ot long ago, I received a cellphone photo of a brochure showing a medical society’s annual award recipients. The two female physicians who snapped the photo did so because all nine of the recipients were men.
Where are the women?
With several colleagues, I have been studying the gender of medical society award recipients to understand what it says about women in medicine and how they navigate the medical society landscape, which is often part of the path to career advancement.
We first looked at recipients of physician recognition awards in a medical society I belong to, the American Academy of Physical Medicine and Rehabilitation. Women were obviously underrepresented. The gaps were greatest for the most prestigious awards, especially those associated with lectureships — in 40 of the 48 years we reviewed, no women physicians received these awards. Notably, 1 in 3 physicians in this specialty are women and this has been true for decades. Of those in academia, approximately 41 percent are women.
We did a similar analysis of 27 years of awards given by the Association of Academic Physiatrists. Female physicians were once again underrepresented. No women had received awards for the most recent four years or in half of the categories during the most recent decade. Perhaps the most troubling finding was that not a single woman had been chosen as the outstanding resident/fellow since the award’s inception. Essentially, we found a glaring absence of women.
The number zero is particularly persuasive. In arguments about discrimination, its presence is sometimes referred to as an “inexorable zero,” indicating the absence of women or minorities in a given environment. In employment litigation, the Supreme Court and other courts have ruled that a “glaring absence” may suggest an underlying organizational issue. True zeroes or very low numbers may constitute an inexorable zero.
To see if this gender imbalance occurred in other specialties, we looked at a wider range of medical societies. This week in the journal PM&R, we reported zero or near-zero representation of female physicians among recognition award recipients in dermatology, neurology, anesthesiology, orthopedic surgery, head and neck surgery, and plastic surgery. This wasn’t an exhaustive study; we believe that other specialties have similar gender gaps.
Why look at medical awards? We used them as a rubric for successful navigation of medical societies. That’s an important skill because these organizations own or control key resources such as medical journals, scientific speaking opportunities, and leadership roles on task forces, committees, and boards. For physicians in academia, the curriculum vitae (an extended resume) is an important key to promotion. This formulaic document has categories for all of those resources. An inability to successfully access them could slow or even halt promotion.
Leaders in academic medicine routinely encourage trainees (medical students, resident physicians, and fellows) and faculty physicians to join and actively participate in medical societies, in part to gain access to these resources. Promotion supports academic physicians’ careers; the higher they are promoted, generally the more they earn and the greater autonomy they have (lack of autonomy is closely linked to physician burnout).
Many studies have demonstrated that female physicians make less money than their male counterparts and are not promoted as quickly, if at all. Although I’m focusing here on gender, the same issues are well-documented for ethnic minority physicians and, while less studied, they are likely true for LGBTQ doctors and physicians with disabilities. Furthermore, though I’m describing advancement for physicians in both academic and non-academic practice settings, these problems occur with Ph.D. scientists and others. An impressive curriculum vitae supports career advancement in any field.
Developing one of those in academic medicine involves successfully navigating several gatekeepers. In gatekeepers like federal granting institutions (such as the National Institutes of Health) and employers (such as academic medical centers), funds flow from the organization to the physician. It’s just the opposite for gatekeepers like medical societies, in which money flows from physicians (or their employers) to the society. Collectively, medical societies constitute a billion-dollar-plus physician-supported industry.
I and other academic leaders who have risen through medical society ranks, many of whom currently have leadership positions in these organizations, face an ethical and financial dilemma: Should we continue to encourage the trainees and faculty members we work with to join these organizations if they do not appear to equitably support physicians from underrepresented groups? I call this “mentoring against a closed gate.” It can have tragically demoralizing consequences if physicians believe that they are “not good enough” when, in fact, the gate is simply not open — or only partially open — to them.
I’ve come to believe that mentoring early-career physicians against a closed gate is unethical. Although this highly coveted group of individuals is one that medical societies are keen to engage as members if they are to survive in the future, the majority of early-career physicians in the United States are from underrepresented groups and far too many are struggling with crushing debt. Their mentors, including me, are not serving them well morally or financially by encouraging them to join organizations that will not equitably support them.
In a First Opinion I wrote entitled “Invisible women: Female doctors and health care leaders are being hidden in plain sight,” I described the illusion of inclusion whereby photos of women and ethnic minorities are used to create the illusion of inclusivity. Some medical societies have become masterful at creating this illusion, but it’s easy to look beyond the newsletters, conference brochures, and websites that contain many photos of women and ethnic minorities to see that their journal editor-in-chiefs and society presidents, board members, committee chairs, keynote and plenary speakers, recognition award recipients, and the like do not reflect the same diversity.
My colleagues and I believe that physician-supported medical societies can and should tackle physician workforce disparities through data-driven initiatives. Here’s a six-part call to action to help achieve that goal:
- Examine diversity and inclusion data through the lens of the organization’s mission, values, and culture.
- Transparently report the results to members and other stakeholders, including medical schools and academic medical centers.
- Investigate potential causes of less-than-proportionate representation of women and others.
- Implement strategies designed to improve inclusion.
- Track outcomes to measure progress and inform future strategies.
- Publish the results to engage stakeholders and advance diversity and inclusion physician workforce agendas.
Every health care organization does wonderful things but also has room to improve. Hospitals tackle thorny issues such as safety and diversity through metrics and ongoing attention to improving outcomes. Medical societies should use a similar strategy to focus on diversity and inclusion.
By using their impressive influence and resources to equitably support all physicians, medical societies could have a huge impact on advancing research agendas, improving health disparities for our patients, and reducing symptoms of physician burnout. You can help move them in that direction by joining a growing group of physician thought leaders and influencers at #SocietiesAsAllies.
Julie K. Silver, M.D., is an associate professor and the associate chair for strategic initiatives in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and the Spaulding Rehabilitation Network. She is also on the medical staff at Massachusetts General Hospital and Brigham and Women’s Hospital.