease versus T2 disease gets missed, you know, because the resection isn't done adequately enough just with white light. So up to 15 to almost 30%. So of the residual disease being T1 to T2.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So again, we know this totally changes the The prognosis of the patient, right, and what we're going to do next or what we should be advocating for next. I just wanted to make that point that when we look at the newer, I think they came out in 2024, yeah, just last spring, the AUA-SUO guidelines concerning this.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
They actually say in patients with non-muscle invasive bladder cancer, we should be offering blue light cystoscopy. Now they make the caveat, you know, at the time of TURBT, the caveat is if available to enhance detection and decrease recurrence. So it's a moderate grade, grade B evidence strength. But again, they do put that word should in there as opposed to saying should. could, right?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So the data is pushing a little more towards or pointing towards the real potential, the benefits of this blue light imaging.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
for the men's encounters and almost 18, almost 19, I mean, minutes, right? So another two and a half to three minutes per encounter.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And then that also doesn't talk about some of the things that we have alluded to before about the amount of time spent not only face-to-face with the patients, but afterwards and phone calls or communicating with families, so on and so forth, that don't get into the actual encounter visit that women are also doing. So two-year point. Yeah. So it's good to put numbers.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I also wanted to say one little caveat just for the listeners so they understand that when we're talking about these numbers, like the 25% of the people that are less than 45 are women, right? We're talking about The practicing urologists, we're not talking about trainees because we do know that that number is increasing too, right? The number of trainees that are women.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we just want to make sure we're looking at that fairly to say, yep, it's also the number of people who are coming out of training and in practice. That's the 25% number that are women. So.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I wanted to go back to the comment, and maybe Dr. Nielsen, you can comment on this then too, is this idea of fellowship. More people overall, men and women, more of our trainees coming out or feeling they need to do fellowships or they want to do fellowships. I shouldn't say need, want to do fellowships and not always necessarily going into academic practices, but feel they want to do fellowships.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And then what do you think that that says, though, about the landscape of our urology and the type of practices that people want when they're done with their fellowship? And what does that mean that we can offer to patients then when we get so super specialized?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Because we're going to get in a little bit later into things like burnout and all that. But if somebody's not getting the practice that they thought they wanted because the demand is different, you know, what does that say about physician satisfaction about their practice? Right.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we need to be thinking about that as we're training people to get out into the greater urological community, what the need is. So that's why this data is so important, too. Right. For us to find out what what the needs are.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Maybe you could also speak to the subspecialties, what the top subspecialties are when people are doing fellowships or versus, you know, how many of the what we consider subspecialties are really part of a general practice, how much people are doing these things, even though they're not specialized with the fellowships.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So before we get started, I'm going to do a formal introduction, of course, of our two guests. They are very well known in the broader urological community already, but I'll go ahead and do the formal introduction nonetheless. First, we have Dr. Amanda North.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, they don't have ED. I got it.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But, you know, to your point, you know, we're all at academic institutions. And how many mission statements have you read from, you know, four-year students? Medical students trying to get into urology that say the reason they really like urology is the diversity. And then so many people ultimately end up specializing and subspecializing at the end of the day. Right.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So it is really an interesting, interesting thing to watch and be careful of. Right. As time goes on. So I think another thing that was super interesting, and you already said something, Dr. North, about more women going into academics and just overall, but just bringing that into the conversation.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I was really interested to see that overall, almost 50% of urologists are still, however, in private practice. And so it showed that some of the more men are in private practice and more of the older men. Right. Older, I just say it says greater than 45. I don't consider that older, but it didn't break it down more than that that I saw.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I think they're in that traditional practice that now is potentially changing as the landscape changes. Right. Was that a surprise to you to see still so many people in private practice?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
She is chair of the AUA Data Committee, so the committee that really was quite responsible for all of the data here, collecting it with the AUA census, putting it together, and then looking at what does it really mean. She's associate professor of pediatric urology, so that's her specialty, and she's division chief now at Children's Hospital at Montfiori in the Bronx, New York.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Thank you so much. why are these the most important things, right? They're pretty specialized there, the questions. And I see why they're in themselves important, but there are lots of questions that weren't asked. I mean, so the first one, you know, dealing, there are two buckets I saw, endourology bucket and then the sexual health bucket. The first one was, you know, the use of double J stents.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
that so many practicing urologists really prefer using double J stents when they do even a simple ureteroscopic procedure, they'd still lead up a stent rather than doing it stentless, right? That not many people in the country are doing it stentless yet. And was there anything in the data that, or your other discussions about why that was an important question? Yeah, to have that answered? Yeah.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, that makes sense. There's always a rotating pecking order, right? And then to your point about newer technology, there were questions about how many people are using homium lasers versus if they're going to invest in some new laser. Are they transitioning to the thulium laser? I thought that was very interesting. You know, almost half.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So welcome, Dr. Amanda North. Thank you so much for having us. Our next guest is Dr. Matthew Nielsen. He's chair of the AUA Science and Quality Council, so also was quite involved in the data and what does it mean for us. He's professor of urology and may know chair of urology at University of North Carolina in Chapel Hill, and his specialty is urologic oncology. Hello, Dr. Nielsen.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
of people were saying they were going to have a new purchase in the future and it was gonna be Thulium. So just showing the utilization of the newer technology that's here. So, and another interesting thing in the endourology bucket was how many people are using strings on their stents. Now I didn't see a timeline associated with that.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I know personally that determines for me if I'm gonna leave a string or not. You know, if I think it's gonna stay in 24 or 48 hours, string it. But if not, I'm not gonna have a string on it. But how many people really preferred doing a cystoscopic scent removal in the office rather than leaving any kind of a string? And even those who had a string still having the provider remove it, right?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Having them come into the office so that the provider can pull the string. It was about 25% versus 20% of the patient pulling it. So I think things like that are really interesting to see different practice patterns that people are doing. Is there anything more that you're looking at that you're going to use this data for?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So that was a question I had. Who has access to this data? If they have an idea, is it hard for them to get some of the raw data to be able to look at? Or is there oversight of their utilization of the raw data?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Thanks for being with us.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So let's just dive in, shall we? We're going to talk, first of all, about the data itself, how it's collected, how it's acquired, and who it really represents. When we look overall, we do see some of the data that's in there that it really had a response rate of about 13.5%, I think, if that number is correct.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, those are wonderful opportunities. I love what you said about I think the word you said is democratize the data. I love that. And it's also provides her more transparency. We know that with different statistics, people can manipulate data to say what it needs to say or things get left out. And this really provides for the ultimate transparency. And that's so important.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So let's look again at a little bit more of some practice patterns that are happening. One big topic is telehealth, right? And then how much that people are doing in the area of telehealth. There was so much during time of COVID that But now that we've all backed away from that, what's really happening in that domain?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
How many people are still doing telehealth and how many people are willing to if they're not going to be reimbursed the same as an in-office visit?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
To that point, telehealth crossing state lines, right? I know here I am in the state of Washington and we, during the time of COVID, could cross state lines. We're part of the big whammy region, Wyoming, Alaska, Montana, you know, what's all the W's? Washington, Idaho. There, I got them. But suddenly now we're not right and we won't be reimbursed.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And it's like now you've established care for some patients. You can continue with established, but the new, you know, it and it just seems unethical to some degree, at least in my opinion. Right. And so we have a service that we're able to provide to people. We should be able to. do that without being penalized just because we won't be paid for it.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
of our urological workforce that answered the surveys and whether you think that that's really an accurate representation, I mean, of who we are and how we use that information then to make some decisions in the future. So I'll just throw that out to both of you or maybe starting with Dr. Nielsen.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
That just seems so, yeah, people that are championing for this policy work, doing advocacy work, it's so important. Thank you for doing that, for sure. Yeah. And then the idea, too, about the telehealth, if it's the reimbursement for it is reduced, how many people will actually then say, I'll still do it? There was less than 20 percent said yes. The vast majority said no way. Right.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
A few people said maybe. But for the most part, I mean, it is our livelihood, too. And so it's hard. You set up that precedent. Yeah. And now that's what you're doing all day long and not getting paid for it. So yeah, working with the policy changers is what's so important. And also another one is the big burden of prior authorizations, right?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So we could just say real quickly, maybe Dr. North, you can speak to that. How many people that that really involves and what that means if we look at overall staff shortage issues, right? Absolutely.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And with that also describing what were your roles in this process and your committees and how many other committees and if there are influential people that should be mentioned who should be given, you know, accolades for their work they did for all of this data?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I really wanted to highlight a number that you said. You said it real quickly, but you said, you know, 54%, but, you know, more than half of urologists. It's not only a headache to the urologists and to their staff, but they said it affects the clinical outcome of the patient, right? And so when we put it in those terms, too, my goodness. We definitely need to make some changes.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So that's great data to have. That's wonderful. Yeah. And then if we look at the staff shortage, I was astounded. Of course, we all experience it to some degree in whatever kind of practice we're in. But what I was really astounded to see is that real high percentages of vacancies, not only of nurses and support staff, 56% vacancies or difficulties filling vacancies.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
positions for nurses, for MAs or LPNs, same, close to 50%. Urologists, hard-filling urologist positions too, the MD, 55%. That one was for me a real eye-opener. So that brings me to this idea too about, you know, where are we sending our trainees? How are we training them? Where are they going? setting them up for success to go into some more rural communities.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And then also, I didn't see any specific questions about locums. And, you know, again, what this looks like for our urological workforce, as I think more people are just really jumping into the locums pool for a variety of reasons, right? And then what that makes our urological workforce look like. Yeah. So I know that's a hefty one. Locums is on our radar. Don't worry. Yeah. Yeah.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Locums and private equity are both on our radar. It'll be on next year's. Yeah. And then the other thing is that with all these shortages of the acknowledgement that 82 percent of urologists said that they actually significantly utilize support staff such as a nurse practitioner or a P.A., So there you go. In order to keep me moving, this is what I need.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And if I don't have that, you can't keep me moving. And there's our shortage, right? So, yeah, which then, of course, leads to the next big topic, burnout, right? Why don't you go ahead and talk about that, what you found in the census?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, it's hugely important or we won't be able to move forward, right? We know everyone needs a helping hand at times and being able to do that confidently and confidentiality you know, that's what we all need. And then the next area is for, you know, diversity, equity and inclusion, looking at discrimination, harassment in the workforce.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I was pretty astounded again to see, you know, the differences here, how many people have witnessed some type of a harassment or discriminatory event and how many people have experienced. Both were close to the 30 percent area. So a third of our urologists are experiencing and or you know, seeing it.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And for women, of course, the numbers are higher than for men, women more around gender and sexual harassment, men often around bullying and violence. It's just really astounding. You know, of course, now this is feeding into the burnout. You know, if you're doing the best you can during the day, Being the best person you think you can be and suddenly, you know, somebody's bullying you.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, it certainly, you know, makes you want to go home.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah. And then the last area for us to talk about, we're running out of time here, but is the area of ergonomics. That's such a hot topic today. I had the privilege of hosting Dr. Kristen Krauser from the University of Michigan on a Backtable Urology episode that we entitled, I Love My Job, But It's Killing Me, and all the statistics around that.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So you were able to glean some statistics here too about the the impact the ergonomics has and people even retiring early because of musculoskeletal issues and what our trainees are telling us even, right? The young ones, we think it's the older ones that are having trouble and they're going to retire anyway.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But my goodness, Dr. Nielsen, you've been on practice longer and with your geo-oncology, probably do a lot of robotics. I noticed in the questions, it was laparoscopy and robotics that was pulled out. That maybe is a question for Dr. North, but why that versus, you know, I do a lot of vaginal surgery. I'm sitting, but I still have back issues, right? And because of the ergonomics.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
But anyway, in your practice and what you've seen and with residents, so on and so forth, how big of an issue is it? And what kind of things do you do in your program to try and mitigate them?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
It is one that's great to have in conversation here with our residents as well and fellows, and they're the ones, I think, to your point, are really leading this, saying, hey, this is my future, and we want to have more formal training around this.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So they're really squawking at the ACGME to make it part of residency training, make a core curriculum out of this, which is wonderful that they're doing that. But it is really, really important as we look at our workforce shortage here And what are we doing to ourselves, right? We're making it even shorter if we can't get out of bed in the morning because we're too sore, right?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, it's such an important thing.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So my question again for you then is that the questions were specific towards laparoscopic and robotic cases. Do you see that more with those cases? I mean, I've sat at the council too, but I also feel like standing up out over a body is just as taxing.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, I think we hit, you know, most of the main take home categories there. Is there anything else we didn't hit that you were really passionate about wanting to discuss today, either one of you?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, good. And then with that rotating schedule, what are the additional topics that we can expect?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And Dr. Nielsen, any final thoughts or words of wisdom?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Well, thank you. That was really wonderful. Most sincerely, thank you to both Dr. Amanda North and Dr. Matt Nielsen for sharing your vast expertise and experience with us about this AUA census. And we look forward to what the data tells us for next year. Maybe we'll hold another one and see what the differences were. It would be quite enlightening.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And thanks to everyone, to all our listeners, once again. Your support for these programs is really invaluable. We do hope that you find that these podcasts enhance your understanding of current issues in urology, and we strive to be your informative resource for all things urological. Until next time, I'm Dr. Suzette Sutherland, your host for Backtable Urology Podcast, signing off.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So a question I have for you then is, when you look at those who do respond, is there something about the demographics of those who respond? Is it mostly academic urologists that end up responding or more community urologists? Or what did you find out?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Great. That was a great insight into that. Thank you. So let's dive into some of the data that we see in that. It was broken up initially into primary observations up front, some highlighted summaries. So clearly, you know, the committees that went through all of the data found that these were really the highlights or the take-home points. So We don't have enough time to talk about all of them.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Hello and welcome once again to Backtable Urology Podcast, your educational resource for all things urological and then some. As a reminder, Backtable Urology offers many informative episodes that you can find on iTunes, Spotify, And of course, on backtable.com.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Of course, this isn't meant to be exhausted, but I've picked out a few that I think people are pretty passionate about. And so we want to look at some of those. We'll start off, of course, just about what's the demographics, right? What do we look like, our urological community here in the United States?
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I mean, that's really almost half, right? So a state like North Dakota has half of what New York does. That's amazing if you think about it in that term. So, yeah.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
So as more people retire, I think there was some data too about the anticipated retirement age, which was about 67. And so as we look at that age group, as they're aging and they are retiring, and most of those are men, very few are women, but yet more women are coming in down the pike. Right. On the other end, it really is going to change our urological landscape a bit. Right.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
And I would imagine also change some of the traditional priorities within urology, things like that. Maybe Dr. North, maybe you didn't notice I'm wearing my swoop in here. So maybe you can address some of those issues, too.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
I'm your host today, Dr. Suzette Sutherland, and I'm super excited to have two guests today to talk to us about the 2023 AUA census data. We have Dr. Amanda North and Dr. Matthew Nielsen.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
This is vital data about our urological community, about our urological workforce, and our practice patterns that really help us to inform our future directions for policy efforts and overall urological care as well. So again, super excited to be talking about some of the pertinent things that came out of the AUA census data with all of you here today.
BackTable Urology
Ep. 187 Urology Trends: AUA 2023 Census Report Highlights with Dr. Amanda North and Dr. Matthew Nielsen
Yeah, just to put some numbers on that, the census said that the average patient encounter per week, how many? For men was 74. The average overall was 73. But since there are more men, of course, then for men it was 74 and women was 63. So to your point, you know, some would look at that as a pretty big difference. But then when you also looked at how many minutes per encounter was 16 minutes per
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
We know that TURBT procedure is critical in the care of patients with non-muscle invasive bladder cancer. With data that shows that CIS was missed by TURBT in more than 45% of radical cystectomy cases and 86% of residual tumors have been found at the original resection site, it's clear that enhanced visualization could be a significant benefit during TURBT's.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Welcome once again to Backtable Urology Podcast, your educational source for all things urology, and then some. Backtable Urology offers many informative and entertaining episodes, which you can find on iTunes, Spotify, and of course, backtable.com.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I'm your host today, Dr. Suzette Sutherland, and I'm super excited to have Dr. Jair Santiago-Lastra with us today from the University of California, San Diego. She's here to discuss issues pertaining to the gender gap, the gender gap in medicine, and especially in surgery and urology. Why it exists, what are the common misconceptions or misconceptions
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
When you spoke about the difference in the pay structure then and how that changes, whether men or women are in the field, there's a great example that we have how certain tasks or procedures are compensated for. In urology, it's the difference between putting in a mesh synthetic sling for stress incontinence in a man and
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
versus the amount of money you make for putting in a mesh synthetic mid-urethral sling in a woman, which, by the way, was done in women way before it was done in men. And so it was a technique that was refined to fit the male anatomy, I would say, right? So it was in the women's world way before it was in the men's. But the compensation difference between those two are pretty outrageous.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Go ahead and tell us about that.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah. So the other thing that you touched on a little bit, but in the same category with respect to what women are able to get during in their working environment compared to the men. And so a big thing that also can affect compensation is number one, you mentioned that they spend more time with their patients, but oftentimes they have less resources provided to them.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I don't know if it's an assumption or thought or aggressiveness on the part of their male colleagues, but just as an example, having more rooms in clinic, right? Or having more support staff or even having administrative assistant that takes care of more of the sort of menial tasks. The assumption is that the women can take care of their own menial tasks or be the one to do
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
myths concerning why there is a gender gap and what perpetuates it and what can be done, what needs to be done in order to even the playing field in both medicine and surgery for compensation, promotion, and other aspects as well. So thanks, Dr. Santiago-Lestra for being here with us today. Happy to be back, Suzette. Thank you for having me. So a little bit about her.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Uncompensated work is their contribution to things in the department, right? Like plan the holiday party, whereas somebody else might be asked to write a paper and that helps them for their promotion. Me planning a holiday party doesn't help for my promotion. So those kinds of things really increase that gender gap as well.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah. So that's encouraging that things are changing. And I think I wanted to touch on a big piece of this, especially with respect to the compensation issue is really transparency. Right. So if we give any advice, I think, to anybody about getting out there and negotiating for yourself is just ensuring that there's transparency.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
She is Latina from Puerto Rico. She's a first-generation physician, surgeon, and urologist. She's an associate professor at the University of California, San Diego. She has been designated a rising star in our national organization, the American Urology Association, because she's very involved in a number of task force and committees. most prominently the AUA DEI Task Force.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
You're dealing with an organization or you're dealing with someone who's going to be your boss who's really honestly being transparent because being told we don't do it like that here, everyone has the same compensation model, but then you find out there are lots of little cherries placed on the top that you're not privy to or you don't have that opportunity.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And so that's how the compensation increases, right? Or someone has more resources so they can be more productive. So they are getting bonuses and they look at... the woman and say, well, you're not working hard enough. You're not getting the bonus. Why don't you work harder? Well, I don't have the same resources. I don't have the same number of staff.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I don't have all the residents working with me. I don't have two rooms going at a time. All of those kinds of things. That's the lack of transparency, I think. And so it's super, super important to find yourself whole in a place where everything's really transparent. It should just be on the table.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
So I'm going to switch gears here a little bit because we have three more myths to talk about. But this one is really, I think, the compensation one and all of the pieces that come into that are just such a big one. So one, the other myth is the competency issue, right? Right. So we call it the meritocracy myth, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
So women and their merit, their sense of competency, and are they leadership worthy, right? Go ahead. Let's talk about that.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
She's also been involved in the DEI Task Force for our Society of Urodynamics and Female Pelvic Medicine. And she is the Society of Women and Urology Representative on Public Policy. So she's very involved in advocating for women and underrepresented minorities across the board in the area of urology. She's a member of Urology Unbound as well.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I was going to just pepper something in there is a lot of times people think, well, women are taking longer to get promoted because they're having babies. But we know there's data to show that is not the case. That's not getting in the way of their promotion. taking off time to have their babies. It's not that at all.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And when you look at very well-qualified women who are going, as you just said, early promotion and going up against some of their male colleagues for early promotion, and they don't get it, but the male does. But the qualifications are there.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I forgot to mention that, which is also an organization that supports underrepresented minorities in urology. And of course, has a personal interest in health care equity for all patients. So this isn't just about the physicians and equity about the physicians and in the workforce, although that's a big issue, but also equity when it comes to patient care. So thank
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Gosh, that could be another podcast and probably should all by itself. I mean. So we see this very commonly, of course, we're in a very male-dominated field, urology, right? One of the most male-dominated still today of all of the surgical specialties, right? Has the lowest number of women. And, you know, women traditionally have tried to fit in to a man's world, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
We certainly try to gravitate away from that to some degree and allow women to feel empowered to be themselves, even if it's extremely feminine and that is who you are and it makes you a great doctor. And the culture needs to embrace that, embrace those differences, as opposed to the women just need to fit in.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
But even there are some business characteristics that are very advantageous if someone comes in and can be quite decisive about and can move the needle forward in a quick manner. That's great for business. But when men, women do that, they're oftentimes, you know, perceived as being bossy, or you're too pushy. You need to make sure that you have the consensus in the whole room and get
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Kumbaya, have everybody put their arms around each other and feel good about what you're doing. But when a man comes in and is very decisive and says, this is what we're going to do, acknowledges you can't please everybody. I'm going to try to please most, but I'm not going to kumbaya and please everyone. And that's acceptable, right? It becomes really this catch-22.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
You want to be effective in what you're doing, but you can't do it in too aggressive manner, right? or you're labeled, and then suddenly all these negative connotations are attached to you as a leader, right? And it becomes really difficult. So that's another hard one. And we just need people to wake up to that, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And to understand, and they can see that in the boardroom as an example, and recognize we have a very decisive woman here, giving great advice as opposed to being really pushy.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
It's really wonderful work that she's been able to do in our national organizations, and we sure appreciate all of your efforts. So thank you, Dr. Santiago Lastra, once again. Thank you so much. That was very generous. So let's dive in. I've had the great fortune of hearing you speak on this topic, the gender gap, before. So that's what we're going to be talking about here today.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah, that's a great point. So let's move on to the third myth, the big one. We call it the pipeline issue. You hear this term often. And what's really meant by that, the pipeline issue?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I was very impressed with all of the data. You certainly know your stuff, and you had a great presence to be able to convey the issues in a very concrete way. So that's what we want to do today. So first of all, though, when we talk about gender gap, most often people assume we're talking about issues in compensation between men and women, maybe promotion.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Right. With that example, whether it's male or female, you know, in academia, yeah, there are people that seem to stay in these positions for so long. And if you're going to change a culture and bring it up to date, you have to do it from within.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And we'll dive into that, of course, in a minute. But I'd also like to talk about some other gender gaps that exist in the medical arena. between men and women that affect not only individuals, but populations of people too.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Further, with only 23% of patients coming back for re-resection, it's all the more important to do a complete TURBT right from the start.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah, that's really a great point, right? So we know that there's the stepping stones that have to happen, but who made those rules?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
A big thing that you were talking about, you put it on the list of things, but I just want to go back and touch a little bit more about this because I think it really needs to be emphasized is the difference between changing a culture so that people feel that they are included, and they feel like they're part of that whole process, as opposed to the word we use is tokenism, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And that's things like the gender gap in funding for research in areas specifically that focus primarily on female-related issues, which leads to gaps in our knowledge about things that predominantly affect women. So can you speak to that, please?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I have a very diverse department, says the head of the department. Look at my picture. It looks like a picture out of the colors of Pendleton, right? But do all those people feel like they truly belong and their voices are all heard? That's such an important thing. What can we do to really ensure
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
that you've hired these people, all of these different types of people, and how does everybody feel engaged?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
So, and the last myth is that one we've already sort of touched on and talked about a bit, but just to say the last myth is the issue about diversity, having a diverse environment versus an excellent one. Are diverse candidates as qualified, right? Or are we just choosing diverse candidates because we need to feel we need to have a diverse environment?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And I think we've talked quite a bit about that already. I don't know if you have other things that To add, we talked about the inclusion. Workforces are much more productive, are happier workforces. So inclusion does matter. And it hits the bottom line, the bottom dollar line, too, in different businesses and organizations. And so we know that to be the case.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
We want to wrap this up here at this point, but I want to give an opportunity to just sort of look at it overall. We talked about a number of myths that contribute to what we call the gender gap, right, with this discrepancy between men and women in the workforce and certainly in medicine and urology. A couple of big ideas is that issue of transparency is really paramount. That's so important.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
The issue of having a diverse workforce, but then making sure that diverse workforce feels included in all the processes that are going on, right? That it really is almost a big family. And that's how you keep people happy. And that's how people then remain productive.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And I think one of the other things that you had talked about too was, you know, if you're the leader in that organization and you're not very diverse in your organization or you're losing people, you talked about the leaky pipeline, which is so important. You recruit people, they're not successful. You let them go. You say, well, they weren't successful because they weren't really qualified.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
We hired them because they were, you know, either a Latina or they were a woman or they were whatever it was, right? Turn the lens back on yourself and say, what's going on in my organization that's not allowing us to be having a successful, diverse workforce, right? Looking back at the biases with your own organization.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
So maybe you can speak a little bit more to that, put that in more profound terms than I did.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I wanted to add to that really quickly as I know the firsthand experiences of so many women talking about the leaky pipeline who didn't get regular check-ins and they were so miserable or whatever the situation was that by the time somebody checked in with them, they'd already found another opportunity. They had one foot out the door. They get excited about that. moving on.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And it's really hard to pull somebody back once they have a foot out the door. And so that organization lost that opportunity to retain that very highly qualified person because they didn't check in enough and stop the train before it hit the station, so to speak.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah. And what is it? Two to three years is the average ramp up period before a junior faculty, somebody new gets to their productivity level where they're sort of on automatic pilot and they can do their thing. Right. So that's a huge cost right there. And I will say I've I've navigated both arenas, the academic arena as well as a private practice arena.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
I have a lot of friends in private practice as well as I'm sure I know you do, too. But that idea of an all-male group wanting to have a woman come into their group because they know they need it to be competitive in that community and they hire a woman and then that woman's really not supported, right? And then that woman ends up leaving after a few years.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
She has her two to three year guarantee on which then she has to go on a productivity model and she's like, I'm not happy. and then she leaves and you have to start all over again. So I think you said that, and it's really important.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Those regular check-ins, I mean, it should be for any new hire, no matter what your gender is or your race or ethnicity, but that's a part of really having an inclusive environment where people feel they're part of that process and they're being checked in on, right, and considered. So it's really important.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Look, thank you. We need to wrap this up at this point. I could talk about this all day with you, but I think, you know, you brought home some great points and great advice, not only for the individual, the women, the men, underrepresented minorities, but also some really great points for those leaders out there, how they can develop a good diverse culture and foster it, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And nurture it is the word you use. That's really great. So Thank you so much, Dr. Javier. Santiago Lastra from the University of California, San Diego. You can see why we had her as a guest on here. She's an absolute expert in this area and very, very entertaining podcast here today. So thanks so much.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah, a very common thing that we think about in urology, of course, because we deal with sexual health, is how many millions of dollars have been spent and how much research has been done on male sexual function, erectile dysfunction specifically, and other issues with the penis that can go wrong.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
And yet the paucity of research that's done on female sexual health and hormones included, to your point, right? So that's sort of a glaring one that we see, you know, in our area of urology for sure. So thanks for bringing that up. So yes, this becomes, you know, of course, this affects individuals.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
It becomes then a generational issue, passing on misinformation from one generation to another concerning as your example, hormones, right? Then it becomes a population-based issue.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
We hear all the time women going into the emergency room and they're having classic chest pain like an MI, right, a heart attack, and it's not diagnosed in a timely fashion where a man would come in with those same symptoms and the first thing they do is give them aspirin and do the whole routine for an MI, whatever, right? And women don't think about it.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
So it becomes then not only a population-based thing, but we can think of it as a global issue too, right? Because this just expands the entire globe, women across the globe and how it impacts their health. So...
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Yeah, that's a great point and a great example. And I love what you said, health is wealth. And certainly, and we think about that across the globe, we know that, right? And it's so important. Yeah. And as you also said, I love the productivity issue is just being a contributor to society, right? However, whatever role that takes, right? So that's awesome.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
Let's look now at what people traditionally think when they think about gender gap. People think about compensation, but what we do is put that into a bucket called professional, right? Gender gap and the different issues that are at play there. So there are a number of assumptions that often get spewed, I would say. Misconceptions are what you like to call myths, right?
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
about the things that contribute to this gender gap. So I'd love to go over these, our four main myths, and take them one by one. So the first one is a very common one. We hear this all the time, that the reason there's a big gap is because it's a lifestyle choice. The women are choosing to not work as much because they are striving towards this perfect work-personal life balance.
BackTable Urology
Ep. 192 Closing the Gender Gap in Urology with Dr. Yahir Santiago-Lastra
But can you poke holes in that myth, please?