“We’re Running Up the Wrong Side of the Escalator” | MedPage Today, Shikha Jain, MD, March 23, 2022
It is Women’s History Month in March and something I fatally did not know until this morning when I pulled this article up in my inbox. My daughter is a teaching nurse in Colorado and has run into similar issues with pay, status, etc. I am
not going to edit this column as it to reflect s issues which my daughter has faced (also) including aggression.
This Women’s History Month, as we reflect on the names of women who have made an impact in healthcare, we must also remember the countless women whose names have been erased from the history books — and how the very gender inequities that contributed to their erasure continue to plague women in medicine today.
A few facts help tell the story. We live in a society where the overwhelming majority of our healthcare workers are women (80%), yet women hold less than 20% of our industry’s leadership roles. Women physicians working equal (or more) hours with comparable workloads earn an estimated $2 million less than men over the course of their careers and are less likely to be considered for promotions or career advancement. Meanwhile, the pandemic — which has disproportionately burdened women — only lengthened the hill we need to climb. The result of these pervasive inequities is a hemorrhaging of capable, exceptional women from healthcare. What’s more, these inequities in the workforce have a direct impact on patient care.
Advocates for change have been sounding the alarm for years and the pandemic has given us an opportunity to implement real systemic change. We can emerge from this public health crisis with a better, stronger system if we are intentional and strategic. Now is the time to transform all the data, research, and words into action to fix a broken healthcare system.
It’s Not a Women’s Problem – It’s a Systemic One
For years, I wondered if the professional challenges I faced were due to my own shortcomings, and I spent a lot of time and energy working to improve myself. It wasn’t until I started talking to other women in medicine that I realized these barriers were not unique to me, and many were not obstacles I could overcome alone.
The obstacles facing women are structural and systemic in nature. They infect everything from the set up of our tenure and promotion committees, to compensation decisions and valuation of services and contributions, to the system as a whole, to the processes (or lack thereof) by which healthcare professionals are sponsored (nearly 40% of our industry’s panels are comprised entirely of men).
Because these issues are so ingrained in our system it can feel like this is just how things are supposed to be. When women work twice as hard as their male colleagues, and contribute services categorized as “citizenship” tasks — essential for the success of institutions, but not valued in compensation or promotions — we set women up for failure. The endless cycle of women completing this work for the “greater good” with no reciprocal recognition or return on investment fuels underlying feelings of inadequacy that have been embedded and cultivated due to the effects of persistent implicit biases. This contributes to a lack of advancement, thereby perpetuating the cycle.
Many of my women physician peers and I feel this regularly. A colleague recently gave a grand rounds lecture on the root causes and impact of gender inequities in the workforce, and was interrupted by a senior male leader, saying these women should just “choose different jobs” if they weren’t up to the task of medicine. Similarly, when interviewing for a job, I was told I should plan to only work part time indefinitely and not plan for any career growth, as they were sure I would “want to have another baby any time now.” After returning from maternity leave, my colleague was told she wasn’t “pulling her weight” in the department and watched her career shift into the “mommy track.” Male colleagues have informed me that advocacy and equity work, committees, and teaching would all lead nowhere on a path to leadership, and I should stop wasting my time with system improvements. The currency in medicine remains relative value units (RVUs), publications, and grants. Amy Gottlieb, MD, said it best in the latest Association of American Medical Colleges (AAMC) report:
“Our traditional way of compensating physicians and faculty inadvertently devalues women’s contributions and monetizes men’s.”
A Culture of Inequity
Real, systemic change will require cultural shifts in how we treat women in medicine. For, along with pervasive systemic inequities, there continues to be an epidemic of microaggressions and harassment that significantly impacts our careers. What might this look like? It can be as subtle as being asked during a job interview if you plan on having children, or being told to “smile more” or “be less bossy” — or it can be more overt, like sexual harassment and even physical assault.
Unfortunately, when this behavior occurs, little can be done. The victim is often in a situation where reporting might label them a “troublemaker” and could negatively impact their career. Even if reported, many aggressors are simply asked to leave quietly, only to move to a different institution where they can further advance their careers — while continuing to harass women. I have had countless women open up to me regarding overt harassment or discrimination, who were advised not to report the issue as it would “destroy their career.” The potential impact of the “whisper network” on one’s career is a powerful deterrent for reporting inappropriate behavior.
This “failing up” is pervasive in medicine — the “TikTok Doc” and Axel Grothey, MD, are just two recent examples of reported abuse that went unchecked for far too long, thus perpetuating the cycle. I recently asked others on Twitter to share a time they were harassed or treated inappropriately. Many responded, while others sent DMs explaining they could not share their stories publicly for fear of retribution. The stories ranged from sexual harassment and assault to overt discrimination. Unfortunately, these behaviors are often not only tolerated in medicine, but overlooked, and the accused are given a pass because of the funding they generate or their national reputation.
Solving the Problem
I created Women in Medicine (WIM) and the Women in Medicine Summit when I realized women needed more than drive, intelligence, and leadership skills to succeed. To ascend in healthcare, and address the omnipresent inequities, it is necessary to network, learn tools and skills for success, and use data and science to restructure the system from within.
Part of this entails making the contributions and successes of women in medicine more visible. WIM’s first-of-its-kind Speakers Bureau aims to do just that, providing a comprehensive resource for conference organizers, media, research labs, and other organizations to find women experts across healthcare — and end the “manels” so endemic in our industry.
We also need our male colleagues to help drive change. Male allyship programming to help men develop a range of ally skills — such as generous and spacious listening, building trust, disrupting bias and sexism, and mentoring with transparency and intention — aims to get more men leading the charge. Such programming is based on substantial research: for instance, when men are deliberately engaged in gender-inclusion programs, 96% of women in those organizations perceive real progress in gender equality, compared with only 30% of women in organizations without strong male engagement.
Right now, women in medicine are running up the wrong side of an escalator — the system is rigged such that the top keeps getting farther away. Yet, just because this is the way it has “always been,” this does not mean this is the way it needs to stay. We need to adapt with the times and develop more structured and strategic sponsorship opportunities that lead to promotion, job satisfaction, and success. There must be real consequences for abusers and protection for the victims.
Together, we must begin the hard work needed to heal a broken system.