Women leaders in hematology, oncology must ‘want to make things better’

Women in medicine must promote and amplify each other, seek coaches and sponsors, and strive to craft their own legacy statements, according to leaders in the field.

“Lead from where you stand, whether it be pediatricians addressing vaccination or emergency medicine physicians talking about disaster preparedness in a hurricane. Speak about the health impact of an issue,” Vineet Arora, MD, MAPP, an academic hospitalist at University of Chicago, said during an AMA webinar in honor of Women in Medicine Month, observed in September. “Use your voice to promote medical truth. ... Celebrate the medical heroes among us.”

Arora kicked off the webinar by asking a crucial question: Where are the women in medicine who are leading?

Approximately 32% of the 14,457 active physicians in hematology/oncology in 2015 were women, according to AMA data.

Though roughly half of applicants to medical school are women, only one in five women make full professor and just 16% rise to the level of dean of a medical school, Arora said.

The key to effecting change in this area goes beyond self-promotion and instead relies more on women in the field promoting other women, Margaret V. Ragni, MD, MPH, professor of medicine and clinical translational science in the division of hematology/oncology at University of Pittsburgh Medical Center, told HemOnc Today.

“In doing that, you’re promoting the group of women who are becoming involved,” Ragni said. “You try to set examples in doing so and engaging other women in work.”

Women also are underrepresented in benchmark areas of academia, such as award recipients of medical societies.

The American Academy of Dermatology touts nearly half of practicing physicians as being women, Arora said. Yet one of its prestigious awards has only been given to women 8.3% of the time. In invitations to grand rounds, women are less likely to give those at other institutions and are less likely to be named visiting professors, Arora said.

ASH works with women to address equality among women and racial or ethnic minorities, Ragni said.

“[ASH tries] to make the proportion of women and minorities comparable to that of society to the best that we can,” Ragni said. “You will see almost a 1:1 male-female ratio among those who are leading speakers at the annual meeting, and that is very important.”

Volunteering may increase female hematologists’ and oncologists’ presence and leadership in the medical field, particularly within academia and medical societies, Ragni added.

“Women talk about issues that are critical to their success and forward movement in the field,” she said. “To get involved, you have to volunteer and really want to make things better. In doing so, you probably improve a lot of young hematologists.”

Coaches, sponsors

Arora attributed at least some of the circumstances in modern medicine to a discomfort among women — even female physicians — with self-promotion. In many cases, a physician must be sponsored for recognition like grand rounds and association awards and, in many cases, the best way to get that sponsorship is to ask for it.

“Many of us can find mentors in our workspace. It’s harder to find coaches and sponsors,” Arora said. “A coach is short-term interaction to help with targeted feedback and problem-solving. ... You need a sponsor to ... use their influence in their field to support their mentee to gain visibility.”

Coaches can help women work through job negotiations and sponsors can put names forward for Grand Rounds or society awards.

Women also must recognize the passive ways in which their roles can be minimized, Arora said.

She showed data that illustrated how women are introduced as “doctor” less often than men.

“This could be a more subtle form of bias, and you might think it’s not much,” Arora said. “We need to stand up in defense of our colleagues.”

Maternal, internal discrimination

The situation is compounded by “maternal discrimination” in the workplace, where four of five physician women reported discrimination and one-third reported discrimination based on being a mother.

Pay discordance, consideration for promotion, disrespect by support staff and exclusion from administrative decisions all were heavily impacted by maternal discrimination, Arora showed.

Additionally, women who reported maternal discrimination had 74% higher rate of burnout.

Lastly, Arora pointed to internal threats to women’s success — threat of stereotype, the likeability penalty and imposter syndrome as well as women not supporting one another through Queen Bee syndrome — can further reinforce the lack of visible women leadership in medicine.

Even the women quoted in Arora’s presentation made statements that played down their leadership roles, she said, even though they all very much lead from where they stand.

“We have to accept that and fight the internal voice in our head and go out and lead,” Arora said. “We all have to overcome this.”

Ragni recommended women physicians fight back in a “pleasantly aggressive” manner.

“You need to try to establish what you think is important, even if it is not there,” Ragni said. “It is all about how you talk about these things, and that you work with groups to help promote equality and make that known.”

Amplification of women voices

Arora suggested women take on a role of amplification for one another. If each woman consistently gives credit to other women for the strides they have made, the research they have done or the stance they have taken, that amplification will be heard and cuts off the chance for someone else to take the credit.

Instead, women often are seen to be each other’s worst enemies, with women bullies directing much of their antagonism toward other women.

“We have enough battles to fight that we have to work together, and here’s this genius strategy we can operate on,” Arora said. “It’s important we step out from hiding and say, ‘I’m here and I’m ready to lead.’”

To do so, Arora offered simple advice to women in medicine: “Find your posse.”

For example, she belongs to Physician Moms, a Facebook group for physicians who also are mothers. Contacts made through social media — as well as women in the workplace or professional societies — can serve as a sounding board for physicians, allowing for confirmation and amplification of women in medicine.

Each woman in medicine should craft her own legacy statement, stand by it and find her support system to make it happen, Arora concluded. This entails creating their image as a leader and setting the goals they want to achieve.

“This legacy statement centers you to think about what’s your compelling future and inspires you to change your present,” she said. “Think about your legacy because you are writing it every day.”

Ragni suggested women in medicine involve their male colleagues in these discussions.

“We have to work together, we have to promote, and gently but aggressively let our male colleagues know that we are going to promote equality in those ways,” Ragni said. “There is no reason why half of our medical school classes are women but half of our hematologists are not women. It is growing but, as a group, we need to represent them and promote them.”

Healio.com has covered women in medicine for decades in various forms, and these themes recur time and again. See the articles below for more information about how things have changed and how women in medicine continue to fight similar battles to their predecessors. – by Katrina Altersitz and Kristie L. Kahl

2017

VIDEO: Expert reviews steps for women physicians to advance careers

“The focus of our discussion ... was really about encouraging [women and underrepresented individuals] that are earlier in their careers to really utilize those tools in order to gain the advantages of being able to become leaders in their field and to have greater satisfaction with their career and career development,” said Norah Terrault, MD, MPH. Watch here.

Women face challenges, opportunities as roles change in endocrinology

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Women in endocrinology confront challenges, changes as influence grows

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Leadership begins locally for women in ophthalmology

“It’s wonderful to see so many women in leadership and on the podium more and more. It’s very encouraging, but it’s not the only agenda. It’s about serving the profession and serving our patients. I think those of us in leadership try not to lose sight of that. It’s our main goal, serving the profession and our patients,” Cynthia G. Mattox, MD, FACS, said. Read More

2016

Flexible work hours, clear boundaries key to work-life balance for rural women physicians

“A lack of women rural physicians especially limits access to care for women patients, who often prefer women clinicians and appear to complete more screening tests when seen by women,” Julie Phillips, MD, MPH, of the Michigan State College of Human Medicine, in Grand Rapids, and colleagues wrote. Read More

One-third of female physician–scientists report sexual harassment

“Even in a modern academic cohort of medical faculty, experiences with sexual harassment and discrimination are not uncommon, and they are more frequent among women,” Reshma Jagsi, MD, DPhil, associate professor and deputy chair of radiation oncology at University of Michigan Medical School, told HemOnc Today. “I do not think this is a castigation of academic medicine specifically. It is a sobering reminder of how far we have to go as a society. This is a broader issue.” Read More

Female physicians make 'substantially' less than male counterparts

“Fixing the pay gap between male and female physicians in academic medicine requires more than just studies showing that it exists; concerted efforts are needed to understand and eliminate the gap,” Vineet M. Arora, MD, MAPP, wrote in an accompanying commentary. “Fixing the gap will also require the courage and leadership of women academic physicians — the ‘Dr Lilly Ledbetters’ out there — to advocate to eliminate it. It is time that the ‘woman card’ be worth the same amount as the ‘man card.’” Read More

2015

Representation of women, minorities in physician workforce improving, still a long way to go

“Continued efforts are needed to increase the diversity of the physician workforce in the United States, particularly the specialties with the lowest representations of women, blacks, or Hispanics,” the researchers concluded. Read More

Study finds only modest improvements for women in academic medicine

“From our findings, we are concerned that there is complacency around the issues of women in academic medicine and a perception that gender issues have been addressed and are no longer a focus of attention,” the researchers wrote. Read More

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2012

Female doctors’ pay lags behind men’s

“Maybe there are lessons to be learned from some other health care professions ... where gender differences are closer to zero,” John Appleby, PhD, chief economist at the King’s Fund, said. Read More

2010

National symposium focuses on increasing the number of women in surgical careers

“Lack of exposure means there are not role models for medical students interested in a career in orthopedics,” Lisa K. Cannada, MD, said. “Certainly, one cannot look for a female department chairperson of orthopedics and, if there are not women faculty in orthopedics who truly are role models and mentors, we cannot make an impact. For those female residents and orthopedic surgeons, the time is now to realize that any positive exposure and communication to women in medicine can make an impact. I encourage all women in orthopedics to take the time to make a difference.” Read More

2007

Women making gains in ophthalmology, medicine

“Women are still underrepresented” in executive academic leadership, Ann M. Renucci, MD, FACS, said. Just 10% of department chairs are women, and 16% of full professors and 11% of medical school deans are women. Read More

Women in orthopedics: Facing the challenges, reaping the rewards

“The women of the Ruth Jackson Society are living testament that women could be orthopedic surgeons, professors, wives, mothers, athletes and achieve all the accomplishments and activities that life and our specialty had to offer,” Peggy L. Naas, RN, MD, MBA, said in this roundtable. Read More

1999

Women in Pediatric Practice: Trends and Implications

The data from this American Academy of Pediatrics Periodic Survey demonstrate that women are less likely than their male counterparts to practice a pediatric subspecialty. This is a probable result of the ongoing pressure for professional women to balance career and family, as demonstrated by our finding that subspecialty pediatricians work more hours than do general pediatricians. ... The tendency for women in pediatrics not to subspecialize may become a factor in future subspecialty workforce considerations. Read More

1977

The Evolution of a Professional Support System for Women Physicians

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1976

Sexism in Medicine and Psychiatry

Medical school deans and members of admission committees, most of them men, insist that there is no sex discrimination in their admission policies. Yet in far too many instances, women applicants continue to be asked questions related to marriage and pregnancy. A woman colleague, while a member of the faculty of a well-known East Coast medical school, made a number of observations that depict institutionalized sexism. A major administrative change consisted of the development of a system of deans. The positions of three deans and several associate deans were filled by white men. The school was said to be implementing an affirmative action program, but no positions higher than the rank of assistant professor were filled by women (or by minorities). An additional slight: there were no women members of the “powerful” committees, such as curriculum and faculty promotions. The colleague observed academia to be divided into two parts, the served and those serving; the latter, composed mostly of women, were the auxiliary personnel and often included the women faculty. It was her impression that women are diagnosed rather than dealt with by male psychiatrists. In other situations, women professionals are ignored by male colleagues. A frequent observation: a male colleague addresses a professional group (of men and women) as “gentlemen” - perhaps adding “ladies” as an afterthought, perhaps not. Read More