Sima Porten: Hello everyone. My name is Sima Porten. I am a urologic oncologist at UCSF. And it's my pleasure today to lead this discussion on women in urologic oncology. And I'm really excited for our three discussants today. I'm going to have each of them introduce themselves, and we will start with Dr. Schuckman.

Anne K. Schuckman: Hi, my name's Anne Schuckman. Thank you, Sima. And thank you for inviting me to participate today. I'm a urologic oncologist at USC.

Sarah Psutka: Hi everyone. I'm Sarah Psutka from the University of Washington. I'm also a urologic oncologist and really excited to be here. Thank you for having us and for also highlighting this discussion.

Kristen Scarpato: Hi, yes, Kristen Scarpato. I'm a urologic oncologist at Vanderbilt, and I'm really glad we're having this discussion. Really happy to be here.

Sima Porten: Okay, let's jump into it. So I really wanted to discuss about the women in urologic oncology, a bit about the history, the current state and future plans and directions. And, Anne, I think I'll start with you. If you could set the stage in terms of what do you feel is the need for a group like this, women in urologic oncology, both in the past and in the future? And if you can draw a bit on your experience and your thoughts over the past years. You could talk a little bit about that.

Anne K. Schuckman: Great. Well, thank you for asking that. I am, as Sima pointed out before we started, the oldest one in the group today. And so I guess I'm the historical perspective at this point. But when I started out in urologic oncology, honestly I feel like I was exceptionally lucky in that at my institution I had a female mentor, Eila Skinner. But when I would go to meetings and look around the room, there were virtually no women in the room. And we had some really early urologic oncologists. And I really honestly just want to give a shout out to Cheryl Lee, Sherri Donat, Carol Salem, people who were truly one of 10 people in the nation doing this. But for people my age, we were still one of maybe 30 people my age in the room, maybe not that many. I'm not sure.

And when you're going through something as rigorous as urologic oncology training, I think it's really important not only to have mentors academically, but mentors personally. And then not only mentors, but peers. And as the next group of women came along, I really found myself gravitating towards those women to find somebody who had a shared experience. And that has led to, I think, really the development of a group of peers and peer mentors, friends, social support, professional support that has then been formalized through the process of the WUO (Women in Urologic Oncology). So I will pass that on I think at this point.

Sima Porten: Thank you for that. And so I think this is a nice lead-in to, I'm going to go to Dr. Psutka now. Can you talk a little bit about how the WUO came about and some of the structural processes and changes in terms of what we see today?

Sarah Psutka: Absolutely. So I think Anne sets the stage well. I think when I started, and most of us are contemporaries, so Anne, I don't think you're the oldest one in the room by far, but we all started at a time when the female membership of the SUO was in the 2% to 3% range of members. And so basically back in about 2014, 2015, a number of us just started to gather informally. 2015 was the official sort of initial bagels and coffee at about 6:00 in the morning. And there were about 14 of us who got together. And basically just acknowledging the need for community and to create a space where we could support each other and also start to think about how to recruit and retain more women into our organization and really support trainees who were looking for mentors to identify people who they could look up to, but also just find people to bounce ideas off of.

We just started gathering informally, and we did that for several years where a couple of us would get together. We harnessed the power of social media and just put out a call and said, "If you're a woman coming to the meeting, come to lunch, we'll pay for it." And it ended up being this really lovely tradition that got started, but it quickly became very apparent that there was this really wonderful momentum, but it also needed to be acknowledged at the board level. So back in about 2019, we wrote an official letter applying to the executive board of the SUO, which I presented on behalf of, and I'm going to make sure I read everyone because this was a group effort. So Doctors Jen Taylor, Armine Smith, Sima Porten, Katie Murray, Cheryl Lee, Eila Skinner, Angela Smith, Anne Schuckman, and Kristen Scarpato were all members of that original first crew that put together a letter and just said, "Listen, we need to actually think about developing what's basically an affinity group but acknowledge a creative space that's analogous to what the YUO was at the time, the Young Urological Oncology Association, but just a space that would support the recruitment and retention of women into our organization."

And the initial asks were pretty simple. It was really just some funding for a gathering to allow a common space where women could find each other. And then we also, because we were really interested in trying to sponsor opportunities for women to have visibility within the organization and also to support the research endeavors of young women entering the organization, we created two research prizes; a best abstract and also a research prize that then would also have some financial opportunities. And this was at the time also when the SUO board was increasing their investments in some grant funding and also a sponsorship for trips to the AUA Summit. And there was an opportunity to create a space that was for a woman or an underrepresented individual to be funded to go to the AUA Summit. So this all happened, and the board unanimously was incredibly supportive, and we're so grateful to them for that back in 2019.

And that basically created the opportunities for these yearly gatherings to be formalized and not only acknowledged but represented as part of the program at the annual fall meeting. And then that momentum just took off from there. And so things snowballed. We in 2022 drafted a charter, which you can see on the WUO website, which codifies our bylaws and also created a democratic election structure. And I think I just want to finish up by talking about what happened in 2023, which was that we had our first elections. And so as this kind of core group that had really informally started meeting and then formally developed the structure for this organization, we had our first elections, and our first elected executive board of the WUO was represented. The chair was Dr. Amy Luckenbaugh, our chair-elect was Katie Murray. And the steering committee members at that time were Christine Ibilibor and Ruchika Talwar.

The point of the board of the WUO is that every year, two new members will roll on, and there's opportunities for increased leadership and visibility for women throughout the organization with representation as a non-voting member on the board of directors. And I think it's all about having a seat at the table. It's all about having visibility. It's all about having opportunities for growth. And then if you read our bylaws, they very much mirror those of the SUO. And we constructed them specifically with that goal because with the strategic plan that the SUO has rolled out over the past couple of years, they've really made a commitment to increasing efforts towards recruitment and retention of diverse individuals and creating a space where everyone has an opportunity to have a voice and to have opportunities for success and their support, their unequivocal support of the WUO clearly has been just the board of directors putting their money where their mouth is and really supporting the opportunity for cognitive diversity and opportunities for women entering our organization.

And I think you see the proof in the pudding now when you see our gatherings at the annual meeting. We've gone from 14 people eating bagels at 6:00 in the morning to groups of close to and over 100 people gathering. And the energy in the room is palpable. The representation at the scientific programs, the representation on the podium, you see the effect of this and the number of women who are entering the fellowship application process, progressing through fellowship, and then becoming attendings and mentoring the future generations. So it's been a pretty wild ride, but I think we're all pretty excited about where we are at this point in time.

Sima Porten: I agree. We've been lucky to have very powerful and strong allies in the development of this, but also really amazing group of women really committed to moving things forward. So to close it out, Dr. Scarpato, you have a unique perspective. You're a double program director, so you see folks starting from residency as they move through fellowship. What do you think the future holds for the WUO, and what do you see as some exciting next goals and steps?

Kristen Scarpato: Yeah, thank you Sima, and thank you Anne and Sarah. I feel inspired and motivated just by listening to all of you talk. It has been a wild ride, and I think we've seen so much progress in terms of the number of women who are applying into urology, applying into urologic oncology. And I think we're all familiar with the data about lead authors and senior authors and presentations at scientific meetings and panels with female representation. So all of this, I think an organization like the WUO is really helping to push forward and support and inspire and encourage and sponsor our young female colleagues who are interested in our great field. So I think you heard that at the scientific meetings, the WUO is offering some monetary prizes for females who are submitting great work for research and presentation. We're having meetings at the SUO, and I think the goal is to expand that to the AUA SUO meetings as well.

And I know the leadership of the WUO right now is working together with various sponsors to put together things like a coaching program. And so I think there's a lot of exciting things that are coming down the pipeline because of all of these creative motivated women who are leading the charge here. But I think the goal is just to continue to allow women to know that urologic oncology is a field for us, and women are great surgeons and great leaders and academics and also often wives and mothers, and it's a really exciting place to be.

Sima Porten: Thank you for that. So in terms of closing up, I'm going to ask each one of you one piece of advice for any woman who is considering a career in urologic oncology. Dr. Schuckman, we'll start with you.

Anne K. Schuckman: I'm never good at just one piece of advice, but I have a few thoughts for sure. First of all, I really like your mention of the allies, and I think that when I was coming up, the standard wisdom was, the best thing you can have is a strong male mentor to help promote your career. And I don't believe that anymore, and I don't think that's true anymore. But I do think that there are many, many people who are amazing allies, and really meant to shout out earlier, but I will now, Don Skinner is a prime example. He trained probably the entire first generation of female urologic oncologists, had a string of female fellows when that wasn't a thing. And so I think that you need to look for people like that who see you for who you are and promote you based on your merit and your work and your skill.

So look for the allies. If you're a young woman going through a program where there's not a female oncologist, I guarantee there's somebody there who will promote you and will see you for who you are and push your career forward. Second of all, look for a female mentor as well. I think that through the WUO, through the AUA, through the Women in Urology mentorship, through the SWIU, there are many, many women out there who are thrilled to mentor young upcoming urologists. Whether you end up going into urologic oncology or not through your residency time, your plans may change. And then I guess my final piece of advice for people who are already urologic oncologists and coming into positions that are more senior is put women on your panels. Make sure that you're conscious about the way you give women real opportunities, not token opportunities, but build people's careers when you are in a position to do that. And I think that's so important and something that the more senior you get, the more you can pay that forward.

Sima Porten: Awesome. Thank you for that. Dr. Psutka?

Sarah Psutka: I love everything Anne said. There's going to be a lot that are very similar, but I think just a couple of things. The point about allies is so clear and so important. I never actually have gotten to operate with a woman who does what I do. I think the closest was when Sima came to visit and we got to be in the same OR, and she wasn't scrubbing, just hanging out and chatting, working with me as an angel on my shoulder while I was tackling a tough case. But I think that the point is our community, I would say there's something really special about the urological oncology community, and I think it is really supportive of trainees as they grow up, regardless of what they look like or their specific identifiable characteristics. I had a lot of men who were incredibly supportive of me, and I'm very grateful to them.

And I think the WUO is really grateful because it was the leadership of Chris Evans, Mike Cookson, Jeff Holzbeierlein, Dan Lin. Those were the folks, Steve Boorjian who said, "Yeah, you guys should do this. You should actually make this a thing, and we will support you, and we will put the weight of the SUO behind that." So I mean, we are fortunate to be, I think, in a field that is incredibly, incredibly supportive. But there's also this whole thing about how you can't be what you don't see. And so I think having representation matters, having a voice at the table, having diverse perspectives, hearing those diverse perspectives and giving women the opportunity to add their perspectives to the conversation is really critical. So that's where we come in, and that's where an organization like the WUO has so much potential power to do good. And I think one of the things we've always said the whole way along is it's all about widening the path so more people can walk.

And basically, it's not that there's just one role for the one woman on the one panel, it's that we're all a part of this community, and you belong. Your contributions matter, and we want to hear all about it because otherwise we are squandering the experience and expertise and all the training that went into making all these women incredible surgeons, incredible researchers, incredible leaders, incredible folks who are working at the policy level. So I think the point is share the mic. I love Anne's perspective about just being really mindful about making sure that when you have a panel, getting diverse perspectives up there, get someone who does MIS, get someone who does open surgery, get someone who trained in the South, get someone who trained in the North, get someone who's a woman and get someone who's a man. It's all about having that opportunity to hear all of those different expertise because that's where you get a really rich discussion.

And I think we all learn a lot more. And there's a pretty clear business case for why diversity is a really important and positive force for productivity, innovation and I think forward progress. And I think the last bit is just we got to support each other. We got to support each other no matter who you are. We always said we wanted to create the WUO so that the WUO didn't need to exist anymore. It just became apparent that everyone belonged within the SUO. And I think that's already happened.

But there is also something really powerful about just having a place where we can build community and continue to support each other and focus on the balance of life outside of the hospital and the balance of life in the hospital. And I think it's also just become a really great place where collaborators find each other, surgeon scientists find each other. It's all about the momentum. So advice, get after it, keep having fun, keep supporting each other, keep going after your goals. And if you think that if there's an opportunity or something that you're excited about, go for it. You deserve it. And we will support you as you get there. And we continue to support each other as we all go after all of our dreams. So I don't know, that's where I come down. That's a lot more than one, Sima, I'm sorry.

Sima Porten: That's okay. Thank you for that. And so we'll close with Dr. Scarpato.

Kristen Scarpato: All right, we're all breaking the rules here. I think what I'm going to take away is get after it. But in the spirit of saying more than one thing, I have two pieces of parting advice. One is based on something that someone told me in training once. A male mentor said, "Scarpato, you can't have it all. You got to pick and choose." And I understand I think where that was coming from. But I want to say to everyone out there, you can, and it depends on what your all is, but if you want to be a urologic oncologist and you want to be a researcher, and you want to be an educator, and you want to be a mom and all the things, it's not easy, but it is possible. And so we need to continue to lift each other up and say that things are possible and look to others who have done it before you and talk to them and find out what has been helpful in their success, but more of yes, and how can we do it? And less of, no, that's not possible. You need to pick and choose.

And then my second piece of advice is when I think about career satisfaction, I love a lot, almost all of what I do. But I think one of the things that brings me the most joy and I find the most grounding is the community and the friends that I've made. And when I have the opportunity to get together with the likes of this group, Anne and Sima and Sarah, my cup feels full. And so I would encourage you to participate not just for the mentorship and advice, but for the friendship and the collegiality. It really is wonderful. And we talk about work, and we talk about life, and we talk about travel and food and all the things that bring joy. So being a part of this group is more than just finding sponsors and getting advice. It's really making lifelong friends, and I think that is priceless. So get after it y'all.

Sima Porten: That's an amazing way to end. So with those parting words, I would like to thank the three of you for joining me today as well as to UroToday for hosting this and supporting this important discussion. Thank you.