Mind the Gap: Women in Pediatric Hospital Medicine Free

The term “equal opportunity” has been used loosely for decades. Disparities in pay, promotion, leadership, funding, and career advancement have existed for women in medicine.^1–7  In the United States, 35% to 36% of all physicians are women and women also compose 45% of the US workforce.²  Since Dr Elizabeth Blackwell graduated from medical school in 1849, progression in gender equity and parity has been very slow and disproportionate to the number of women in medicine.¹  Today, >50% of women enter medical school and, even though the proportion of women in all academic ranks has increased since 2009, women only represent a majority of faculty (58%) at the instructor level.^4,5  From 2003 to 2018, the proportion of women serving as division and section chiefs has increased from 16% to 29%. This rate of increase has only been at ∼1% per year.⁵  Women as department chairs have grown from 13% to 18% and as deans from 12% to 18%, yet these changes have been slow.⁵  With >50% women entering medical schools and only 13% to 18% reaching to senior executive leadership positions, there is a clear gap in the proportion of women progressing in academic leadership positions. Similar gaps exist in compensation, promotion, grant funding, authorship, leadership in major national societies, endowed chair positions, and other areas of career advancement for women.^3–9  Additionally, women in medicine face challenges of conscious and unconscious gender bias, professional isolation, bullying, intimidation, sexual harassment, and lack of recognition.¹⁰  Such biases and discrimination can have a profound effect on physical, mental, and professional well-being and career advancement, and may negatively impact women in the workforce.^1,10 

Women physicians are more likely to adhere to clinical practice guidelines, provide preventive care support and psychologic counseling, and spend more time with their patients.¹¹  Data suggest better outcomes when women physicians are caring for patients.¹²  Therefore, leaders in academic medicine responsible for maintaining a workforce of talented and competent physicians must prioritize equal opportunities in career development and career advancement for women in medicine that are proportional to and representative of the number of women in medicine. In this month’s Hospital Pediatrics, Kim and colleagues report on the gender distribution in scholarship and measures of national recognition in pediatric hospital medicine. Because the original science paper focused on gender distribution, racial and other disparities are not discussed in this commentary, though critical and important gaps remain in these areas, as well.

Gender distribution in pediatrics is different because relatively more women join pediatrics as a specialty. With such a high proportion of women in pediatrics, one would assume that gender disparities would not exist or would be lower in pediatrics. Women comprised 55.4% (29 919) of pediatricians in practice,^8,9  48% of full-time faculty in academic medicine, and 28% of full-time professors,^8,9  yet very few women in pediatrics are represented in senior leadership roles such as deans, department chairs, and division chiefs.¹  Despite high numbers of qualified women in pediatrics, gender disparities in pediatrics are similar to those of women in medicine overall.^1,2,5,10  Disparities for women in medicine exist across specialties and are not related to proportion of women in the field,^1,5–10  Spector et al demystified myths related to advancement of women in pediatrics to top-level leadership positions and found that data did not support misconceptions such as lack of pipeline of women, family and/or lifestyle choice, or lack of qualified women in pediatrics.¹  They noted similar gender discrepancies in authorship, funding from national organizations, composition of editorial boards of major pediatric journals, and pediatric societies and boards.

In this month’s Hospital Pediatrics, the authors reviewed gender distribution within pediatric hospital medicine (PHM) through the framework of scholarly content, national conference speaking engagements, national awards, national leadership roles, conference planning committees, and editorial boards. Compared with Journal of Pediatrics, where women as first and last authors have steadily increased over the last 4 decades to 39% and 38%, respectively,³  the authors report 67% women as first authors versus 49% as senior authors in PHM. Although in pediatrics, women as first and last authors are not proportional in representation, trends in PHM show increasing representation among women as first authors. This representation was not noted among senior authors in PHM. The authors estimate that senior faculty represent 57% of women in PHM and represent those with 10 to 20 years of experience. Authors identified gaps in invited speakers, appointed leadership positions, and leadership positions in national PHM societies. These positions are typically occupied by mid- or senior-level faculty. By 2019, 780 academic pediatricians had received formal leadership training through the prestigious Association of American Medical Colleges mid-career faculty program or Drexel University’s Executive Leadership in Academic Medicine program.¹  Yet, senior women in pediatrics and PHM were underrepresented in leadership positions, such as in invited presentations, board leadership, and in leadership for national societies and advisory boards.^1,3,5–7  The authors concluded that first authorship of original research, submitted presentations, national awards, and some leadership roles, such as planning committee and elected leaders for national societies that support PHM, are representative of women in PHM and that gaps exist in invited speakers and seniors authors. Similar trends were noted for women in medicine, obstetrics and gynecology, and general surgery and surgical specialties, and perhaps the problem is not of the pipeline but of the process.^1,3,13 

PHM has 70% women and, as a young field, we may be poised to pave the way in gender equity.¹⁴  Allen et al, in their study of 142 PHM programs, found that women appear to be underrepresented as division and program leaders (70% vs 55%; P < .001) but not as fellowship directors (70% vs 66%; P > .05).¹⁴  They further noted that, within PHM, women were proportionally represented in associate/assistant leadership roles.¹⁴