A Call For Change: Why I can’t “Celebrate” with the AUA

I write this letter conflicted and disappointed. Before I lay out the case for my discontent, I believe it’s important to say what this letter is not. This letter is in no way intended to be an attack on the people of the AUA’s Diversity Task Force. I respect the task force’s co-chairs, Tracy Downs and Simone Thavaseelan, immensely. Their work to increase diversity and foster a system of equity and inclusion is greatly appreciated and admired.

Furthermore, I respect all the task force members, many of whom I know personally. Your hard work and dedication are not overlooked. Additionally, the work you do is COMPLETELY VOLUNTARY and speaks to your true passions. So again, thank you for all your work and commitment.

Ultimately, my opinion is that the AUA is beholden to its members, not the other way around. As such, we, the members of the AUA, should not be afraid of calling for the transformative change we desire. To make the type of change that’s needed, here are a few of my suggestions:

• A DEI chair that has voting power amongst the Board of Directors
• Defined metrics and goals to accomplish at the 5, 10, and 20-year intervals and have this data presented at the annual meeting
• A clear and defined financial investment from the AUA aimed explicitly at targeting underrepresented minorities and attracting them into the field of medicine and the specialty of urology.

Now, I would like to comment on why it is hard for me to see the recent press release by the AUA as anything more than window dressing and not the steps towards the transformative change that’s truly needed.

In September 2020, Adam Klausner, a member of the J&E committee of the AUA, invited me to write an article commissioned by the J&E committee on the importance of improving diversity in urology. In drafting this article, we provided facts on how a history of systemic racism has impacted our profession and how this emphasizes the importance of diversity. After preparing this article, legal counsel from the AUA and another AUA member asked for a meeting with the authors of this article. Rather than sending their comments via email. During this meeting, we were told our article was too opinionated and would be taking a stance that the AUA has never taken before, and as such, they would not publish our article. When pressed about what specifically was too opinionated, they provided no specific details. This same article was subsequently published in Nature Reviews Urology (https://www.nature.com/articles/s41585-020-00406-4).

As this situation was undoubtedly disappointing, even more, disappointing information came about as we neared the 2020 election. In October 2020, Dr. Greg Murphy, congressman from the 3rd district of NC, published a disparaging tweet about our current Vice President. Essentially, stating that she was only selected because she’s a Black woman. Dr. Murphy also receives money for that AUAPac. When outrage over this tweet came about, our organization said nothing, and it’s unclear if he still receives donations; the only step was for the AUA to announce its plans to create a Diversity Task Force shortly thereafter.

Now, we fast forward to this most recent announcement, and the lack of commitment seen in these two situations is again on display, and here’s why.

Of those recommendations put forth in the press release listed below, I’m hard-pressed to find anything that actually increases diversity and fosters equity and inclusion.

• Establishing a Diversity, Equity, and Inclusion (DEI) award to recognize members’ efforts and achievements in DEI.

o Most people who dedicate their nights and weekends do it because they’re passionate about making change. Giving an award does not help the next generation of learners become urologists, nor does it make our field feel more inclusive. Unless the AUA is willing to provide funding to support awardees’ initiatives, this will not move the needle.

• Enhancing AUA surveys and databases to include the collection of voluntary demographic information

o The fact that we’re in 2022 and this information is not already standard shows why we need transformative change, not small incremental steps. Other organizations such as ACS and AAFP have collected this data for years.

• Creating mentorship opportunities for underrepresented individuals in urology

o There needs to be a collective understanding of the barriers underrepresented individuals face for a longitudinal change. Without a real commitment to inclusion, sponsorship, and representation at the leadership level, this recommendation will not improve our current situation.

• Establishing a DEI abstract category for the AUA Annual Meeting

o Again, this does nothing to improve diversity, equity, or inclusion. Multiple researchers have shown that people of color aren’t the ones benefiting from publishing DEI work. Furthermore, it’s not enough to continuously talk about issues with no initiatives set forth to change the issues.

• Incorporating DEI and health disparities in AUA educational programming

o Similar to my comment on AUA surveys, none of these issues are new, and our organization should have already begun incorporating these subjects. While these subjects are important, it remains difficult to see how this will impact change in our field. This field is highly homogenous, with severe underrepresentation for racial/ethnic and gender minorities.

• Increasing diversity among researchers at every stage of the career journey

o While this is a great goal, it’s difficult to see how you can accomplish this without the change needed to bring in and move more underrepresented minorities through the pipeline of becoming a urologist.

In closing, I’m reminded of one of my favorite quotes from Gandhi, which he said, “Be the change you wish to see in the world”. Our society is full of inequities, yet our profession has the power to bring about change. But if we don’t make the changes in our professional organization, we’ll fail to be that change that we wish to see. My greatest fear is that 20 years from now, we’re in the same position, discussing the same issues. So I ask everyone apart of the AUA to help us be that change.