HealthMarch 17, 2020

Women in medicine face unique challenges

By: Shikha Jain, MD, FACP
In 2017, for the first time, women outnumbered men matriculating in medical school, and in 2019, they became the majority of U.S. medical students, as Inside Higher Ed reported.

Yet these trends haven’t translated into equal opportunities for women in medicine. The barriers female clinicians face have led not only to a significant equity gap for those women but also for the patients being treated, as the findings of one JAMA Internal Medicine study suggest.

Women in medicine face challenges

Studies on hiring demonstrate that both men and women show strong preferences for male candidates. In a paper published in the Proceedings of the National Academy of Sciences of the United States of America, Yale University researchers asked 127 scientists from six major academic institutions to review applications with identical resumes, the only difference being the candidate’s gender. Despite identical qualifications and experiences, scores for level of competence, hireability, and willingness to mentor all favored the male. He was also offered a 13% higher salary.

A significant pay gap in healthcare has been reported elsewhere. It stands somewhere between 10% and 33%, depending on the study cited and the specialties involved, as the Harvard Business Review notes.

Inequalities persist in other areas of professional development as well. A study published in Academic Medicine found that men and women may be held to different standards for National Institutes of Health (NIH) grants, while Neurology found that women physicians are underrepresented in American Academy of Neurology awards. The authors of a JAMA Network Open paper determined that female pediatricians are less likely to be first authors of perspective-style articles, meaning “they are less likely to have opportunities to express their opinions and provide insights that may influence the field.” Meanwhile, JAMA Internal Medicine found inequities in mentorship and sponsorship between male and female doctors.

When it comes to workplace culture, a paper published in the Journal of Clinical Oncology showed that female physicians are more likely to be introduced in public speaking settings by first name and not title. This unequal form of addressing men and women with equal levels of education can reinforce perceptions that women are of a lower status; it also diminishes their level of expertise.

Combatting gender bias in medicine

These documented disparities significantly hinder the careers of women and contribute to physician burnout, as the American Medical Association reports. Achieving gender parity is not just an ethical issue: Supporting the well-being of women in healthcare with equal pay, opportunities and cultural value is likely to improve job satisfaction, performance and retention.

So how do we begin to solve these problems? A report by the National Academy of Sciences, Engineering and Medicine identified the essential role that leaders must play in addressing and fixing the system that leads to these disparities. Leadership must recognize its own implicit biases that may impact decisions. Doing so will enable the community to make a concerted effort to look outside the usual circles of individuals who mirror similar backgrounds. For example, Digital Journal reports that NIH director Dr. Francis Collins has called for an end to “manels,” or all male-speaking panels, in an attempt to ensure scientists of all backgrounds are fairly considered for opportunities.

We need intentional and visionary—yet concrete—plans to address and treat the systemic issue of gender inequity in healthcare. Some of these are easy to accomplish. As more women complete medical school, simple solutions such as accounting for career advancement during childbearing years, accommodations for maternity leave, scheduling pumping breaks and other essential structural changes will be necessary to mitigating persistent disparities.

This mitigation needs to happen now. Physicians sacrifice years of their lives, delay financial gains and often go into debt to become practicing physicians; the decision to pull back from or abandon a medical career is never taken lightly. Yet these disparities result in almost 40% of female physicians going part-time or leaving medicine entirely within six years of residency, according to the American Association of Medical Colleges (AAMC). Until solutions are put into place to reform a system that was built without regard for women in the workforce, gender disparities will continue to plague our healthcare system, and disparities in retention and advancement will continue. Change requires building on the work of individuals and institutions nationwide, consolidating the numerous efforts to share resources and metrics, establishing a national baseline for parity and holding leadership accountable.

Promising developments for gender equity in healthcare

There are encouraging signs that strategies to break the glass ceiling in medicine can be effective. The Lancet recently published a special issue focused on women in medicine, and the AAMC has launched a new initiative focused on addressing and eliminating gender inequities.

A paper published in Academic Medicine showed that a 20-minute educational intervention on implicit bias and strategies to combat it significantly changed all faculty members’ perception of bias. The intervention also had a “small but significant positive effect on the implicit biases surrounding women and leadership of all participants regardless of age or gender.”

A follow-up interventional study to the Yale resume study published in CBE Life Sciences Education showed that when 126 scientists were educated on the original study and practiced strategies to limit gender bias, bias was significantly reduced. These scientists were also more assertive about increasing gender diversity.

These gender imbalances must be rectified at a systemic and global level. Not only is it crucial for fairness in the workplace, but these inequities also directly impact the healthcare workforce and the care provided to patients.

Shikha Jain, MD, FACP
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