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First Generation and Low Income Individuals in Urology: Analysis of the 2024 AUA Census Data
Brandon Ward, MD1, Sijin Zheng, MD, PhD1, William D. Meeks, MA2, Alexis Helsel, PhD, MPH2, Jaime A. Cavallo, MD, MPHS, FACS1.
1Yale School of Medicine, New Haven, CT, USA, 2American Urological Association, Linthicum, MD, USA.
BACKGROUND: First-generation and low-income (FGLI) individuals contribute unique perspectives and cultural competency to the medical field, yet remain underrepresented in surgical subspecialties such as Urology. We hypothesize that FGLI Urologists would demonstrate different demographics, practice patterns, compensation models, and research participation compared to non-FGLI Urologists.
METHODS: Data were analyzed from the 2024 AUA Annual Census. For practicing Urologists, post-stratification weighting accounted for nonresponse bias using gender, geographic location, certification status, and years since initial certification. Descriptive statistics and chi-square testing were performed (significance: p<0.05).
RESULTS: 1,729 Urologists completed the 2024 AUA Census and were weighted to represent 14,274 total practicing U.S. Urologists (12.2% response rate). Among them, 20.5% identified as FG, 11.8% as LI, and 6.9% as FGLI. The majority of FG, LI, and FGLI Urologists identify as heterosexual non-Hispanic White men. Statistically significant differences were identified in ethnic, racial, and sexual orientation distributions between FG vs non-FG, LI vs non-LI, and FGLI vs non-FGLI Urologists (all p<0.05). There were no statistically significant differences in clinical work hours/week, number of clinic visits/week, or minutes/clinic visit across groups. FG and LI Urologists were less likely to be compensated by relative value units compared to non-FG and non-LI Urologists respectively (p=0.039, p=0.008). Compared to non-FG, non-LI, and non-FGLI Urologists, significantly more FG, LI, and FGLI Urologists reported lack of research facilities or equipment (p=0.003, p=0.006, p=0.011). FGLI representation was higher among residents (21.5% FG, 20.2% LI, 12.1% FGLI), suggesting improving pipeline diversity.
CONCLUSIONS: This study is the first national analysis of FGLI representation in Urology. Despite comparable clinical productivity, FGLI providers more often report different compensation models and limited research resources. These data may be used to inform targeted initiatives including inclusive recruitment policies, mentorship, and equitable resource distribution needed to support FGLI Urologists.
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