Gender inequalities persist in ID, more awareness required

Gender disparities in compensation, promotion and career advancement continue to be an issue in the infectious diseases workforce, according to recent research.

Judith A. Aberg, MD, FIDA, FACP, director of infectious disease at Icahn School of Medicine at Mount Sinai, and past chair of the HIV Medicine Association (HIVMA), and colleagues reported that women working at private practices earn 13% to 44% less than men each year, and women 40 years of age or older working at an academic medical center earn 16% to 24% less than men.

In addition to salary gaps, HIVMA Chair Wendy Armstrong, MD, FIDSA, FACP, said other research has shown that women are more likely to perform internal services such as administrative and volunteer work and less likely to perform external services that generate publicity compared with men.

“The hours that women tend to take on for the team are hours that may subtract from academic productivity, which could lead to promotion differences,” she told Infectious Disease News.

A 2007 survey distributed to more than 3,000 life sciences faculty members at 50 universities revealed that women professors worked more hours per week and performed more administrative and professional activities than men. The results further showed that women researchers in life sciences earned $13,226 less per year than their male counterparts.

To begin to address these gender inequities, Armstrong said it is essential for division leaders, chairmen of departments and leaders in private practices to acknowledge that they exist.

“I think that most people are not consciously trying to have women earn less or be recognized less, but there are implicit biases that we all have and need to be aware of,” she said. “This needs to be a discussion among everybody.”

Last year, the IDSA established the Gender Disparity Task Force to identify factors that contribute to compensation inequities. Armstrong, who is a member of the task force, said it will be key for ID societies, academic departments and practice leaders to develop metrics and track gender differences in compensation, promotion and career advancement to reduce disparities.

“When you track those things, then you can start to address those inequities that you realize are there,” she said. “Until leaders — women and men — really talk about this and call it out, despite everyone’s best interest, progress will be slow.”

'Lead from where you stand'

During a recent AMA webinar held in honor of Women in Medicine Month, Vineet Arora, MD, MAPP, from the University of Chicago, said that women in medicine need to amplify one another, find their “posse,” request coaches and sponsors and craft their own legacy statements.

 

“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,” she said during the webinar. “Use your voice to promote medical truth. ... Celebrate the medical heroes among us.”

Arora kicked off the webinar by asking, where are the women in medicine who are leading? 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, she explained. Those who are leaders often go unrecognized in the press and are underrepresented in benchmark areas of academia such as award recipients of medical societies. For example, Arora said the American Academy of Dermatology touts nearly half of practicing physicians as being women as well as faculty, yet one of their prestigious awards has only been given to women 8.3% of the time. In addition, women are less likely to give grand rounds at other institutions and are less likely to be named visiting professors.

Coaches, sponsors

Arora attributed at least some of this to a discomfort among women — even women 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,” she 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 must also recognize the passive ways their roles can be minimized, Arora said. Specifically, she showed data in which women are introduced as “doctor” less often than their male peers. Although women who made introductions demonstrated parity between the sexes, men introducing women called them doctor only 50% of the time while they did the same for men 72% of the time.

“This could be a more subtle form of bias, and you might think it’s not much,” Arora said. But it adds to the image of a doctor as a man. “Women are not perceived of not only as doctors but as leaders. ... We will see bias and we need to stand up in defense of our colleagues.”

Maternal, internal discrimination

Arora showed that this is compounded by “maternal discrimination” in the workplace where four out 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 were all heavily impacted by maternal discrimination, she showed. Additionally, women who reported maternal discrimination had 74% higher rate of burnout.

Lastly, Arora pointed to internal threats to women’s success — stereotype threat, the likeability penalty and imposter syndrome, as well as a lack of women who support one another because of the Queen Bee syndrome — all of which can further reduce the visibility of women in leadership positions in medicine.

She cited medical school observation data showing that men scored 1.5 levels higher than women, which is equivalent to 4 months of additional training. The only correlation was the difference in sex, leading the researchers to hypothesize that this could be due to stereotype threat. Other research looking at critiques of medical residents’ performance showed mixed messages to women addressing their levels of confidence, assertiveness and aggressiveness.

Even the women quoted in her presentation, Arora said, often responded to her with statements playing down their leadership roles, yet they all very much lead from where they stand.

“The truth is that we are, and 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 to lead.”

Amplification of women voices

Arora suggested that 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 it will cut off the chance for someone else to take the credit. Instead, women are often 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.’”

And, to do so, Arora says to women in medicine: “Find your posse.”

She belongs to Physician Moms, a Facebook group for physicians who are also mothers, and she said, “Social media has made it easier to find your posse.” These women, along with those in the workplace and in societies, can act 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. In this, you should create your image as a leader and set the goals that you 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.”

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

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,” Norah Terrault, MD, MPH, said. Read More

Women face challenges, opportunities as roles change in endocrinology

“Endocrinology is definitely currently a women’s field, and it will probably stay that way for many years,” Pauline M. Camacho, MD, FACE, professor of medicine and director of the Osteoporosis and Metabolic Bone Disease Center at Loyola University Medical Center, president of the American Association of Clinical Endocrinologists and an Endocrine Today Editorial Board member, said in an interview. Read More

Women in endocrinology confront challenges, changes as influence grows

“We must engage and, I will dare to say, demand, institutional support,” Ann Danoff, MD, chief of medical service at the CPL Michael J. Crescenz VA Medical Center in Philadelphia, said. “There needs to be an openness to change, and an embracing of new viewpoints. There has to be transparency about how salaries are arrived at [and] how promotions are arrived at.” Read More

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

Barriers to Women Entering the Field of Orthopedic Surgery

In conclusion, women are more underrepresented in orthopedics than in any other specialty. ... One possible way to overcome the previously cited barriers and combat the misconceptions about orthopedic surgery is to provide medical students with opportunities to identify people in the field to whom they can better relate while simultaneously providing practitioners the opportunity to contradict misperceptions about orthopedic surgery. Read More

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

In 1971 the women psychiatrists petitioned to become an official committee of the American Psychological Association district branch. The local psychiatric newsletter reported that “a goal will be to stimulate increased interest and participation on the part of women in their profession and in the society.” ... The meetings held in members’ homes have encouraged a social informality. Furthermore, they have permitted the women to see how their colleagues live and cope with problems common to all professional medical women. In addition, annual picnics - complete with spouses, lovers, and children - furthered the important social-support aspects of the group. Read More

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

References:

Aberg JA, et al. J Infect Dis. 2017;doi:10.1093/infdis/jix332.

DesRoches CM, et al. Acad Med. 2010;doi:10.1097/ACM.0b013e3181d2b095.

Guarino CM, Borden VMH. Res High Educ. 2017;doi:10.1007/s11162-017-9454-2.

Ritter JT, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofw083.