Gender Equity in Medicine - Are We There Yet?

Christina Surawicz, M.D.
Assistant Dean for Faculty Development, Professor of Medicine, University of Washington

Percentage of Women Medical School Graduates has risen from 1948: 10% in 1948 (mostly pediatrics and internal medicine) to 33% in 1990 (mostly internal medicine) to 50% in 2003

Subspecialty fellowships: 50% of the women apply in rheumatology and in endocrinology (nighttime emergencies are rare) only 15% in cardiology and 17% GI

Women have changed the practice of medicine-> parental leave, part-time work and day care centers at work

Barriers to subspecialty choice include no women role models, lifestyle concerns (e.g.: night call and emergencies) and that extensive training occurs during childbearing years

The rules of the game and the culture of institutions are hidden from women;

For example there is often a discrepancy between the job that you want to do and the job that your chairman wants you to do

Salary inequity in clinical care documented in a 10 year follow-up study of GI fellows. Several factors: women act more as internists, do fewer procedures and they make less money for the same hours worked. (Arbou et al, ACG Women's Committee, 1997) (Do women physicians attract high maintenance patients who require more support?)

Currently 31 % of male and 10% of female academics are tenured full professors in United States. If the rate of women becoming full professors continues at the current rate, in 25 years, 15% of full professors will be women.

We can improve the situation for women in academia. Currently they work similar hours as men but earn lower wages, advance more slowly with fewer academic awards, are less likely to be promoted, are less likely to have mentors or role models, are more likely to feel isolated and dissatisfied. Furthermore they have conflicts with advancement because of travel versus family responsibilities and childbearing and the fact that they juggle family and work more than their spouse.

Women who do mentor carry a greater burden of responsibility than men since there are potentially more women looking for mentors. The task can be overwhelming made worse if there is no reimbursement for mentoring.

The institution wants you to succeed — therefore it needs to improve mentoring and must put a dollar value to percentage time spent mentoring

Focus on faculty development — use outside resources (AAMC and ELAM)

Introduce leaders of school to new faculty via orientation session.

And establish local workshops in career advancement skills: to learn rules for promotion, skills for communication, presentation, leadership, and negotiation.

In addition training can help clarify personal issues including work-life balance and developing list of life priorities.

The institution must embrace diversity.

References

Relation of Family Responsibilities and Gender to the Productivity and Career Satisfaction of Medical Faculty. Carr et al. Annals of Internal Medicine, 1 October 1998. 129:532-538.

On Being Dr. Mom (Related editorial)  Annals of Internal Medicine, Christine Laine, MD, MPH 1 October 1998. 129:579-580

The Professional Lives of Women in Gastroenterology:  A Canadian Comparison Study With Men Heathcote et al Gastroenterology 1997;113: 669—674

Dr. Surawicz's Top 10 List

10. Do whatever is necessary to decrease your guilt. (Mothers feel guilty because they are working or because they are not working)

9. Lower your expectations: don't let work consume you and don't have a perfect home

8. Try to understand the other persons' point of view

7. Cherish those friends who will come by with the "second casserole"

6. Find novel ways to be with your family - bring child on a business trip

5. Do not always say no -e.g. one committee may open doors to new unexpected opportunities

4. If it is important, just do it

3. Learn culture and rules and understand why communication is not clear

2. Follow your heart-do not waste time on things that do not interest you

1. Golden Rule: People will forget what you say, may remember what you showed them and will remember how you made them feel

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