It’s been an interesting month for women in medicine. On September 15, JAMA published a large database study and a letter with a brief report, both describing disturbing gender disparities in medicine. On September 17, Medscape published results of a survey of over 3,000 women physicians, showing that over 25% of the women had no interest in pursuing leadership positions at all. Data like this would normally have depressed me. However, as I read the studies and processed their results, I actually felt hopeful.
First, let’s discuss the aforementioned studies.
The large JAMA study is an analysis of a database of over 90,000 physicians, using the outcome measure of full professor rank. Women were found to be substantially less likely to achieve the rank of full professor, even after correcting for age, time since residency completion, specialty, number of publications, NIH grants, and other measures of research productivity, challenging the enduring belief that women are not reaching rank of professor due to time spent in medicine or other personal factors. The research letter describes how median start-up packages for men engaged in basic science are a whopping 67% greater than those of women: $980,000 vs $585,000!
As a side note, ever notice how large the burden of proof for gender disparities is? If you took all the studies demonstrating gender bias in medicine and instead made them about a disease, there would be no question of the attributable risk of that disease. Instead, there are recurring arguments about the potential confounders of the association between gender and career success in medicine and the various means by which women are choosing lesser careers and slower advancement. But still, I think this issue provides a blow to the skeptics.
Then there’s the Medscape study. Medscape surveyed 3,285 women physicians to understand their attitudes towards attaining leadership/ partnership positions. A leadership position was defined as holding a partner position or academic or organizational title. Of those not in leadership positions, more than 50% expressed no interest in ever becoming leaders, despite thinking that “women leaders are important.” How could this be? Why would women who think female leadership is important in medicine, not think it was important for them to be leaders? The answer was work- life balance. Despite the fact that the leaders were found to be happier at their jobs and equally as satisfied with their personal lives, the perception is that female leaders in medicine must sacrifice some element of their personal happiness to get there.
So, why, after reading these articles, was I not depressed at the state of women in medicine today? It is because in Emergency Medicine, we are actively and systematically working to change things.
Just to take a slice of this year:
- The site you are on now, FeminEM, our open access resource for mentorship and development, is a readily accessible community of women EM physicians for networking, advocacy, and shared wisdom.
- AWAEM has planned a number of innovative and provocative didactics addressing gender disparities (including a “shark tank” that challenges chair “investors” to adopt programs supporting gender equity). These didactics are aimed not only at educating those in our field about systemic, unconscious biases, but also asking our leaders to be proactive in developing novel and assertive solutions to combat them.
- The AWAEM and AAWEP newsletters, edited by Devjani Das and Jenny Beck-Esmay, respectively, continue to put out content that month after month, discuss issues that stymie women in medicine, including negotiation, promotion, and leadership.
- Our SAEM pre-conference sessions will provide hands-on, practical career guidance and mentorship to the next generation of women physicians.
- Our AWAEM-AAWEP working group passed our “Best Practices” Recommendations for Supporting Women in Emergency Medicine Policy Statement through ACEP and SAEM this past year. This robust document — a relatively simple document that has never existed, probably because the dominant culture of medicine kept saying it wasn’t needed — will hopefully serve to support organizations across the country in addressing gender bias.
- Capitalizing on the momentum created by Boards’ approval of the Policy Statement, “Supporting Women in Emergency Medicine,” AAWEP and AWAEM partnered to present a panel discussion, “Throwing the Gauntlet,” at SAEM 2015, which opened a frank discussion of the ACEP Policy Statement, and included several prominent leaders in emergency medicine.
- AAWEP was awarded a grant to pursue important communication research: “Working in Fours—Understanding and Facilitating Intergenerational Communication for Women in Emergency Medicine.”
- The AAWEP Executive Council has committed to establishing and maintaining a leadership pipeline for women of ACEP, by developing, mentoring, and advising women who are seeking major leadership roles.
Awesome, no? And I know this list is only the tip of the iceberg. There are men and women out there who are, no doubt, working on initiatives and projects that are off my radar. While the JAMA articles are a refreshing wake-up call — and I am excited to watch the reverberations from them — as I read them, I felt super proud that none of this is news to this group. I know some of this work can be extremely time-consuming, sometimes tedious, sometimes frustrating but in aggregate, I am convinced we are changing the face of emergency medicine, and likely doing it well ahead of most other specialties.Keep up the wonderful, inspired, brilliant work. I am proud to have all of you as colleagues.
- Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA. 2015;314(11):1149.
- Sege R, Nykiel-Bub L, Selk S. Sex Differences in Institutional Support for Junior Biomedical Researchers. JAMA. 2015;314(11):1175.
- Byington CL, Lee V. Addressing Disparities in Academic Medicine. JAMA.