The evidence is in. We need more women emergency physicians.
There is a marked gender discrepancy in emergency medicine. Although females comprise 50 percent of medical school classes, they make up only 25 percent of EM-trained physicians (see Table 1). An even smaller percentage of women are in major leadership positions within EM (see Table 2).
While emergency medicine has made some progress in the quest to increase the number of women in the workforce, it has not succeeded at the rate the specialty needs nor has it reached anticipated outcomes based on the pipeline of women medical students.
Without the full participation of women in EM, the nation’s ability to provide emergency care will be stretched even further. EM must attract and retain women physicians while concurrently addressing their unique needs in order for professionals to provide medical care for the millions of patients who annually visit the nation’s emergency departments.
As the nation adapts to meet unprecedented challenges of health care, teams should include women physicians not only because more emergency physicians are needed within the medical community but because the ideas, skills, interests, and creativity women bring are essential to the ongoing success of the specialty.
Be cognizant of the fact that women leaders are the best tool to improve recruitment and retention of women.
Women especially appreciate the need for work-life integration and have already provided guidance for the implementation of processes that support life “balance,” and these concepts represent best practices for both men and women. In fact, millennials of both genders appreciate and agree on the need for work-life integration.
Investing in women physicians for the long term is key. Research shows that women may take off more time early in their careers but that they take off less time later in their careers as compared to men.
Improving Recruitment and Retention of Women Emergency Physicians
Fortunately, there is a lot that can be done. The list below is not exhaustive, but it provides a good starting place.
- Include positives about emergency medicine opportunities for work-life balance in recruitment.
- Ensure that maternity/paternity leave policies are in place.
- Include information regarding maternity/paternity leave, accommodations for pregnancy-associated needs, and family leave as a standard part of the recruitment package so applicants don’t have to ask.
- When an emergency physician informs her group of pregnancy, the first response should be “Congratulations!” followed by assurance that maternity/paternity policies are available and that it is expected that they will be used.
- Remove any stigma associated with taking maternity/paternity leave.
- Monitor the use and advertise the utility of family-related policies to ensure that all employees feel comfortable using them without penalty.
- Ensure female involvement in recruitment, and when possible, pair women with female mentors for at least the first year after starting a new position.
- Be cognizant of the fact that women leaders are the best tool to improve recruitment and retention of women.
- Encourage involvement in Women in Medicine groups, such as ACEP’s American Association of Women Emergency Physicians, Society of Academic Emergency Medicine’s Academy for Women in Academic Emergency Medicine, Association of American Medical Colleges’ Group on Women in Medicine and Science, and social networks like FemInEM blog and Physician Moms Group. Also encourage home institutional opportunities.
- Make it a point to highlight any recent progress made for women physicians at your place of work. Recognize and promote the added value women bring to the department.
- Work to improve work-life integration in your department/institution.
- Integrate and allow part-time positions for physicians who need this option.
- Experiment with changes in practices that are out of step with the realities of modern life and work to create environments that foster success for all the physicians in your group. (Yes, the emergency department has to be staffed for the present, but by making incremental adjustments now, you will help ensure the future staffing of the emergency departments of the future.)
- Conduct periodic audits to check for unjustified gender disparities in compensation.
- Implement family-supportive scheduling practices for all physicians. For example:
- Schedule critical departmental meetings and functions during hours typically covered by school/child care services, and allow meetings to be conducted and attended via phone or electronic media.
- Explore and consider implementing child care subsidy programs for all employees (eg, dependent care flexible spending accounts).
- Explore and advertise options for emergency/backup dependent care for employees.
- Develop a policy that supports the needs of employees experiencing a significant life event. Such a program may include offering support surrounding devastating illness or death of loved one; guaranteeing physicians paid time off for family leave around the birth/adoption of a child; treating medical and family leave similarly in terms of paid time off, backup coverage, and flexible scheduling; offering graduated return to work after a significant life event; and offering job shares or flexible scheduling for the first six months after the birth or adoption of a child.
- Modify clinical staffing patterns and personal shift requirements (eg, set schedules) to minimize physical stress on pregnant staff. Consider taking pregnant women off overnight shifts during the third trimester.
- Provide clean, private non-bathroom facilities for lactation within or immediately adjacent to the emergency department. Ensure physicians are able to leave the department during their shift for lactation needs without compromising patient care.
- Create and implement supportive work policies and a stable income when physicians experience a significant life event (ie, family crisis, an increase in work burden at home, or an event such as pregnancy, birth, or adoption).
Bottom line: More women physicians in emergency medicine are needed. The consequences of neglecting to address the unique needs of women in emergency medicine will negatively impact the ability to recruit and retain emergency physicians and will ultimately affect the ability to provide medical care for the millions of patients who need emergency care.
Dr. Clem is chair and chief of the department of emergency medicine and professor of emergency medicine and pediatrics at Loma Linda University in Loma Linda, California, and immediate past chair of the American Association of Women Emergency Physicians.
- Committee on Maximizing the Potential of Women in Academic Science and Engineering; Committee on Science, Engineering, and Public Policy; Institute of Medicine; et al. Beyond bias and barriers: fulfilling the potential of women in academic science and engineering. Washington, DC: National Academies Press; 2006.