‘We need to fix the system’: Improving gender equity in medicine

Although gender equity improves productivity, creativity and communication in the workplace, women in medicine continue to be underrepresented in leadership positions and earn less than their male counterparts, according to Women in Medicine Summit keynote speaker Darilyn V. Moyer, MD, FACP, FRCP, FIDSA.

“We need to fix the system,” Moyer, who is an adjunct clinical professor of medicine at Lewis Katz School of Medicine at Temple University and executive vice president and chief executive officer of ACP, said during her presentation.

Gender pay gap

A paper published in Annals of Internal Medicine in November 2018 revealed significant differences in salary among male vs. female physicians in internal medicine. On average, men received $50,000 to $52,000 more than women.

Moyer noted that data published in the New England Journal of Medicine showed female primary care physicians generated 10.9% less revenue from office visits than their male counterparts in 2017. However, after adjusting for factors such as PCP, patient and visit characteristics, researchers reported that female PCPs spent 15.7% more time with a patient.

Although they earn less than men, Moyer said women in medicine are held to higher expectations. Results of a 2018 survey showed that male and female patients expected more listening time and more empathy from female vs. male physicians, which leads to a “much higher rate of burnout in women,” Moyer said.

“We’ve got to adjust for this in compensation plans,” she added. “It’s well-known that the more satisfied your practitioners are, the better your patients are. Having those more professionally satisfied practitioners impacts patient adherence, decreases medical errors, impacts physician retention and impacts patient satisfaction.”

‘Punctured pipeline’

More women in academic medicine are being promoted to leadership positions, but they continue to be underrepresented, according to data from the Association of American Medical Colleges. In 2003-04, women accounted for just 10% of deans, 10% of department chairs and 14% of full professors. In 2018-19, they accounted for 18% of deans, 18% of department chairs and 25% of full professors. Moyer said efforts are needed to fix the “punctured pipeline” among women in medicine.

“I would hypothesize that for women of color in academic medicine, they are much less likely to progress from assistant to associate to full professor to leadership than white men are,” she said

Moyer cited previous data from Julie K. Silver, MD, associate professor and associate chair in the department of physical medicine at Harvard Medical School, that revealed Hispanic, Latina and Black women represent less than 1% of full professors at academic institutions. 

Not all physicians recognize the importance of diversity, data show. In a survey of cardiology fellowship training program directors, 31% were uncertain or did not support the statement, “Diversity is the driver of excellence in the health care setting.” In addition, 63% thought their program did not need to be more diverse. Among 37% of directors who wanted to increase diversity, only 6% listed this as a top priority when creating fellowship rank lists, and less than half had a plan to increase diversity.

Addressing inequities

COVID-19 has exacerbated gender inequities in medicine, Moyer said. Women are disproportionately impacted by the pandemic, representing about 75% of cases among health care workers.

Since the pandemic, data also show that fewer grant proposals are being introduced by women, and there are 16% fewer publications where the first author is a woman.

Addressing gender inequities during the COVID-19 pandemic and beyond requires communication, coordination and collaboration, according to Moyer. She stressed the importance of identifying and investigating the cause of disparities.

“You’ve got to know where you are to know where you are going,” Moyer said. You’ve got to examine gender data and data around underrepresented medicine folks.”

ACP has been a leader in combatting gender bias, Moyer said. In May 2018, the organization published a position paper on gender equity in physician compensation and career advancement.

“But remember that policy will sit and basically draw dust on a shelf if you don’t implement,” Moyer said. “So, you have got to find a way to execute your plan.”

ACP has taken several actions. The organization implemented unconscious bias training and established a committee for Diversity, Education and Inclusion (DEI). The committee reports to the Board of Regents, which manages ACP’s business and affairs. Among its other efforts, ACP created a harassment policy and reporting process; provides support to Chapters that created DEI and Women in Medicine committees and programs; and developed a Women in Medicine initiative.

Because women are often overlooked for awards, ACP removed biased language from its descriptions for national and Mastership honors to address potential barriers for nominations. As a result, women are being recognized more often, Moyer said. In 2007-08, four out of 80 MACP nominees were women. In 2019-20, women accounted for 27 out of 87 MACP nominees. Two-thirds of the nominated women were selected vs. one-third of the nominated men, Moyer said.

“We know that [women] don’t want to go for a job until they are more than 100% qualified, whereas men go for things when they are only 50% or 60% qualified,” she said. “We need to be thinking of the women who are probably suffering from imposter syndrome and who we may not have had on our radar screen, because it is likely that they are just as — if not more than — qualified for awards and Masterships and other honors than men.”

References:

• AAMC. The State of Women in Academic Medicine. https://www.aamc.org/data-reports/data/2018-2019-state-women-academic-medicine-exploring-pathways-equity. Accessed Oct. 9, 2020.
• Crowley AL, et al. J Am Heart Assoc. 2020;doi:10.1161/JAHA.120.017196.
• Ganguli I, et al. N Engl J Med. 2020;doi:10.1056/NEJMsa2013804.
• Espinoza M, Hsiehchen D. JAMA. 2020;doi:10.1001/jama.2020.1810.
• Linzer M, Harwood E. J Gen Intern Med. 2018;doi:10.1007/s11606-018-4330-0.
• Lo Sasso AT, et al. Health Aff. 2020;doi:10.1377/hlthaff.2019.00664.
• Moyer DV. Let's Get Loud: Time to Unleash a JEDI Healthcare Workforce. Present at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual).
• Read S, et al. Ann Intern Med. 2018;doi:10.7326/M18-0693.