Female career advancement in obstetrics/gynecology, and urology: a spatio-temporal comparative study over the last 2 decades in Germany.

INTRODUCTION: Most medical graduates and specialists of obstetrics and gynecology (OB/GYN) in Germany are female, and numbers of female urology specialists are rising. However, the number of women in higher academic positions does not correlate with this increase. This study analyzes female academic career advancement on a spatial and temporal scale in Germany using the Brüggmann-Groneberg (BG) Index. The academic BG Index relates female-to-male (f:m) ratios in chair positions of state universities while representing lower career levels. It is updated in this study from 2013 (OB/GYN) and 2015 (urology) onwards, while a modified clinical BG (BGclin) Index, introduced here for the first time, assesses career progression ratios in leadership positions in clinical medicine. METHODS: The gender distribution among medical students, OB/GYN and urology specialists, clinical leaders, and academic chair holders was obtained from governmental and non-governmental sources. The f:m ratios of the populations were assessed and used in the BG indices which were calculated for five time points (2004, 2009, 2014, 2019 and 2024) and across Germany to identify spatial-temporal trends. RESULTS: F:m ratios among hospital specialists increased in OB/GYN (0.847 to 2.388) and urology (0.13 to 0.361) from 2004 to 2024. In contrast to urology, significant changes in the distribution of male and female chair holders toward gender equality could be observed in OB/GYN. Simultaneously, the academic BG Index rose from 0.045 to 0.099 in OB/GYN and from 0 to 0.084 in urology. The BGclin Index slightly decreased in OB/GYN (0.108 to 0.102) and increased in urology (0.086 to 0.114). No spatial trend could be observed. DISCUSSION: This study demonstrates persistent gender imbalance in German academic and clinical leadership positions in OB/GYN and urology. The academic and BGclin Indices indicate stagnation and/or decline in gender parity, emphasizing the need for targeted career development programs. Furthermore, a spatial analysis revealed an absence of spatial patterns in German chair holder positions. The continued use of these indices will prove a helpful tool to assess and document changes in the upcoming years.