Fixing the System: Strategies to Support Women in Academic Medicine

Institutions play a key role in recognizing, supporting, and rewarding the role women play in scholarly projects and initiatives. Institutions must ensure that resource allocation, including dedicated nonclinical time, is transparent and tracked over time. Because the COVID-19 pandemic has disproportionately impacted women as first authors,⁷  institutions should pay particular attention to supporting early career faculty, who may have missed out on foundational scholarly opportunities while simultaneously facing the highest work-life stress.⁶  Institutions can support academic productivity through programs that provide guidance from project development through publication. Additionally, institutions should offer structured mentorship programs that go beyond individualized guidance to create valuable networks as well as sponsorship opportunities. Providing the infrastructure for mentorship networks, including peer mentorship, can maximize limited resources, cultivate new collaborations, and increase the diversity of mentee–mentor relationships.⁸ 

Institutions should also pay particular attention to midcareer faculty women, who face unique challenges at their career stage.^9,10  Because of the pandemic, midcareer women may have missed a period of high academic productivity and national recognition because of a plethora of professional and personal demands. Institutions need to recognize the unique needs of women at this stage and provide support for the transition to senior authorship, recognize scholarly activities that were postponed or canceled because of the pandemic, and adjust promotion structures to account for disruptions or delays in academic productivity.

Although women in senior academic positions may be somewhat protected from the loss of productivity during the pandemic, they are often expected to do the extensive work of ushering more junior colleagues of all genders through the promotion process. With the disproportionately low number of women in senior positions compared with women entering academic medicine, the load of serving as a mentor for so many younger women falls on a small number of shoulders. Institutions must recognize and reward senior faculty of all genders and backgrounds who mentor junior faculty with diverse backgrounds, recognizing that effective mentorship does not require a demographic match.¹¹ 

Institutions must also acknowledge and adapt to the ways that the pandemic has increased demands on health care workers’ time, both at home and within the workplace. Sharp et al found that 60% of physician parents reported unreliable childcare during the pandemic.¹  Unstable childcare was a significant contributor to the gender disparity in perceived academic productivity, further supporting the need for medical institutions to provide on-site, reliable, and affordable childcare. In addition, institutions should offer reasonable leave policies and permit the use of federally permissible funds for dependent care.¹²  Innovative programs, like the Doris Duke Charitable Foundation’s Fund to Retain Clinical Scientists, provide institutions with support to retain physician researchers, especially during times of increased caregiving responsibilities.¹³  Additional support and funding during these critical years not only allows continued productivity but also validates, rather than stigmatizes, individuals as both caregivers and researchers.¹⁴ 

Finally, institutions should specifically reward service activities that are often undertaken by women, to avoid an uncompensated “citizenship tax” that takes time away from scholarly activities.¹⁵  This step is particularly important for women with multiple marginalized identities who face the challenges of intersectionality¹⁶  and an increased burden of tasks, including mentorship, due to underrepresentation of women of color in senior positions.

Grant funding agencies have particular power stemming from their control over resource allocation. Studies reveal that women receive less overall grant funding¹⁷  and bias is present during the grant peer review process.¹⁸  To combat bias, grant funding agencies can embrace practices such as increasing the representation of women on review committees and requiring recurring implicit bias training for all members on review committees.¹⁹  Grant funding agencies should provide applications and reviews with objective, nongendered language and encourage best practices to promote the diversity of applicants.²⁰  Agencies should expand the topics of research funded beyond what has conventionally been viewed as the center of biomedical research, including diversity, equity, and inclusion work both focused on the workforce and to address disparities among patients in health outcomes, work which is largely done by women and underrepresented groups without any external funding. Finally, grant awards should have increased flexibility for extended funding time periods during times of increased caregiving demands and processes for support.²¹ 

Medical societies are in a critical position to support women in academic medicine. Society-sponsored conferences offer valuable opportunities for members to present scholarly work and gain national recognition. The underrepresentation of women as invited and plenary speakers has been well described, even in fields of medicine that are now predominantly constituted by women, such as pediatrics.³  Strategies to promote the representation of women as speakers include establishing and publishing a clear commitment to speaker diversity, transparently tracking speaker demographics, and ensuring diverse members on conference program selection committees.²²  Support for lactation at conferences should become the expectation, rather than the exception. Lastly, conferences should establish codes of conduct that not only specify unacceptable overt misbehavior but also highlight more subtle ways that women are systematically devalued. For example, societies can explicitly instruct moderators to introduce all speakers by their professional titles in light of evidence that absent such instructions, women are less likely to be treated respectfully than men.²³ 

Medical journals must make a commitment to diversity throughout the publication process, from invited authorship to reviewer selection to editorial board composition. The underrepresentation of women as editors-in-chief is pervasive across medical specialties and, unfortunately, shows minimal improvement over time.²⁴  Because editors-in-chief are frequently selected from editorial boards, increasing the representation of women on editorial boards must be a priority. Journals should also track author demographics and target increasing the representation of women as solicited authors.

Commitment to change must also occur at the individual level. Although the transition to a virtual world has allowed some increased flexibility, there has also been a blurring of work–life boundaries as described by several comments in Sharp et al, Leaders have a responsibility to create and promote a work culture that is inclusive of all members and acknowledge that early morning and evening meetings are unlikely to be family-friendly. Leaders should also look for and encourage diverse perspectives and ideas, which have been shown to promote innovation.²⁵  Because men hold the vast majority of senior leadership positions in medicine and constitute the majority of senior authors,²  men need to be intentional when selecting protégés and inclusively sponsor women as well as men for project involvement and leadership.²⁶ 

The importance of allyship is not limited to leaders; all individuals, including other women, can amplify women’s ideas, sponsor women for positions, and nominate women for speaking opportunities and awards. Similar to public declarations of refusing to participate on a panel of all men, individuals need to closely consider their participation in projects with all men. The actions of individuals have the potential for positive compounded change and serve as important role modeling for others. Lastly, and perhaps most importantly, are men’s contributions at home. Prioritizing shared household responsibilities, especially tasks with significant cognitive load, is key to supporting women’s success in academic medicine.²⁷ 

The COVID-19 pandemic has exacerbated inequities for women, particularly around academic productivity. The responsibility to promote change cannot fall on the shoulders of women. Institutions, grant funding agencies, medical societies, journals, and leaders must make intentional and ongoing commitments to promote gender equity in medicine. As the evidence for worsening pandemic-related gender disparities continues to grow, the medical community must transition from awareness to action. It is time to implement strategies in all areas of medicine to achieve the retention and advancement of women.