Robot-assisted Radical Cystectomy in Octogenarians and the Effect of an Enhanced Recovery Pathway on Peri- Operative Indices

R.S. and 84 year old Caucasian male presented with a mass in the right spermatic cord slowly increasing in size for several years. The lesion was causing some discomfort and he wanted it resected. Examination revealed a rubbery soft lesion of the cord. The patient was taken to surgery with the preoperative diagnosis pf a cord lipoma. Upon exploration of the scrotum the lesion did not have the usual appearance of a lipoma so a radical orchiectomy was performed. The pathology revealed a spindle cell tumor of the cord; the second reported case. Pathology and management are reviewed. GENDER DIFFERENCES IN COMPENSATION, JOB SATISFACTION, AND OTHER PRACTICE PATTERNS IN MILITARY UROLOGY Objective: Coinciding with the increasing number of female medical students, the number of women entering the field of urology has increased significantly. Additionally, 33% of students matching in urology are now female. Despite these increases, urology remains a predominantly male dominated field. However, interest has emerged regarding the impact of gender on job satisfaction. Contrary to the civilian workforce, the military poses equal pay between genders of similar rank, and all active duty urologists are considered full-time employees. Our objective was to characterize the female workforce in military urology with regard to income, workload, and job satisfaction and compare these factors to their male counterparts. Methods: A total of 182 military urologists (30 women and 152 men) were sent survey invitations via e-mail. The survey consisted of 27 questions (22 multiple choice and 5 open-ended) and took approximately 15 minutes to complete. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction and compensation. Results: A total of 106 responses were collected (21 female and 85 male), for a total response rate of 58%. The 21 female respondents represented 70% of the total female cohort, while the 85 male respondents represented 56% of the male cohort. Of the female respondents, 35% were residents and 65% were staff urologists, while 22% of the male respondents were residents and 78% were staff urologists. The age distribution of respondents did not differ significantly between genders. Despite an equal proportion of residents and staff in each cohort, women military urologists reported working more hours than males, with 42% vs. 19% reporting 70+hour weeks. When adjusting for the other predictors of income, women reported a lower average military income (P =0.016) and were less likely to have ancillary income (P = 0.06). When adjusted for fellowship training and resident status, the reported pattern of lower compensation for females is consistent by rank. When accounting for ancillary income and adjusting for rank, there is a larger gender difference since female urologists make $20,000 less on average than male urologists (p=0.015, 95% CI: $4,000-$36,000 less). All 21 female respondents stated that career has compromised family and personal life at least somewhat, while 26% of men stated that it compromised little to none. Moreover, if given the opportunity, 44% of women would choose a career outside of medicine vs. 19% of men (P = 0.047). Despite these findings, women and men have similar rates of job satisfaction. Overall, 67% of women and 81% of men were very or mostly satisfied with their jobs. Males and females cited similar reasons for job dissatisfaction. The top 5 reasons cited for job dissatisfaction in both genders included increased administrative burden (51%), dissatisfaction with facilities and support staff (24%), underutilization of urology training (13%), salary (18%), and limited opportunity for career development (16%). Conclusions: Income disparities between male and female physicians in the civilian workforce are well established and have been reported in urology. The military system poses equal pay between genders of similar rank and all are full time employees. Despite this, female military urologists reported a lower income compared to their male counterparts. This finding within a gender neutral equal pay system may reflect a large reporting bias, or the perception held by female urologists of a difference in compensation. If so, this would call into question the findings of numerous studies reporting an actual difference in physician compensation based on gender alone. Despite the perception of lower income compared to male urologists, job satisfaction between male and female military urologists did not differ, suggesting that although the two are thought to be positively correlated, income is not interchangeable with job satisfaction. Further studies on actual income discrepancies between genders and job satisfaction are warranted. EXPERIENCE AT THE JEEV SEEWA SAMITI HOSPITAL UROLOGY CAMP IN AJMER, INDIA