How to Fix the Gender Disparity in Pediatrics

Since Elizabeth Blackwell became the first woman to graduate from an American medical school in 1849, women have made many gains in the health care field. However, as Spector et al¹  point out in this issue of Pediatrics, the battle for gender equity in medicine in general, and in pediatrics in particular, is far from over. The real questions for those of us who, like myself, have been in positions to make change are why have we not achieved more progress, and what exactly are we going to do about it?

Medicine is doing better than business, in which only 5% of companies had women chief executive officers in 2016,²  and nonmedical higher education, in which only 30% of colleges and universities had women at the highest level of leadership.³  Some progress is being made, as reflected in improvements in the trends toward pay equity, representation among the leadership of academic medical centers and other health care organizations, participation on journal editorial boards, research funding, and recognition by medical societies that have women in leadership positions and as plenary speakers. Unfortunately, as noted in this article, despite the progress, the increases have not kept up with the growing percentage of women physicians in the United States.

I am writing from the perspective of having spent the majority of my professional career in leadership roles in academic pediatrics and pediatric critical care, including as a former division chief, a medical school pediatric department chair, a senior vice president at a major medical center, a current editorial board member of this journal (which I am delighted to note has an equal number of men and women on the board), a previous editorial board member of 2 other journals (both of which are male dominant), and a mentor to male and female medical students, residents, junior faculty, and new department chairs. Most importantly, I am also a wife, a mother, and a grandmother. I am not unique. There are many others like me. There are chairs, deans, provosts, university presidents, and chancellors who are women, albeit the numbers are low. But they do exist. Can the presence of women in the highest ranks of academia not help organizations overcome their potential intrinsic bias against women as well as other underrepresented groups and allow women and others to succeed equally to men?

Spector and her colleagues¹  suggest a solution that can be used by interested organizations, the 6-step equity, diversity, and inclusion cycle, which they provide in their Fig 6. They make a plea for transparency, mentorship, and sponsorship from senior leadership and financial support to make the elimination of gender and other disparities in medicine a reachable goal. Looking at this cycle, it seems similar to a plan-do-study-act cycle often used for quality-improvement projects. Perhaps we can learn some lessons from the quality-improvement field in how to implement needed improvements in our field of pediatrics and in medicine overall.

Although the authors point out the activities of many pediatric organizations and the collaborative efforts of the groups, including the American Academy of Pediatrics, that belong to Women’s Wellness Through Equity and Leadership consortium, many other organizations working to achieve gender equity in the academic and business realms of health care seem not to be working together and to be disorganized. So, it is unlikely that the equity, diversity, and inclusion process will be adopted across the board. This means that progress will not lead to the broad-based societal change that is needed. We need a more audacious goal. We need to bring together the organizations and sectors that are all working toward this goal, some of which are listed in Table 1, to focus collaboratively and work in coordination to eliminate the disparities that exist between women and men in our field. It is striking to note that some of the work of achieving gender equity in academics (for example by the American Association of University Women) has been going on since the late 1800s.⁴ 

We need to publicly celebrate those organizations achieving success and be more open about those that are not achieving the desired outcomes similar to how we publicly recognize the best and worst performing health care systems. Spector et al¹  provide us with the plan, now we must do more, check on how we are doing, and act accordingly to eradicate the gender gap in pediatrics. In addition, all individuals, especially those of us in leadership positions, must challenge ourselves and our organizations and institutions on a continuous basis to identify and correct any bias, explicit or implicit,¹³  against any underrepresented group and work diligently to make inequity live only in the past.