[sidebar]The ACEP19 opening session “Perspectives from Female Physicians on Leadership, the Ascent of Women in Medicine and Women at the Forefront of Change” focused on empowering the audience to become change makers in health care. It featured five women emergency physicians speakers (from left): Resa Lewiss, MD, FACEP; Joneigh Khaldun, MD, FACEP; Megan Ranney, MD, MPH, FACEP; Hiral Tipirneni, MD; and Dara Kass, MD, FACEP.[/sidebar]
For the first time in history, women accounted for the majority of medical school matriculants in 2017.¹ Gender-equity problem solved, right? Not quite.
Although this reflects progress for women in medicine, many studies have demonstrated that gender inequity becomes increasingly apparent as women progress through their careers. Increasing the number of women in medicine will not adequately address or magically fix this.
Both within the United States and beyond, women are much less likely than men to become full professors, even after taking into account age, experience, specialty, and independent measures of research and clinical productivity.²
Women of color are particularly affected, accounting for 7.5 percent of all full-time faculty in the United States and, even more alarmingly, only 0.9 percent of professors in the United Kingdom.³
In emergency medicine, a 2017 study by Madsen et al revealed a salary gap of $19,462 in academic emergency medicine, with women earning less than men regardless of rank, clinical hours, or training.4
Course correction is needed. A multipronged approach is necessary and will include some temporary stopgap solutions as well as lasting systemic reforms. In 2016, Choo et al published best-practice recommendations to support the recruitment, retention, and promotion of women within academic emergency medicine through specific and feasible recommendations.5 Mentorship and networking opportunities are the core strategies, in essence mirroring successful paths that men have used. A more organized approach can be found in gender-specific groups created specifically to propel success for women in academia. Until recently, though, there was little evidence to validate the utility of such groups in advancing the career objectives of female physicians.
A small recent qualitative study utilized semistructured interviews of female physicians at various career stages who have been a part of a national women-focused group.6 Most participants found many reasons that membership had helped further their careers. Several dominant themes, both objective and subjective, emerged.
Mentorship and Sponsorship
In a recent systematic review, mentoring was seen as a central component in almost all formal programs that were created to support the careers of women in academic medicine.³ Although no generalizable method for mentorship or formalized program was universally implemented, those undergoing such mentorship noted improvement in perceived skills and self-esteem.7 In particular, Lin et al found that junior female faculty often felt mentorship increased their sense of confidence. Sponsorship, an entity distinct from mentorship, was also highlighted as a benefit, as it led to senior members nominating junior members for leadership, awards, and research opportunities.6
Facilitating Peer Support and Collaborations
Opportunities for research collaboration were deemed a major benefit of being part of a women-focused group. Not only was participating in such a group conducive to formulating pertinent avenues of research to pursue, it was also a method by which women felt that they were able to acquire new skills and gain confidence in their writing.6
Facilitating Nonacademic Opportunities and Collaboration
Separate from purely academic pursuits, Lin et al found that participation in a women-focused group also allows for networking opportunities that eventually can lead to enhanced employment options.6 In addition, several women commented on how they were inspired to pursue careers outside of purely academic medicine, including founding organizations and businesses to promote the advancement of women.
Enhancing Negotiating Skills
Research has shown women have undue difficulty when negotiating. Even when attempting to negotiate, women are viewed more negatively by their peers and supervisors than their male counterparts.8 Members of women-focused groups are acutely aware of such issues and, whether formally through workshops or informally through mentorship networks, are able to address this important topic.
Navigating Bias and Harassment
The rates of gender-based harassment are staggering and contribute to the long list of gender-based inequities. As a National Academies of Sciences, Engineering, and Medicine report described, harassment includes a mix of verbal and nonverbal behaviors that “convey hostility, objectification, exclusion or second-class status about members of one gender.”9 Members of women-focused groups are able to band together and put forth best-practice standards that call for institutional reforms that may be key to the recruitment, retention, and advancement of female physicians.
Navigating Work-Life Demands
For many, the initial impetus for creating or joining a women-focused group was to bring attention to the precarious balance that many women face when attempting to balance professional duties with family/personal life demands. The old adage of work-life balance has been largely supplanted by the concept of work-life integration. Nevertheless, many well-known issues remain. For example, a report from the Association of American Medical Colleges found that 40 percent of women physicians scale back their medical practice, whether going part-time or leaving medicine entirely, within six years of completing residency.10 Among the reasons women leave full-time medical careers so soon after completing training are family-specific concerns.10 Women-focused groups allow female physicians to find camaraderie while working together in calling for institutional reforms to accommodate different life phases. Without the explicit and implicit support offered by such organizations, many women may feel isolated and find reasons to leave the medical field entirely.
Reduced Professional Isolation
Though largely attributed to work-life-family conflict, it is likely that women feel isolated for many reasons and suffer from a lack of support at their home institutions. Becoming part of a women-focused group is a way for women to decrease professional isolation and increase their sense of belonging within a community of individuals who have dealt and continue to deal with similar issues.
Here, the digital age offers potential avenues for improvement by making it possible for women to easily communicate on a larger scale than what was previously possible. Women from a variety of different racial and ethnic backgrounds, upbringings, experiences, and perspectives are now able to communicate instantaneously and form communities that were once inconceivable. Grassroots efforts have formed powerful networks of women, such as FemInEM, that have used their online footprint to spread important messages to a global arena. Social media campaigns, such as #TimesUpHealthcare, #WomenInMedicine, and #GirlMedTwitter, have been able to spread their messages and bring together a global community of women who face similar issues, though they may be separated by time and distance.
Women today are entering the sciences, particularly the medical field, in record numbers. However, it is clear that we are losing great numbers of these women (and women-hours of productivity) as they advance through their careers. We must find ways to curb this problem so we retain the diversity and value that female physicians provide to medicine. Research is now shedding light on the tangible benefits of joining women-focused organizations. The potential improvements span across multiple domains, including creating opportunities for mentorship, promotion, scholarly productivity, and advocacy for gender-specific issues. But this is only the beginning. With the advent of so many different avenues to create a network of women with similarly focused goals, we are just now sensing how much can be accomplished.
“The Equity Equation” is curated by Dara Kass, MD, and Uché Blackstock, MD.
Dr. Das is director of undergraduate point-of-care ultrasound medical education and assistant professor of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons in New York City.
- More women than men enrolled in US medical schools in 2017. Association of American Medical Colleges website. Accessed Nov. 18, 2019.
- Sethuraman KN, Lall MD, Watts SH, et al. A commentary on impact of women-focused professional organization and academic retention and advancement: perceptions from a qualitative study. Acad Emerg Med. 2019;26(3):354-357.
- Laver KE, Prichard IJ, Cations M, et al. A systematic review of interventions to support the careers of women in academic medicine and other disciplines. BMJ Open. 2018;8(3):e020380.
- Madsen TE, Linden JA, Rounds K, et al. Current status of gender and racial/ethnic disparities among academic emergency medicine physicians. Acad Emerg Med. 2017;24(10):1182-1192.
- Choo EK, Kass D, Westergaard M, et al. The development of best practice recommendations to support the hiring, recruitment, and advancement of women physicians in emergency medicine. Acad Emerg Med. 2016;23(11):1203-1209.
- Lin MP, Lall MD, Samuels-Kalow M, et al. Impact of women-focused professional organization and academic retention and advancement: perceptions from a qualitative study. Acad Emerg Med. 2019;26(3):303-316.
- Varkey P, Jatoi A, Williams A, et al. The positive impact of a facilitated peer mentoring program on academic skills of women faculty. BMC Med Educ. 2012;12:14.
- Holliday E, Griffith KA, De Castro R, et al. Gender differences in resources and negotiation among highly motivated physician-scientists. J Gen Intern Med. 2015;30(4):401-407.
- National Academies of Sciences, Engineering, and Medicine. Sexual harassment of women: climate, culture and consequences in academic sciences, engineering, and medicine. Washington, DC: National Academies Press; 2018.
- Paturel A. Why women leave medicine. Association of American Medical Colleges website. Accessed Nov. 18, 2019.