By Rebecca Ganetzky, MD
Editor’s Note: While the medical community has made great strides in establishing medicine as a field that is inviting and welcoming to women, our guest blogger points out that more work is needed to improve gender equality in the medical community. Dr. Ganetsky is a postgraduate genetics research fellow at The Children’s Hospital of Philadelphia and liaison from the Organization of Resident Representatives to the Group of Women in Medicine and Science for the Association of American Medical Colleges (AAMC).
I came to medicine following an undergraduate program in computer science. After four years of often being the only female student in a class, entering a medical school felt like a gender nirvana. My medical school, like most, had equal numbers of men and women. But despite my initial impression of gender equity, I realized that there are still gender obstacles in medicine; looking above me, I noticed a difference in numbers of female and male faculty staying in academic medicine, succeeding in research, and taking on leadership roles.
As part of the steering committee for the Group of Women in Medicine and Science for the AAMC, I have worked to be an active part of the solution. This summer, a summary of our group’s call to action was published in the official peer-reviewed journal of the AAMC, Academic Medicine. In this blog post, I will share our main points, in hopes of continuing this dialogue.
We identified four areas that can and should be addressed to promote gender fairness in academic medicine: salary, mentorship, research funding, and promotion.
These areas all show persistent gender differences, not as a result of deliberate or malicious choices, but rather due to unconscious bias and gender socialization. Unconscious bias is the part of everyone’s brain that makes unnoticed decisions based on our previous experiences and beliefs about gender. Gender socialization is how men and women are raised to relate to themselves and the world in the context of gender; for instance, men are encouraged to be confident and outgoing, whereas women tend to be raised to be team players and perfectionists. Women also tend to be socialized to take on more responsibility for caretaking roles, including parenting and caring for sick relatives, which can conflict with work responsibilities.
The “wage gap,” where men are paid more than women, is a phenomenon that affects many different jobs, including academic medicine. This has been published by my own academic society, the American College of Medical Genetics, which found discrepancies in the median salary of men and women even when controlling for public vs. private sector and years of experience. For new faculty, the gender disparity for median annual salary was $40,000. A difference that starts at the first faculty position is magnified, leading to career-long earning discrepancy between male and female physicians.
One reason for the salary discrepancy is gender differences in negotiation. When you sit down with a job offer, what do you say in response? Men are likely to ask for more money and women aren’t. Why not? First of all, many women don’t even know that they are allowed to negotiate, or they don’t want to, or they don’t know how much is reasonable to ask for. If women do negotiate, they tend to pay a “social cost” — being seen as less of a team player and less “nice” compared to men who negotiate.
Luckily, all of these issues can be addressed by providing negotiation training, salary transparency, and mentorship (so that people know what to negotiate for), and implicit bias training for people involved in hiring.
The “old boys’ club” is socialized into men as a critical part of advancement. While it’s true that networking allows the right person to be in the right place for an opportunity, women are more timid about seeking out mentorship. Mentors, especially those with experience in mentoring women, can help women address their unconscious biases about self-worth, as well as navigate a system that still contains a gender bias. Since the progress that we have made so far toward gender equity is new, rising female faculty are less able to identify senior female physicians to serve as mentors to them.
Both institutions and professional societies have a role in helping junior women identify mentors. Institutions are more aware of potential internal mentors, including cross-disciplinary mentorship pairings. Professional societies can help women identify external mentors to help supplement local mentors, which is of particular value to women in male-dominated fields, who may not have other female physicians within their local group. One way that institutions and professional societies may help women identify mentors is to keep rosters of members interested in mentoring, hosting networking events, and providing recognition and support for mentors.
Men receive significantly more money for research start-up funding and receive more grant support from the National Institutes of Health. It’s likely this is related to differences in negotiation as well as women asking for less money in grants. Additionally, our culture encourages women to be perfectionists, so men may submit a larger number of less polished grants and be more willing to resubmit grants that were previously rejected, resulting in more funding.
Unconscious bias training for reviewers, or simply blinding reviewers to the name and gender of the applicant, will help mitigate the issue. But a truly key solution in this area is strong mentorship for the female grant applicant to encourage her to apply early, ask for as much funding as necessary, and reapply if needed.
The equality in numbers that I enjoyed as a medical student does not extend from medical student to full professor. Instead, women tend to leave academic medicine along the way. Many factors contribute to this situation, but one that is easy to address is that traditional “up or out” promotion clocks place intense work-related pressure on faculty at the same time that many women are facing increased family responsibilities, such as maternity leave, child rearing, and other caretaking responsibilities. Rather than losing these women from academic medicine, a flexible promotion system that allows for more time for advancement may allow these women to stay in academic medicine.
I am optimistic that with thoughtful focus on key aspects of remaining gender barriers, academic medicine can be an area where both men and women can be equally successful. Along my journey, I have met many men and women deeply invested in providing equal opportunities for medical trainees. It is my hope that by calling attention to these four factors, we can provide a framework for individuals and institutions to further gender equality in medicine at every level, all the way up to the leaders in the field.