Medicine has an abundance of highly trained and qualified women. So why are there so few of them at the highest levels, including full professors, chairs, and deans?
For many years, the belief was that when there were enough women in medicine, critical mass alone would correct such gender disparities. Yet this theory has not panned out and it is now clear that despite the fact there are many qualified women for any given leadership position, they are not promoted equitably.
Dr. Keith Lillemoe summed it up nicely during his presidential address to the American Surgical Association when he said, “The number of outstanding, qualified female candidates is more than adequate to fill every open surgical leadership position in America today. The problem is not the pipeline — it is the process.”
Slow progress in gender equity isn’t limited to medicine, of course. It is universal, which is why Melinda Gates announced that her foundation is committing $1 billion over the next 10 years to accelerate gender equality.
In addition to funding work on gender equality, what else can be done to accelerate progress toward it? The field of dissemination and implementation science may provide some answers, because it focuses on how to circulate research more effectively so it can be more efficiently translated into clinical practice and policy.
Skeptics say that people in power will resist change no matter how well the science is disseminated, and they are right about some leaders’ unwillingness to change. But I believe there are many ethical health care leaders who would work harder to address gender disparities in medicine if they knew more about the research that has already been published and the research that is certainly to come.
Gender equity research is largely driven by women physicians and scientists who have created a robust evidence base documenting disparities between women and men in compensation, grant funding, publishing (including opinion articles in journals), recognition awards, speaking opportunities, and leadership positions in medical schools, professional societies, and scientific journals.
However, there may be an echo-chamber effect, with a small number of people actively discussing studies on workforce gender disparities while many others — including health care leaders who must address disparities within their own organizations — know little or nothing about them because the research has not been widely disseminated. Since the spread of research is a necessary (though not always sufficient) step to adoption, progress toward gender equity will be slow if gender equity studies are not widely disseminated.
Lack of knowledge about research can result in intelligent and well-meaning people believing things that are not scientifically valid. For instance, pay gap deniers spread the myth that equal compensation for equal work exists throughout the physician workforce despite many studies and national surveys that demonstrate otherwise. Their comments are often disruptive to organizational meetings and processes, time consuming to listen to and respond to, and they ultimately slow progress.
For example, I am involved with a national initiative being led by the American Medical Women’s Association called Revolution by Resolution. Its goal is for state medical societies to adopt gender equity resolutions. In one state, when the resolution was brought up for a vote, it likely had the support to pass. But a few people in the audience wondered aloud whether there really was a pay gap, even though the research was cited in the resolution itself. Their questioning of the pay gap, despite an abundance of evidence it exists, caused the resolution to be referred to a committee for further review (without a vote). This means the women physicians and their allies who brought the resolution forward after spending many volunteer hours on it must now wait longer and dedicate more of their precious time to getting it passed.
In the struggle to abolish gender disparities, health care professionals’ lack of knowledge about the science creates a vicious cycle of extra work and potential harm in psychological well-being and burnout for women. This may also adversely affect patient care.
While anecdotes are useful, bibliometrics tell data-driven stories about the dissemination of reports about gender equity in medicine. Conventional metrics measure, among other things, how many times a report has been cited in journal articles. Alternative metrics provide real-time evidence of how a published study is being circulated. These metrics go beyond tweets and other social media dissemination and algorithmically calculate — and weigh more heavily — online mentions in traditional media, policy reports, and the like.
The dissemination of gender equity studies can be strategically improved, though it is time consuming and another burden borne mostly by women. For example, in a study my colleagues and I recently published, we found that strategically disseminating eight published gender equity studies using a Twitter chat and tracking bibliometrics resulted in 1,500 tweets from 294 participants and 8.6 million impressions. The Altmetric Attention Score, which presents a weighted approximation of the online attention an article has received, increased for these articles an average of 126.5 points. We obtained share and download information for one of the articles and found it had a 1,667% increase in shares and a 1,093% increases in downloads.
Wider dissemination of gender equity research can lead to real change at an organizational level. Here’s one example: Dr. Julia Files and her colleagues analyzed video recordings of speaker introductions at medical grand rounds presentations and found that women were less likely than men to be introduced as “Doctor.” Their 2017 report was shared widely on social media and featured in national news outlets. Two years later, as I prepared for an invited lecture at the annual meeting of the American Society of Hematology, the organization’s leaders sent me a list of instructions that included this: Please use professional titles only (“doctor” for those with MD and PhD degrees) when introducing or referencing colleagues during formal portions of the ASH annual meeting.
One group of leaders — editors of medical journals — can help disseminate research on gender disparities in medicine with a relatively simple deed: making such research freely available to everyone.
As part of the annual women’s leadership course I direct at Harvard Medical School, we include a strategic initiative that teaches attendees how to put into action what they have learned. This year’s initiative is called the #NeedHerScience Campaign, which is supported by the American Medical Women’s Association and the Executive Leadership in Academic Medicine program. This campaign is focused on addressing journal-level barriers for women in medicine. Bias, whether it’s conscious or not, at the level of journals has a profoundly negative impact on women’s careers and results in a poor financial return on investment for academic institutions that are supporting a diverse workforce.
Journals such as The Lancet and the Journal of Hospital Medicine are actively addressing these issues and publishing information to guide others. Some journals have published supplements focused on equity in general or more specifically aimed at supporting women. This is a terrific model that may accelerate progress, and all journal editors should consider publishing an equity supplement. Editors may also invite experts to write summary reports that will help readers quickly understand the existing research and figure out appropriate next steps to advance workforce equity.
Recognizing that this strategy may accelerate gender equity efforts, my colleagues and I have written several of these reports (on our own time and without grant funding or any other type of compensation) for the specialties of pediatrics, neurology, anesthesia, infectious disease, and physical medicine and rehabilitation.
As part of the #NeedHerScience Campaign, a small group of women physicians reached out to approximately two dozen journal editors and explained why it’s important to make workforce gender equity research free access. Not surprisingly, some editors did not respond to the invitation or declined to participate. But quite a few agreed to help disseminate this work. For example, the Journal of Surgical Education, Radiology, Journal of Women’s Health and The British Medical Journal all agreed to make some articles freely accessible. Several journals, including Neurology, the American Journal of Physical Medicine and Rehabilitation, PM&R, and Anesthesia and Analgesia have created “collections” so readers can more easily find the articles. The Lancet has already given free access to its recent women’s supplement.
The #NeedHerScience Campaign isn’t limited to participants in the course. Anyone can support it by taking the #NeedHerScience pledge, which endorses the idea that it’s important to ensure that before submitting a manuscript to a journal women physicians and scientists are equitably included at every level as editors, and inviting journal editors to make workforce gender equity reports freely available to everyone.
We desperately need the science of half of the most brilliant minds in medicine.
Julie K. Silver, MD is an associate professor and associate chair in the department of Physical Medicine and Rehabilitation at Harvard Medical School. Follow this campaign at #NeedHerScience.