Income inequality for women in oncology: A long-standing issue made worse by COVID-19
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Income inequality has long been an issue for female clinicians, regardless of their level of skill or accomplishment in their fields.
According to a study of physician-researchers who were granted prestigious NIH career development awards (Jagsi et al, 2012), men received approximately $12,000 more per year than women. This difference could not be accounted for by differences in specialty, productivity or other measured characteristics.
“Even studies that have controlled for productivity and number of work relative value units generated have shown differences,” lead author Reshma Jagsi, MD, DPhil, FASCO, FASTRO, Newman family professor, deputy chair of the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at University of Michigan, told Healio. “These may relate to unconscious biases that affect nonproductivity-related base compensation – antiquated notions like the family wage, which involves paying a person what is needed to support the family, and statistical discrimination by employers.”
The situation is in danger of becoming worse due to the ongoing COVID-19 pandemic, Jagsi said. The virus has disrupted the professional pursuits of many physician-researchers. However, because the onus of balancing work and family continues to be primarily on women, the pandemic has had a more severe effect on the careers of female oncologists, she said.
“We can’t focus on fixing the women. We have to fix the system by embracing evidence-based interventions that target the root causes of inequity,” Jagsi said. “These include overt harassment and discrimination, unconscious bias and gendered expectations.”
Agentic vs. communal behaviors
According to Jagsi, reasons abound for the disparities in income between men and women. One is tied to the socialization of children to demonstrate characteristically “masculine” or “feminine” behaviors.
“Men are raised to demonstrate agentic behaviors — to intervene, as with procedures,” Jagsi said. “Women are raised to demonstrate communal behaviors — to nurture, as with counseling and evaluation and management services.”
Jagsi said even within certain specialties, women may find themselves performing more of these communal services than agentic services. Because the system of medical reimbursement values intervention, this male behavior tends to be more highly compensated.
Biases, discrimination
Jagsi said the outdated concept of the “family wage” is focused on domestic circumstances rather than workplace productivity alone. She added that negotiation behaviors also tend to be societally ingrained, with women perhaps less able to advocate for themselves. Moreover, the employer practice of granting raises only to those who make a credible threat to leave in favor of a better job may disadvantage women, Jagsi said.
“This is harder for women to do, given that women are more likely to have a full-time employed spouse due to the gender norms in our society,” she said.
COVID-19 effects
These same gender norms are likely worsening the effect of COVID-19 on women. Because the pandemic has presented major obstacles to child and elder care, the increased demands of these domestic tasks likely have fallen to women.
“Women may bear the brunt of increased demands at home and have to decrease their productivity, or employers may assume that they have done so,” Jagsi said. “The burden of transitioning to virtual care and education may also have disproportionately fallen to women within the workplace, reducing their time for scholarship.”
Another study that Jagsi co-authored (Andersen et al) showed representation of women as first authors of COVID-19 research was especially low for papers published in March and April.
Jagsi said these gender disparities need to be addressed proactively so that the pandemic does not reverse progress.
“Numerous clever interventions that ensure consistent, transparent processes for hiring, promotion and compensation; that support work-life integration; that ensure equal access to resources and opportunities; and that encourage civility and respect are essential,” she said.
References:
- Jagsi R, et al. Acad Med. 2013;doi:10.1097/ACM.0b013e3182a71519.
- Jagsi R, et al. JAMA. 2012;doi:10.1001/jama.2012.6183
- Andersen JP, et al. eLife. 2020;doi:10.7554/eLife.58807.
For more information:
Reshma Jagsi, MD, DPhil, FASCO, FASTRO, is a member of the Peer Perspective Board for Healio’s Women in Oncology. She can be reached at: rjagsi@med.umich.edu.
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