Melanie Cole, MS (Host): Today, Dr. Jennifer Miles-Thomas, a trailblazing urologist and advocate for gender diversity in the field, shares her inspiring personal journey from her specialization in female reconstructive surgery to her recent appointments as Vice Chair of Regional Integration and Innovation, as Assistant Professor of Urology at Northwestern Medicine, and as Treasurer-Elect of the American Urological Association.

As an expert in the field, Dr. Miles-Thomas shedding light on the unique considerations and approaches that she brings to her practice and the barriers and obstacles that hinder gender diversity in Urology today, offering valuable advice to urologists. And that's all happening today on Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.

Dr. Miles-Thomas, thank you so much for joining us today. Can you share your personal journey and experience that led you to specialize in Urology? What motivated you to pursue an executive and MBA at MIT? And how do you envision leveraging this accomplishment in your career moving forward?

Jennifer U. Miles-Thomas, MD: Thank you, Melanie. I would have to say that I've had a very interesting journey, not typical, not traditional. So actually, I went to Northwestern, I came here for medical school. And when I enrolled, I had in my mind that I was going to be a neurosurgeon, right? I was going to be the next Ben Carson. However, as everyone knows, through medical school, you do different rotations. There were a few of my male upperclassmen who were thinking about Urology. And I'm thinking, "Urology, it's all older men. Like, why would I want to do that?" It didn't really fit, but then I did the rotation. And I would say when I walked into the room, frequently it was a husband and wife that were there in the room as patients, but the wives would kind of pull me to the side and say, "Are you going to be a urologist?"

As a young 20 something, I had no recognition about Urology. Basically, if you don't have the issue, you're never going to know that's a field. And so once I started doing some research, I realized, yeah, 50% of the patients are female. But then, I also realized at the time, less than 5% of urologists were female. And so for me, that was, "Wait a minute. It seems like everyone should have multiple choices. It should be open to everyone." And so, I said, "Well, I think this is a diverse enough field. I can do inpatient, outpatient, peds, recon, infertility. There are a lot of different options. But we're not here. So, let me start and let me be one of the few and help change just the fact that people shouldn't pull me aside and say there's no female urologist and be very surprised that I'm there in that space."

So, I did my residency and fellowship at Hopkins and then went into employed and then private practice. While I was in private practice, it's a very different system than Academic Medicine, I would say. You really have to understand business. And one of the understandings that I did not have is medical school. You are so entrenched of learning about just physiology, biology, how to take care of the patient. But the back end of the business? No, other people are taking care of it, which puts us at a significant disadvantage.

So as I was running this private practice, I realized everything is about data. We know from Epic, we know from any EMR you've ever used, it's about the data that goes in. So I said, "How do I learn more about business and data?" I spent some time looking around and said, "Okay, if I get an MBA, it has to be one that's useful, that makes me understand the way that the world is moving, and to have the same language and conversations when I'm talking to either payers or anyone in business or administration." And so, I decided to pursue my MBA at MIT. And it was a very, very enjoyable experience. I was far enough in my career that I could actually apply what I learned versus just have book knowledge. I think it makes the world of difference to understand how to ask questions, how to consolidate data, how to analyze data, and then actually create frameworks to solve a problem.

Melanie Cole, MS: Thank you so much for sharing that. And other than the business difficulties, which we all certainly do understand, what challenges as far as gender diversity have you faced in your career and how have those helped to shape you, Dr. Miles-Thomas? Because as you said, there were so many just men in your field. So, what challenges have you seen since you did enter the field?

Jennifer U. Miles-Thomas, MD: Ooh, I would say along the whole journey, frequently, well, one, being female and a black female, the assumption is I'm not a physician. And then, assumption is I'm not the urologist. So, I would say even from early on, patients would say, "Okay, I'm done with my tray." No recognition, no white coat, be damned, like they really didn't even pay attention. So, I recognized they were looking at my gender and they were looking at my race. I would say that in residency, it was fairly equitable because I am vocal, but I would say that certain people were geared towards Oncology or other specialties. And a lot of times the female residents, "Well, do you like pediatrics? Do you like Female Urology?" And they're all very different field, but I did feel a lot of times people wanted to pigeonghole versus the entire field as open.

I would say that in private practice, I saw that the more difficult patients, i. e. the ones who required more of an emotional burden to take care of were kind of shifted to female physicians saying, "Oh, This person would be so great. You'd make the connection." Well, that's great, but we all know this is a business. And if it takes you 15 times longer to go through one patient and someone else is quickly going through others, there's going to be a disparity in pay. So, I think now that we're here, we're having these conversations, we're bringing it to light. And when we become more equitable, I think it will level out.

Melanie Cole, MS: That makes so much sense. And you make such great points. And as you were to look at this, in your opinion, what are some of the key barriers? You're speaking to potential urologists here. What are some of the obstacles that would prevent greater gender diversity within this field of Urology?

Jennifer U. Miles-Thomas, MD: Just the knowledge of Urology. I mean, we're a small field, so it's not about 10,000 urologists. So, it's not that every medical student is required to rotate on Urology. And if you don't, then you really don't see the breadth and the width of the specialty. I think also visibility for female faculty, because medical school is when people explore all of the options. They come in with one idea, but it's the time to try something, see what you like, see what you don't like, and assess lifestyles. And so, the more female faculty we have, the more kind of one on one, hey, let me see actually what this lifestyle is like. Let me see what barriers you saw. Let me see how I can communicate in different ways to make sure I'm making parity with my male residents. There's a lot of small connections that happen just by seeing people who are not exactly like you, but you do share a common bond.

Melanie Cole, MS: So then, how do you incorporate these unique considerations, both for female patients and collaborating with female colleagues? As you said, you have male residents and such. But when it's female to female, tell us what's different. What's exciting there?

Jennifer U. Miles-Thomas, MD: What's exciting is some things don't have to be said the same way. You feel a little bit more comfortable because whether it's actually true or not, you feel that some of these same experiences that you've had, they can directly relate to. You don't have to break it down into a way where it's so rigid. It's the emotional experience that people, even if it wasn't the exact same incidents, they can relate to. And I feel like there's empathy, there's understanding, and it's not as forced. It's very natural.

Melanie Cole, MS: I hear that. What about hopes and goals and dreams for gender diversity in Urology, Dr. Miles-Thomas? What are you looking for in the future?

Jennifer U. Miles-Thomas, MD: I'm looking for parity in every aspect. For Urology, I want the same number of male, female, non-binary urologists across stones, infertility, prostate cancer, female recon, pediatrics, just everyone and anyone can do anything in Urology. And that's my goal.

Melanie Cole, MS: Such a big field and really an exciting time in your field right now. As you say, it encompasses so many different populations. Is there any specific research you'd like to share with us today that's going on, initiatives?

Jennifer U. Miles-Thomas, MD: Yes, a few things. One, gender parity. The American Urological Association does an annual census. I did say when I started, it was probably about 5% female. Now, we're up to 10.7. So, I feel it coming. I feel us in residency programs across the country, some programs have entire years, just the female residents, so almost at 50%.

Here at Northwestern, we have a couple of programs. One, we have quite a few female faculty, which is great. It's not something I was used to previously in my other life, but it's great to know that there are women who are doing various different specialties in Urology. Here at Northwestern Department of Urology, we have a gay and bisexual men's health program. We also are starting an African American male prostate cancer clinic. And the department itself is very diverse. there are people from every walk of life that are faculty. And so, once you see that there's diversity, you are more likely to come and continue to thrive in a diverse environment. It's very difficult to be the only one or to be the first one. So, I think one of the special things about this department is that when you look at all of us, we are you. Like, we are the city. We are everyone.

Melanie Cole, MS: Dr. Miles-Thomas, are there any specific resources or organizations that you would like to let other urologists know about?

Jennifer U. Miles-Thomas, MD: Yes. One would be SWU, the Society of Women in Urology. It's a great group of private practice, independent practice, academic physicians from around the country. And there are regional meetings, there are national meetings, and at every level. So if you're a med student, if you're a resident, if you're faculty, this is a great support. But we also bring in a lot of the leaders from around the country who are allies to give us lectures, to do networking, helping people with their CVs, helping people with research. So, it is a great system. It is a great organization. And I'm happy that I'm a member.

Melanie Cole, MS: And as you're offering this up, what advice would you give to aspiring urologists, particularly women, who are considering a career in Urology, but may be hesitant due to a lack of gender diversity in the field?

Jennifer U. Miles-Thomas, MD: Don't let anyone stop you. I have absolutely no regrets. I have enjoyed my journey. I've enjoyed my career. I'm a planner, but I didn't plan this far out of what I would be doing and how I would be pivoting over time. This is a specialty that is needed. And there are a lot of people who don't know anything about it. This is a specialty where really you can make long-term connections with your patients. And we do really, really interesting surgeries. So, I would say keep an open mind, don't get pigeonholed. And if you love it, do it. There are people now to help you through the journey.

Melanie Cole, MS: Thank you so much, Dr. Miles-Thomas, for joining us today and sharing your inspiring journey and story and telling us why it's so important that we look at gender diversity within the filed of Urology. Thank you so much. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.