It’s time to talk about gender equity in medicine. Significant gender disparities exist in both healthcare institutions and professional societies. These disparities persist even in fields that are predominantly female, such as pediatrics. In fact, although women comprise 72.3% of active pediatricians, only 27.5% of pediatric department chairs across US medical schools are women. Why does this disparity exist? What can we do to address it? In this episode of the Little Big Med podcast, host Dr. Jason Woods discusses these questions with Dr. Nancy Spector, Professor of Pediatrics at Drexel University College of Medicine and Executive Director of the Executive Leadership in Academic Medicine (ELAM) program.
Dr. Spector outlines the scope of the issue and provides strategies for decreasing the equity gap and increasing opportunities for women at all levels of academic medicine. Below are some highlights from the conversation.
Our healthcare system across specialties has tremendous issues surrounding gender equity, especially in leadership. These issues exist at both the medical school level and the hospital level. Currently, women comprise about 20% of medical school Deans nationwide. Dr. Spector argues that we need to raise this proportion to a critical mass—which she places at around 30%—before we can begin seeing fundamental changes in infrastructure.
In November 2019, Dr. Spector and her team published a paper titled “Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion” in the journal Pediatrics . They were partly inspired by a 2018 study, which found that women are underrepresented among physician first authors in the 4 highest-impact pediatric journals . Dr. Spector’s 6-month study aims to provide a broad look at gender across the pediatric field. She states that pediatrics, as a majority-women specialty, has a unique opportunity to stand out as progressively equitable.
Although it’s true that women comprise the majority of active pediatricians, they nevertheless continue to face challenges that exist in every aspect of medicine, such as:
- Implicit bias
- Gender stereotypes
One example is the gender bias associated with leadership style. When women demonstrate agentic behavior (assertive, straightforward), they’re often perceived as unlikable. On the other hand, when they demonstrate communal behavior (collaborative, helpful), they are often perceived as poor leaders. In order to address this, we should encourage open-mindedness to different leadership styles and ensure that the selection processes for leadership positions are equitable.
The gender disparity widens as you ascend the authority ladder. According to data from the Association of American Medical Colleges, women comprise the following:
- 46% of Assistant Deans
- 39% of Associate Deans
- 33% of Senior Associate Deans
- 18-20% of interim/permanent Deans
Why does this downward trend exist? One reason might be that some women genuinely enjoy the caretaking roles that are lower on the ladder. The problem is that most of the money lies in the more powerful positions that are currently held by men. Dr. Spector advises that we should reconsider the value we assign to the work people do, while helping women advance to higher levels of leadership.
Women also suffer from a phenomenon called time poverty. Dr. Spector explains that women pediatricians do, on average, 8 more hours per week of unpaid work than men through tasks such as childcare, grocery shopping, and household chores. As a result, they don’t have as much time as men do to engage in activities that build their social capital. With this in mind, we should implement family-friendly policies that encourage flexibility in the work environment so that people can fulfill all the roles they need to.
Finally, Dr. Spector voices her concerns about the 20-25% pay gap for women in pediatrics. One possible reason for this gap is the fact that women tend to underinvest in social capital, thus missing opportunities to advance. In addition, women are often overlooked for promotions based on false assumptions about what they do or do not want. Therefore, we should encourage greater pay transparency and train individuals to advocate for themselves in the workplace.
- Seek leadership training: At the individual level, Dr. Spector recommends that everyone should pursue leadership training. Even if the infrastructure becomes more equitable, people still need to be able to advocate for themselves. As an example, Drexel’s ELAM program is a year-long, part-time fellowship program offering extensive coaching, networking, and mentoring opportunities for women in academic medicine. Fellows are trained in skills such as strategic career planning, resource allocation, financing, personal/professional development, negotiation, and conflict resolution.
- Men should support women: This can be done with such actions as practicing active listening, amplifying the voices of women, calling out sexism and discrimination, ensuring that women get appropriate credit for their ideas, and including women in networking opportunities.
- Institutional change: Institutions should standardize the search processes for leadership processes. This can include ensuring that the search committee has implicit bias training, de-identifying CVs, and including a diversity champion in the decision-making process.
Want to Learn More?
List to Part 2 of the podcast at Little Big Med on Cross-Gender Mentoring in Medicine with Dr. Spector.
Little Big Med Collaboration
We are pleased to partner with Dr. Jason Woods and his Little Big Med podcast focusing on pediatric EM.
- Spector ND, Asante PA, Marcelin JR, et al. Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion. Pediatrics. 2019;144(5):e20192149. PMID 31548337
- Silver JK, Reilly JM, Gallegos-Kearin V, Poorman JA, Bhatnagar S, Zafonte R. Women physicians are often not visible in newsletters published by the American Academy of Physical Medicine and Rehabilitation. In: Proceedings from the annual Assembly of American Academy of Physical Medicine and Rehabilitation; October 25–28, 2018; Orlando, FL