Gender Disparities and How to Fix Them
It might not occur to most people that there is a gender disparity in medicine; especially in the field of Pediatrics. After all, the majority of pediatric physicians are now female, and women make up more than 50% of most medical school classes. So where is the disparity?
Women are not equitably represented among leaders in health care, there is still a pay gap between women and men doing equivalent jobs, women get promoted less often to the highest academic rank (Professor with tenure), women serve as invited authors for important commentaries in prestigious medical journals, and so on.
I was extremely honored to have been invited to write a commentary for Pediatrics, the official journal of the American Academy of Pediatrics, and the pre-eminent journal in our field, dealing with this topic. My paper was written to accompany another article, by Dr. Nancy Spector and her colleagues entitled: “Women in pediatrics: progress, barriers and opportunities for equity, diversity and inclusion. Both articles will be published in the November 2019 edition of Pediatrics but were released ahead of print on September 23.
I chose what may seem to be an audacious title for my commentary: “How to fix the gender disparity in pediatrics.” After all, if I actually know HOW to do it, then it should already have been accomplished. And, in fact that is the point of my article.
There are groups that have been working for years, and one for over a century (the American Association of University Women, founded in 1881 to “advance gender equity for women and girls through research, education and advocacy”) without fully achieving success. Progress is made, then lost. The pendulum swings. There are always excuses, such as “women are more interested in raising their families” “women don’t want to work as hard as men” “women don’t have the qualities needed for leadership” and so on. All of these “explanations” have been shown to be false. Unfortunately, only women can give birth to babies, and there is always going to be some time lost regarding academic advancement due to maternity leave. Women still shoulder most of the work of raising the family and maintaining the household, although this is definitely improving.
My own advancement in pediatrics (considered by many to be an expert in pediatric critical care), academics (Professor with tenure), and leadership (chair of a department and senior vice president of a healthcare organization) was partly luck, partly planning, and partly (mostly) love. But it wasn’t always easy.
I was lucky to fall in love and marry a man who was willing from day one to do what needed to be done for the children and our family. Although he was a surgeon in private practice in those days, he was able to organize his schedule to be home most evenings and cook dinner, help the kids with their homework, and so on. At that time, I was an early career faculty member (Assistant Professor, and division head), and I was trying to build my practice in pediatric critical care while building a division of pediatric critical care. I was recruiting faculty to come and work with me, I was starting a fellowship to train others in this field, I was starting my academic career by doing research and writing manuscripts, applying for grants and giving talks. I was routinely working 60 to 80 hours a week, and sometimes more. Without a husband who was a staunch supporter, most of what I ended up accomplishing would have been impossible.
However, I have plenty of stories to tell about the difficulties. Here is one.
My first job out of fellowship (a fellowship is how physicians get advanced training in a subspecialty, after completing the basic training you get in a residency which follows medical school), already a leadership position, yielded me a salary that was only half of what a man in the same position would have made. When I learned this fact as I neared the end of my first year of employment, and approached my chair about giving me a raise for the coming year he said: “But you have a husband who is a surgeon. You don’t need to make as much as someone who has to provide for their family.”
Yup. That happened.
I started to cry (this is a topic for another blog post) and went back to my office to compose a letter of resignation. That year I got a 25% increase in my salary, and then the following year another 25% to bring me on par with the median salary in the region for a leader in this field. A victory, but it was hard to achieve. We (physicians in general, and women physicians in particular) are not trained to stick up for ourselves. We don’t always know how to have the right conversation when our emotions are so close to the surface. I had no one to guide me. I just had to do what felt right at that moment in time.
It was then that I made a promise to myself that I would never let myself be taken advantage of in the future, and that I would do everything I could to support other women, as well as other minorities in the workplace or academia, to receive equitable treatment.
And so this is how to fix the gender (and other) disparities:
Each one of us has to make these commitments: to be courageous enough to speak up for ourselves and others; to be creative in finding ways to overcome our own and others’ intrinsic or explicit biases, and to have the curiosity to investigate why a person or an organization may be acting in ways that prohibit others from reaching their maximal potential.
This is just one of the reasons I have chosen to coach others at this point in my life. It is one way to “pay it forward.” If I had had a coach back then, perhaps I could have done more, not only for myself but for those who worked for me and with me. If I had had a mirror to help me recognize my strengths and improve my weaknesses, or more easily recognize my biases, well, who knows?
Maybe we would be closer to gender and minority equity in the workplace and the academic environment.
What about you? When have you experienced gender or minority inequity, bias, or discrimination? What have you done about it? Have you had a boss that was particularly helpful or hurtful in dealing with this issue? How are you working to understand your own and others’ biases? What can you do starting today to improve the situation? What help do you need to make that happen?
Please reach out if you are unable to access the linked papers and you wish to read a copy. See below for my email address.