Speaker: Recognize gender biases to improve physician wellness

LOUISVILLE, Ky. — Although gender differences exist that impact health care, there has been evidence of improvement and reason to remain optimistic about future change, according to a speaker here.

Maureen M. Petersen, MD, FACAAI, Colonel, U.S. Army and director of medical education at Walter Reed National Military Medical Center, told attendees at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting that her “why” for becoming passionate about wellness stems from having lost a colleague, an internal medicine chief resident who she described as compassionate and an incredible teacher, to suicide in August 2020.

“That shook our institution and ... was a punch in the face,” Petersen said. “I became very involved in wellness and watched our institution recover from this physician’s death.”

Burnout, gender inequalities

Gender inequalities are impacting the physician population and, in turn, impacting patients, Petersen said.

“If we don’t do our part to address our own personal wellness, and influence our organization’s wellness culture, we will continue to see an increase in the burnout rates [among physicians],” she said. “This in turn results in a cost to us as physicians, a cost to our patients and a cost to our organizations.”

Petersen added that the burnout epidemic has led to high physician suicide rates, with women physicians having 130% higher suicide rate than women in general population.

With a 43% rate of burnout among allergists/immunologists — including a 50% rate among women and 39% among men — burnout can also lead to an increase in patient safety errors, poorer patient satisfaction scores and financial implications from high turnover, Petersen said.

System processes, such as the electronic medical records and prior authorizations, contribute to burnout, along with the “increasing pressure to be perfect, with a spotlight on patient safety, so physicians feel like they can’t make a mistake,” Petersen said.

Gender discrimination also impacts wellness, Petersen said, citing data showing that 30% of women and 4% of men in academic medicine have experienced sexual harassment.

Gender differences among physicians also lead to differences in patient outcomes, she added.

“We need to have women at the seat of the research table in order to remind us of the importance of investigating gender differences, especially in areas like cardiovascular disease, where women and men have equivalent survival rates if given the same therapies upfront, but since 1984, the mortality rate of heart attacks for women is much higher,” Petersen said.

In addition to having lower starting salaries and disparities in compensation, which impact the well-being of women physicians, there are also a lack of women at the top of the medical hierarchy, Petersen said. For instance, in the U.S. women represent only 15% of medical school deans, 3% of CEOs, 6% of department chairs, 9% of division chiefs and 3% of chief medical officers.

Gender imbalances in publication, which may stem from differences in funding, also make it more challenging for women to obtain leadership positions.

“It is optimistic, though, to realize that the representation of women among our fellows in training is shifting in favor of women,” Petersen said, specifically referring to data in the field of allergy/immunology.

Moving the needle

Gender biases must be recognized in order to improve physician wellness, Petersen said.

“Improving wellness and eliminating gender bias in health care first starts with recognizing and understanding the problem,” she said. “Providing opportunities in research and education will continue to move the needle. We need to make sure we recognize gender bias, and make a conscious decision for inclusion. We need to provide opportunities for equity, not equality, and also conduct the research that involves women so we do a better job for our patients.”

Wellness — when defined as fulfillment — consists of three domains: personal resilience, culture of wellness and efficiency of practice, according to Petersen.

Personal resilience involves several components, such as emotional, environmental, financial, intellectual, occupational, physical, social and spiritual. Strategies to strengthen this component of wellness may include developing a life coaching program, giving physicians access to financial advisors, creating volunteering and mentorship programs, and providing physicians with time and resources to exercise.

To improve the culture of wellness, Petersen referred to the competency model of the National Wellness Institute, which outlines five areas of importance, including commitment, education, inclusion, communication and compliance.

Regarding Diversity, Equity, and Inclusion, or DEI, it is important to understand that equity is different from equality, Petersen said, adding that “equity is giving people what they need in order to reach a goal, and inclusion is considering somebody in what you are doing and really serving them. Inclusion is more than having them sit at the table.”

Efficiency of practice can be addressed by using tools such as Vanderbilt’s longitudinal curriculum to improve leadership and teamwork, which will then improve wellness, Petersen said.

Petersen also highlighted the Dr. Lorna Breen Health Care Provider Protection Act 2022, which was signed into law this March and requires HHS to award grants to improve mental health and resilience among health care providers, and to develop policies to change the epidemic of burnout and promote resiliency.

“I have had a career in military medicine ... for 29 years, and during that time I have witnessed and experienced gender differences impacting health care,” Petersen said. “I, though, stand up here today optimistic because I have also witnessed and experienced improvements in gender differences, and I know the opportunity to have this talk today is just one of those things that will continue to bring about change for women in medicine in the future.”