Christina Mangurian, Eleni Linos, Urmimala Sarkar, Carolyn Rodriguez and Reshma Jagsi* say that while increasing numbers of women are studying medicine, gender parity is still not reflected in medical leadership.
Photo: Ani Kolleshi
For over 25 years, women have made up at least 40 per cent of US medical students, yet women make up only 34 per cent of physicians, and gender parity is still not reflected in medical leadership.
Reasons for gender disparities in the C-suite of medicine are manifold.
For example, women do not achieve promotions or advancement to leadership positions at the same rate as their male peers.
Highly qualified women do not attain independent grants, publications, and leadership positions at the same rate.
Evidence shows that women in academic medicine experience greater challenges finding mentors and sponsors than men, and that this gap likely contributes to career disparities.
Women are offered lower pay and less institutional research funding when they join a faculty, and they continue to earn considerably less than men — even among those at the same level and with comparable productivity.
Women physicians in community practice also tend to earn less than men, even after accounting for specialisation and billing.
Recent studies show that women physicians may provide better clinical care and healthcare system savings in comparison with their male counterparts, and women may also generally be more collaborative in both research and education pursuits.
What can be done, then, to reach gender parity in medicine?
What’s holding women back
Implicit gender and maternal bias: Implicit, or “unconscious,” bias against women in medicine is prevalent, affecting their hiring, promotions, development, and wellbeing.
Research has found that workplace discrimination against women physicians is common, as women have reported not only receiving lower pay, but being disrespected by colleagues, being held to a higher standards than male peers, being treated less formally than men (e.g. being introduced by first names rather than professional titles), and not being invited to major talks.
One study suggested some of this discrimination is specific to mothers, pointing to another big factor that seems to stop women from progressing: the “Maternal Wall” that women hit after having children.
System-wide policies that disadvantage women: A number of system-wide barriers undoubtedly contribute to women leaving medicine and therefore not attaining leadership roles.
For example, in academic medicine, many university policies inadvertently penalise women who are in their child-rearing years.
Family leave is often restricted to the “primary caregiver” (a proxy for mother), which prevents partners — who may be at the same institution — from taking leave.
This can hamper cooperative parenting and make it harder for women to stay in the field.
And since almost half of women physicians are married to another physician, this risk of both partners being at the same workplace is quite real.
Medical centeres also typically have insufficient policies and programs to support childrearing, lactation, and caretaking, making it difficult for women to juggle work, motherhood, and family.
Sexual harassment: The #MeToo movement helped make clear just how common overt discrimination and sexual harassment are in our society — including within medicine.
The literature on workplace harassment suggests that such experiences are more common in hierarchical and male-dominated fields like medicine.
Along with facing sexual harassment from colleagues, women physicians are also more likely to experience harassment from patients.
Sexual harassment may be underreported because of fear of retaliation or stigmatisation, and it has been shown to worsen burnout, retention, and productivity.
What can be done?
A look at the research reveals a number of pragmatic, evidence-based solutions that healthcare leaders — from medical school deans to hospital executives — should consider to help retain women and advance their careers in medicine.
Institute family-friendly policies: Strong family leave policies can help ensure physicians are not faced with a binary choice between career and family.
We know that paid maternity leave improves maternal and infant health outcomes, and recent evidence indicates that paid family leave policies also help retain women in medicine and academia, with more weeks of paid leave having the greatest benefit.
Career flexibility: Giving physicians greater control of schedules, flex-time, and the option to telecommute may also help retain those who have children.
Mitigate bias, discrimination, and sexual harassment: There are many solutions that have been proposed to mitigate bias and harassment, and we’re now seeing some preliminary findings that can speak to their effectiveness.
Better reporting systems for harassment: People must be able to speak up about harassment without fear of retaliation or stigmatisation.
Improve mentorship, sponsorship, and targeted funding for women: Medical schools function in an apprenticeship model where mentors — senior faculty who provide input and guidance on research, clinical, and career advancement — are critical for reaching career milestones.
A vast literature has highlighted the importance of mentorship and sponsorship for helping women to develop skills needed for leadership — yet women in academic medicine report more difficulty finding mentors than male physicians.
A recent study also documented that women are less likely to receive sponsorship experiences.
If healthcare leaders want to retain the growing contingent of women in medicine, they need to invest in understanding their challenges and in pragmatic solutions to mitigate them.
We know a more diverse workforce in medicine will help us provide better patient care and drive the most innovative research to improve human health for all.
Implementing structural policies can help women not only survive, but also thrive in the field.
* Christina Mangurian is Associate Professor and Vice Chair in the Department of Psychiatry, Weill Institute for Neurosciences at the University of California, San Francisco.
Eleni Linos is Associate Professor at the University of California, San Francisco.
Urmimala Sarkar is Associate Professor in the Department of Medicine at University of California, San Francisco.
Carolyn Rodriguez is Assistant Professor and Director of Translational Therapeutics in the Department of Psychiatry and Behavioural Sciences, Stanford University School of Medicine.
Reshma Jagsi is Professor and Deputy Chair in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.
This article first appeared at hbr.org.
