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Abstract

Women in academic medicine are paid less than their male peers.¹,2 This salary difference is often attributed to differences in rank and promotion. The goal of this study was to investigate whether sex pay differences exist at the highest ranks of academic medicine: among clinical department chairs. Given that department chairs are exceptional leaders who have reached the top rank of their specialties, we hypothesized that there would be no significant differences in salary between female and male department chairs.

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... This has created a powerful forum to discuss life situations and share experiences and ideas (personal communication). Accessing this community of support via social media can give a feeling of empowerment [21]. Another example of social media's positive role is the development of a Facebook group called "Radiology Chicks," composed and designed by women radiologists. ...
... Overall, women in academic medicine are paid less than their male peers, even when considering same rank and promotion. In a study of 559 department chairs across public schools of medicine, where 17% were women, after adjusting for term length, specialty, title and regional cost-of-living differences, the salary difference was $67,517 in favor of the male chair; in those who had served for more than 10 years, the difference rose to $127,411 [21]. The 2018 Doximity Physician Compensation Report found that radiology had the fourth-highest wage gap between men and women, with women's salaries 21% below men's. ...
... The 2018 Doximity Physician Compensation Report found that radiology had the fourth-highest wage gap between men and women, with women's salaries 21% below men's. This pay gap widens for women who are from underrepresented minorities, are recent immigrants or have differing physical abilities [21]. ...
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Pediatric radiology is the only specialty in radiology that is near evenly distributed among genders. Yet the top leadership positions in the field are still mostly occupied by men. In this article we review some of the history of women in pediatric radiology and discuss how to improve women’s participation in the highest positions of our subspecialty.
... Still, empirical data is limited, especially when accounting for women's race, ethnicity, and sexual orientation. In a review of department chairs (N = 1073) within 29 public medical schools, only 92 chairs (16.7%) were women, including six female and 25 male psychiatry chairs [14]. Among all chairs, the unadjusted average difference in annual salary by sex was $79,061. ...
... Among all chairs, the unadjusted average difference in annual salary by sex was $79,061. After adjusting for term length, specialty, inflation, title, and cost of living, the salary difference was $67,517 [14]. The salary difference by sex for chairs serving for more than 10 years was $127,411 [14]. ...
... After adjusting for term length, specialty, inflation, title, and cost of living, the salary difference was $67,517 [14]. The salary difference by sex for chairs serving for more than 10 years was $127,411 [14]. AAMC 2018 faculty salary survey data showed mean male to female compensation differences of 20% ($138,500) for all clinical science chairs, and 11% ($53,400) for psychiatry chairs in US medical schools [15]. ...
Article
For the first time in US history, first-year female medical school matriculants (50.7%) outnumbered men (49.3%) in 2017 [1]. Moreover, in 2019, women accounted for 50.5% of all medical students for the first time [1]. Yet, female faculty continue to be underrepresented at the highest rankings in academic medicine as a whole and in psychiatry [2, 3]. Women represent only 26% and 32% of full professors among all medical faculty and psychiatry faculty, respectively, with a majority identified as White [3]. Structural racism, gender bias, and discrimination, along with the lack of systematic strategies that aim to achieve gender and racial equity, result in persistent achievement and promotion disparities among students, residents, and faculty, especially among those who are underrepresented in medicine [4, 5]. We will review the barriers women face advancing their careers in academic medicine in general, and academic psychiatry in particular, with specific attention paid to inequities for Black, Indigenous, and People of Color (BIPOC) women and especially underrepresented in medicine (URM) women compared to White women based on race/ethnicity. We will also consider the intersecting impact of sexual orientation and gender identities on women. Although there is a substantial body of research on academic medical career progression for women and URM, research identifying strategies and challenges for URM women is limited. Challenges noted include institutional barriers related to mentoring, time management, influence of bias, exclusion from formal and informal networks, and involvement in committees and non-promotion activities. Notably, the literature often considers women homogenously and does not account for nuanced differences between groups. Still, we propose solutions to narrow persistent gender and racial/ethnic disparity gaps for womenidentifying faculty. The Association of American Medical Colleges defines underrepresented in medicine (URM) as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” [6].We use the term “URM women” to describe these women, who include all who do not identify as exclusively White or Asian [6]. We use the term “Black, Indigenous, and People of Color (BIPOC) women” to describe women whose racial/ ethnic identities are non-White to recognize the significant past and present history of violence, structural racism, and injustice toward Black and Indigenous people in the USA. We use the term “LGBTQIA+ women” to refer to lesbian, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minoritized women in recognition of the discrimination and oppression they experience
... Nevertheless, underrepresentation of women within the medical field is still evident; medical leadership positions lack female participation [3,4] and women are still underrepresented in academic publications [5,6]. Even up to now, there are indications that women within the medical field receive lower salaries compared to men [7][8][9]. ...
... First, the rising amount of young and ambitious female physicians lack adequate role models, particularly in surgical specialties [12,13]. Further, the filling of senior positions within medical departments and filling of editorial boards, conference speakers and leadership positions-dependent on academic visibility-even further strengthens the inequity, thus, reinforcing the existing power structure [3,9,14,15]. Lastly, female underrepresentation can result in research biases [16][17][18][19][20]; this may be due to an unconscious bias (the lack of a female perspective), the historical preference of male animals for experimental studies or, considering clinical trials, unequal inclusion of patients. ...
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The study aims to provide data on authors’ gender distribution with special attention on publications from Europe. Articles (10/2019–03/2020) published in three representative neurosurgical journals (Acta Neurochirurgica, Journal of Neurosurgery, Neurosurgery) were analyzed with regard to female participation. Out of 648 publications, 503 original articles were analyzed: 17.5% (n = 670) of the 3.821 authors were female, with 15.7% (n = 79) females as first and 9.5% (n = 48) as last authors. The lowest ratio of female first and last authors was seen in original articles published in the JNS (12.3%/7.7% vs. Neurosurgery 14.9%/10.6% and Acta 23.0/11.5%). Articles originated in Europe made up 29.8% (female author ratio 21.1% (n = 226)). Female first authorship was seen in 20.7% and last authorship in 10.7% (15.3% and 7.3% were affiliated to a neurosurgical department). The percentages of female authorship were lower if non-original articles (n = 145) were analyzed (11.7% first/4.8% last authorships). Female participation in editorial boards was 8.0%. Considering the percentages of European female neurosurgeons, the current data are proportional. However, the lack of female last authors, the discrepancy regarding non-original articles and the composition of the editorial boards indicate that there still is a structural underrepresentation and that females are limited in achieving powerful positions.
... In the United States, gender differences in salary were found at all faculty ranks and were the largest among full professors among academic physicians (11). Another study also revealed gender differences in salaries of clinical department chairs in US public medical schools, with women earning less than men (12). Whether gender income differences exist at the highest level of professional hierarchy in China's healthcare system is, however, unknown. ...
Article
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Background Gender income disparity in healthcare settings is a longstanding issue around the globe, but such evidence among Chinese psychiatrists is scarce. This study investigated whether gender income differences exist among physicians in China. Methods Data came from the 2019 national survey data of 4,520 psychiatrists in major public psychiatric hospitals across China. Self-reported monthly income after tax (in Chinese Yuan, CNY) by participants at all professional ranks was assessed. Average monthly income by gender was reported. Adjusted income differences between male and female psychiatrists were examined using multivariable regression models, adjusting with inverse probability of treatment weights and controlling for psychiatrist demographics (e.g., gender, professional rank, marital status, educational level, and work hours) and hospital fixed effects. Results The unadjusted mean difference in monthly income after tax by gender was 555 CNY (about $86; 95% CI, −825 to −284; mean [SD] for men: 8,652 [4,783] CNY and for women: 8,097 [4,350] CNY) in all psychiatrists. After regression adjustments, the income difference by gender among all psychiatrists reduced substantially and became insignificant. However, gender income difference was still observed among senior-level psychiatrists, where female psychiatrists earned 453 CNY (about $70; 95% CI, −810 to −95) significantly less than male psychiatrists. Conclusion China achieved gender equity in income for psychiatrists overall, the observed income differences among senior level psychiatrists, however, reveal the persistence of gender inequity at the highest level of professional hierarchy. These findings call for policy attention to the issue of gender income disparity among psychiatrists in China's healthcare system.
... These studies do not contemplate gender issues in their cornerstone since their purpose is to analyze how employee performance can positively affect their salary and motivation and also what kind of extrinsic or intrinsic motivation impacts their performance. In the existing literature, there are articles that expressly study gender differences in salaries in certain sectors such as medicine (Kapoor et al. 2017;Mensah et al. 2020;Popovici et al. 2021;Wiler et al. 2021), surgery (Sanfey et al. 2017), services industry (Kronberg 2020), industry (Goraus, Tyrowicz, and van der Velde 2017), physician collective (Dan et al. 2021;Hayes, Noseworthy, and Farrugia 2020), higher education (Taylor et al. 2020), and banking sector (Tianyi, Jiang, and Yuan 2020). These kinds of studies attempt to promote equal changes for women and, after exhaustive analysis, propose structural and individual solutions to achieve equality not only in terms of salary but also in terms of promotion. ...
Article
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This paper presents a machine-learning-based method for evaluating the internal value of talent in any organization and for evaluating the salary criteria. The study assumes the design and development of a salary predictor, based on artificial intelligence technologies, to help determine the internal value of employees and guarantee internal equity in the organization. The aim of the study is to achieve internal equity, which is a critical element a that directly affects employees’ motivation. We implemented and validated the method with 130 employees and more than 70 talent acquisition cases with a Basque technology research organization during the years 2021 and 2022. The proposed method is based on statistical data assessment and machine-learning-based regression. We found that while most organizations have established variables for job evaluation as well as salary increments for staff according to their contribution to the organization, only a few employ tools to support equitable internal compensation. This study presents a successful real case of artificial intelligence applications where machine learning techniques help managers make the most equitable and least biased salary decisions possible, based on data.
... It concluded, "many features of the medical profession, including its historical male dominance, strong hierarchies, and culture that [tolerates] mistreatment [increase] the risk of sexual harassment in the workplace" (National Academies of Sciences, Engineering, and Medicine, 2018). After training ends, the mistreatment persists, the unremitting gender pay gap and minority taxation being but two examples how (Mensah et al. 2020). ...
Article
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
... This is consistent with published literature showing gender disparities in salaries. 3,4,5 Compensation methods of family medicine PDs are admittedly complex and variable by program. The initial survey analysis did not allow for deeper study of potential confounders to salary, such as geographic region, program type, sponsor, or size, nor for a variety of program director identity factors, years of experience, or scope of practice. ...
... This is consistent with published literature showing gender disparities in salaries. 3,4,5 Compensation methods of family medicine PDs are admittedly complex and variable by program. The initial survey analysis did not allow for deeper study of potential confounders to salary, such as geographic region, program type, sponsor, or size, nor for a variety of program director identity factors, years of experience, or scope of practice. ...
... Women doctors earned on average $20 k less than men in one study, 17 and over ~$70 k less as department chairs. 18 Certainly, discriminatory practices, long work hours, and limited exposure to this field during training could deter females from pursuing this procedural, maledominated subspecialty. Not all of us may have the same priorities, and we need to be open to careers that may be less likely to follow a linear trajectory. ...
... The research in six countries conducted by Dang and Viet Nguyen (2021) shows that women are 24 per cent more likely than men to permanently lose their job during the COVID-19 pandemic. When women and men hold equivalent roles, it is still difficult for women to obtain equal access to fair pay (Kohout and Singh, 2018;Mensah et al., 2020). ...
Article
Purpose The purpose of this study is to explore how gender influences peer assessment in team-building activities in China. Design/methodology/approach A nine-player Werewolf game was adopted to conduct the experiment. Nine abilities were defined to evaluate players’ performances. Before the game, players filled out a self-assessment questionnaire (five-point Likert scale). After the game, players evaluated other game members’ performances using the same questionnaire. Data were analyzed using linear regression. Findings The results showed that gender bias clearly existed in team-building activities, with men more likely to receive better peer assessment than women. In addition, when women presented themselves as actively as men did, they received less favorable evaluations than men, whereas their failures were more likely to be exaggerated. Practical implications This study may help build harmonious teams for gender equality, and we give practical suggestions respectively from the perspective of female employees, their managers, and their companies. Originality/value Given the importance of team-building activities in teamwork, fair evaluations of team-building performances are essential. However, gender influences on peer assessment in team-building activities in China remain unclear. This study adds new and important knowledge to research on gender bias in teams.
... Furthermore, when women become department chairs, they make $67,517 less than their male peers even after adjustment for term length, specialty, title, and regional cost of living. They are also more likely to have 'interim' in their titles (Mensah et al., 2020). ...
Article
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Addressing gender and racial-ethnic disparities at all career stages is a priority for the research community. In this article, we focus on efforts to encourage mid-career women, particularly women of color, to move into leadership positions in science and science policy. We highlight the need to strengthen leadership skills for the critical period immediately following promotion to associate/tenured professor – when formal career development efforts taper off while institutional demands escalate – and describe a program called MAVEN that has been designed to teach leadership skills to mid-career women scientists, particularly those from underrepresented groups.
... There are fewer published female first authors and fewer female senior authors in radiology (7,8). Women radiologists are also underrepresented on editorial boards for radiology journals, in national societies and are known to be paid less than their male counterparts at the highest levels of leadership (9,10,11,12,13). Additionally, NIH funding between 2016-2019 awarded more and larger grants to male radiologists than their female counterparts (14). ...
Article
Rationale and Objectives : The COVID-19 pandemic stresses the tenuous balance between domestic obligations and academic output for women across professions. Our investigation aims to evaluate the impact of the pandemic on the home duties and workplace productivity of academic radiologists with respect to gender. Materials and Methods : A 49-question survey was distributed to 926 members of Association of University Radiologists in October 2020. Several categories were addressed: demographics; workplace changes; stress levels and personal experiences with illness; time spent on domestic obligations; and perception of productivity during COVID-19. Statistical analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Results : A total of 96 responses across 30 states, 53.1% male and 46.9% female were received. Women report spending more time on unpaid domestic duties than men prior to COVID-19, with men spending a median of 5-10 h/wk and women spending a median of 10-15 h/wk (p=0.043). With pandemic onset, both genders reported that women did more of the homecare, when not split equally. Women with young children reported a significant decrease in work-from-home productivity compared to men with young children (p=0.007). Men reported they had more time to be productive compared to women (p=0.012). Conclusion : The COVID-19 pandemic threatens to disrupt the advancement of women in radiology leadership roles by creating disparate effects on productivity due to increased workloads at home for women. This could potentially lead to decreases in promotions and research productivity in years to come that far outlast the acute phases of the pandemic
... advance to higher academic ranks (ie, associate and full professor) and positions of leadership (eg, department chairs and other senior leadership) within the field of otolaryngology. [20][21][22] Despite these inequities, female otolaryngologists who achieve senior academic rank have increased productivity compared with men, indicating that female otolaryngologists are able to achieve high levels of performance in academic medicine despite potential barriers. 18 In addition to senior-career productivity, female otolaryngologists are now beginning to achieve parity in several other key spheres of influence, including specialty society membership and leadership positions, 23 publication of peer-reviewed literature, 24,25 and authorship of opinion pieces. ...
Article
Importance Women comprise an increasing proportion of the otolaryngology workforce. Prior studies have demonstrated gender-based disparity in physician practice and income in other clinical specialties; however, research has not comprehensively examined whether gender-based income disparities exist within the field of otolaryngology. Objective To determine whether diversity of practice, clinical productivity, and Medicare payment differ between male and female otolaryngologists and whether any identified variation is associated with practice setting. Design, Setting, and Participants Retrospective cross-sectional analysis of publicly available Medicare data summarizing payments to otolaryngologists from January 1 through December 31, 2017. Male and female otolaryngologists participating in Medicare in facility-based (FB; hospital-based) and non–facility-based settings (NFB; eg, physician office) for outpatient otolaryngologic care were included. Main Outcomes and Measures Number of unique billing codes (diversity of practice) per physician, number of services provided per physician (physician productivity), and Medicare payment per physician. Outcomes were stratified by practice setting (FB vs NFB). Results A total of 8456 otolaryngologists (1289 [15.2%] women; 7167 [84.8%] men) received Medicare payments in 2017. Per physician, women billed fewer unique codes (mean difference, −2.10; 95% CI, −2.46 to −1.75; P < .001), provided fewer services (mean difference, −640; 95% CI, −784 to −496; P < .001), and received less Medicare payment than men (mean difference, −$30 246 (95% CI, −$35 738 to −$24 756; P < .001). When stratified by practice setting, women in NFB settings billed 1.65 fewer unique codes (95% CI, −2.01 to −1.29; P < .001) and provided 633 fewer services (95% CI, −791 to −475; P < .001). In contrast, there was no significant gender-based difference in number of unique codes billed (mean difference, 0.04; 95% CI, −0.217 to 0.347; P = .81) or number of services provided (mean difference, 5.1; 95% CI, −55.8 to 45.6; P = .85) in the FB setting. Women received less Medicare payment in both settings compared with men (NFB: mean difference, −$27 746; 95% CI, −$33 502 to −$21 989; P < .001; vs FB: mean difference, −$4002; 95% CI, −$7393 to −$612; P = .02), although the absolute difference was lower in the FB setting. Conclusions and Relevance Female sex is associated with decreased diversity of practice, lower clinical productivity, and decreased Medicare payment among otolaryngologists. Gender-based inequity is more pronounced in NFB settings compared with FB settings. Further efforts are necessary to better evaluate and address gender disparities within otolaryngology.
... 4 Gender disparities in medicine can further permeate the academic environment, where women physicians have been less likely to be promoted in their academic positions or hold leadership roles, and if they do hold leadership roles, they are still paid less than men in equivalent roles. 5 One study reported that there are more men with moustaches than women in medical leadership positions in the United States. 6 Women also appear underrepresented as Deans of medical schools: in 2019, only 3 out of 17 Canadian medical schools and 15% of American medical schools were led by women Deans. ...
Article
Objective More women than ever are pursuing surgical specialties despite historical dominance by men. The objective of this study was to examine how surgical residents experience gender-based discrimination during their residency training, including the common sources, settings, and implications of these experiences. Design A sequential explanatory mixed methods design was used to combine results from an initial quantitative survey of surgical residents of all genders at the University of Calgary with qualitative data derived from interviews with surgical residents who identified as women. Participants Thirty-seven surgical residents of all genders completed a survey. Fouteen women completed a one-to-one, semistructured interview. Results Women reported significantly more frequent experiences of gender-based discrimination than men, particularly regarding lack of respect from others, inappropriate jokes or comments, and hostile or humiliating behaviors. Nursing staff and patients were reported as prominent sources of discrimination, and the emergency and operating rooms were the most common settings. The qualitative findings highlighted the additional challenges for women during surgical residency, including navigating the relationships with nursing, having to work “twice as hard” to receive respect from patients and nurses, reports of persistent harassment and bullying, becoming desensitized to mistreatment and discrimination, and the influence of their gender on the quality of their education as well as their well-being. Conclusions Despite the increasing number of women entering surgical specialties, women surgical residents report frequent and severe experiences of gender-based discrimination during their training, even at an academic institution where over half of residents are women.
... Differences in salary between men and women should be transparent and either amended or explained. These inequalities occur at the highest levels of leadership in medicine, with women department chairs earning 0.88 cents per dollar received by men [9]. A lack of transparency in salary between men and women only conceals persistent inequality. ...
Article
Introduction: Prior studies on Canadian physicians' income have demonstrated a gender pay gap (GPG); however, there is a paucity of data in the Radiology specialty. A cross-sectional study was conducted to determine if practicing Canadian radiologists' self-reported income is related to gender, controlling for demographic and work variables. Methods: English and French online surveys were distributed by email and social media to radiologists and trainees (May-July 2021). The association between Gender (controlling for Ethnicity variables, Region, having Children, Full-/Part-Time work, and Academic position) and Self-Reported Income was examined using chi-square tests. Pearson correlations examined relationships between opinion variables. Analyses were conducted using SPSS V28.0. A priori significance was P < .05. Study had ethics approval. Results: Four hundred and fifty-four practicing Canadian radiologists responded. Majority were women (51.2%, n = 227), a non-visible Minority (71.7%, n = 317), and from Western Provinces (67.8%, n = 308). Significant relationship was established between Self-Reported Income and Gender (χ2 = 10.44, df = 2, P < .05). More men (70.6%, n = 120) than women (56.4%, n = 110), reported income "greater than $500 000"; fewer men (20.6%, n = 35) than women (35.9%, n = 70) reported "$300 000-$500 000"; a similar percent of men (8.8%, n = 15) and women (7.7%, n = 15) reported "less than $300 000." No relationship was found between self-reported income and gender for ethnicity variables, those without children, part-time, or non-academic radiologists. The opinion "Addressing the GPG is important" correlated to "Canadian Association of Radiologists should collect demographic data" (r = 0.63). Responses were low for ethnic minorities and non-western provinces. Conclusion: Our results suggest a GPG exists in Canadian radiology and is an important first step for future studies.
Chapter
The focus on diversity, equity, and inclusion (DEI) efforts in academic medicine has increased over the past years. In this chapter, we address the history of disparities in the medical field to explain the context and need for DEI efforts. This chapter will give insight into topics such as imposter syndrome, microaggressions, and minority tax, with the goal of providing tools to protect the physicians most impacted. For those not personally affected, it will offer ways to better support colleagues who are facing discrimination. Finally, for those with the goal of pursuing academic medicine, this chapter will provide the context and resources needed to succeed while promoting diversity and inclusion. While some of the topics discussed may be disheartening, we provide examples of steps already underway to support physicians who are underrepresented in medicine. The focus here is on the challenges facing physicians in the United States, but many of the issues discussed are relevant worldwide.KeywordsAcademic medicineGenderRacial disparitiesMicroaggressionsDiscrimination
Article
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Obstetricians know the statistics—1 out of every 10 babies is born premature; preeclampsia affects 1 in 25 pregnant people; the United States has the highest rate of maternal mortality in the developed world. Yet, physicians and scientists still do not fully understand the biology of normal pregnancy, let alone what causes these complications. Obstetrics and gynecology-trained physician-scientists are uniquely positioned to fill critical knowledge gaps by addressing clinically-relevant problems through fundamental research and interpreting insights from basic and translational studies in the clinical context. Within our specialty, however, physician-scientists are relatively uncommon. Inadequate guidance, lack of support and community, and structural barriers deter fellows and early stage faculty from pursuing the physician-scientist track. One approach to help cultivate the next generation of physician-scientists in obstetrics and gynecology is to demystify the process and address the common barriers that contribute to the attrition of early stage investigators. Here, we review major challenges and propose potential pathways forward in the areas of mentorship, obtaining protected research time and resources, and ensuring diversity, equity, and inclusion, from our perspective as early stage investigators in maternal-fetal medicine. We discuss the roles of early stage investigators and leaders at the institutional and national level in the collective effort to retain and grow our physician-scientist workforce. We aim to provide a framework for early stage investigators initiating their research careers and a starting point for discussion with academic stakeholders. We cannot afford to lose the valuable contributions of talented individuals due to modifiable factors or forfeit our voices as advocates for the issues that impact pregnant populations.
Article
Although the number of Hispanic/Latina women earning medical degrees has increased in recent years, the article by Anaya and colleagues in this issue highlights their stark underrepresentation in the U.S. physician workforce. In this commentary, the authors provide context on proposed drivers of underrepresentation, including bias, discrimination, harassment, and other structural barriers, which are amplified for women with multiple minoritized identities. They summarize the 2020 National Academies of Sciences, Engineering, and Medicine recommendations for supporting women in STEMM (science, technology, engineering, mathematics, and medicine) fields, including committed leadership, dedicated financial and human resources, data-driven accountability, and use of an intersectional approach to address the challenges faced by individuals who encounter multiple forms of bias and discrimination. The authors also provide additional recommendations and highlight innovative new National Institutes of Health funding opportunities to promote diversity in the scientific workforce. They argue that more research is needed to identify and best implement institutional practices that increase representation and retention of Latina women and other women with minoritized identities in STEMM fields.
Article
Objective There are significantly fewer women than men in leadership roles in healthcare. Previous studies have shown that, overall, male physicians earn nearly $20,000 more annually than their female physician colleagues after adjusting for confounding factors. However, there has not been a description of physician leadership compensation in relation to gender. Methods This was a successive cross-sectional observation study design of 154 Emergency Departments (EDs) in the U.S. from five years (2013, 2015-2018) using Association of Academic Chairs in Emergency Medicine & Academy of Administrators in Academic EM survey data. The primary variable of interest, leadership role, was attained by re-coding the survey responses to assign primary job duty into four main categories: no leadership role, operations leadership, education leadership, and executive leadership. Results Overall, 8,820 responses were included. Across all survey years, the average percentage of women in any leadership role was significantly less than men (44.5% [95% CI: ± 1.7%]) vs. 55.3% [95% CI: ± 1.2%]). Women in leadership roles worked more clinical hours than men in the same position (female median = 1,008; male median = 960). Women also had significantly lower salaries than men at each of the five-year time points that data are reported, with unadjusted average salary differences of $-54,409 per year for executives, $-27,803 for operational leaders, and $-17,803 for education leaders. Conclusions Female physicians hold fewer leadership roles in academic EM, and when they do, they work more clinical hours and are paid less than male physicians. As a specialty, emergency medicine should continue to investigate and report out gender achievement disparities as work is done to rectify the system inequalities.
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Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10-15 years into practice. Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.
Article
Women now represent more than half of medical school students, a salutary trend for a once male-dominated profession. Unfortunately, physician salary equality has lagged behind. Female physicians are paid less than male physicians in almost all specialty areas.¹⁻³ In this issue of JAMA Internal Medicine, Wang et al⁴ use survey data from a contemporary cohort of academic internal medicine physicians to quantify this gender pay gap and compare across specialties. The authors find that the gender pay gap is most pronounced in specialties with procedural components, such as cardiology and gastroenterology, which also have the lowest percentages of female physicians.
Article
Women comprise 41% of faculty in full-time academic positions, steadily increasing since 2009.¹ The number of women pursuing Internal Medicine (IM) careers continues to rise; however, gender differences in physician salary and promotion have endured.² Contemporary data on the workforce composition of IM subspecialist physicians are lacking. We sought to evaluate current demographics and salaries of academic IM physician specialists and hypothesized that gender disparities in remuneration persist despite the increase in female representation in academic IM.
Article
Background: Academic centers' and professional societies' top leadership representation and professional societies' award recipients remain disparate by gender in many fields. Little is known regarding leadership representation and recognition within pulmonary, critical care, and sleep medicine (PCCM), which has ∼22% women physicians. We sought to understand the landscape of female PCCM leaders. Methods: We abstracted gender of fellowship program directors (PDs), Department of Medicine (DOM) Chairs and Division Chiefs from academic medical centers with PCCM fellowship programs from 2018 and for comparison 2008. We abstracted leadership and recognition award recipients within four PCCM professional societies from 2013 to 2018 (American Thoracic Society [ATS], American Academy of Sleep Medicine [AASM], American College of Chest Physicians [CHEST], and Society of Critical Care Medicine [SCCM]). Results: In 2018, 29% of PCCM PD, 15% of PCCM Division Chiefs, and 15% of DOM Chairs were women. There were significantly more female PDs in 2018 (29%) compared with 2008 (16%, p = 0.04). On average, 25% of society presidents were women, with 28% of PCCM societal awards going to women, with significant difference between societies (p = 0.04). Each society differed in average distribution of female board members over the 6-year period: ATS 38%, AASM 35%, CHEST 18%, and SCCM 44% (p < 0.001). Conclusion: PCCM leadership and societal recognition are disparate by gender with few women holding top leadership roles and receiving societal recognition. Fortunately, the distribution notably is starting to reflect the specialty's demographics. Understanding why these inequalities exist will be essential to achieving gender parity in PCCM.
Article
Background: Female scientists, who are more likely than their male counterparts to study women and report findings by sex/gender, fare worse in the article peer review process. It is unknown whether the gender of research participants influences the recommendation to publish an article describing the study. Materials and Methods: Reviewers were randomly assigned to evaluate one of three versions of an article abstract describing a clinical study conducted in men, women, or individuals. Reviewers assessed the study's scientific rigor, its level of contribution to medical science, and whether they would recommend publishing the full article. Responses were analyzed with logistic regression controlling for reviewer background variables, including sex and experience level. Results: There was no significant difference in perceived research rigor by abstract condition; contribution to medical science was perceived to be greater for research conducted in women than men (odds ratio = 1.7; p = 0.030). Nevertheless, reviewers were almost twice as likely to recommend publication for research conducted in men than the same research conducted in women (predicted probability 0.606 vs. 0.322; p = 0.000). Conclusions: These results are consistent with abundant data from multiple sources showing a lower societal value placed on women than men. Because female investigators are more likely than male investigators to study women, our findings suggest a previously unrecognized bias that could contribute to gender asymmetries in the publication outcomes of peer review. This pro-male publication bias could be an additional barrier to leadership attainment for women in academic medicine and the advancement of women's health.
Article
Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.
Article
PURPOSE Variation in the use of radiation oncology procedures and technologies is poorly characterized. We sought to identify associations between the treatment planning codes used to bill for radiotherapy procedures and the demographic characteristics of the radiation oncologists submitting them. METHODS The Physician and Other Supplier Public Use File was linked to the Physician Compare database by using the physician National Provider Identifier for the year 2016. Analysis was stratified by practice setting, considering both the freestanding non–facility-based (NFB) setting and the facility-based (FB) setting. Multivariable logistic regression was used to determine provider characteristics (gender, practice rurality, and years since graduation) that predicted for the use of 3D-conformal RT (3DCRT) planning, intensity-modulated RT (IMRT) planning, and brachytherapy planning in the Medicare population. RESULTS Three thousand twenty-nine physicians were linked for analysis. In both the FB and NFB settings together, male gender predicted for decreased likelihood of 3DCRT planning (OR, 0.70, 95% CI, 0.62 to 0.80, P < .001) and increased likelihood of IMRT planning (OR, 1.35, 95% CI, 1.19 to 1.54, P < .001). Brachytherapy planning was also more likely with increasing years since medical school graduation (OR, 1.03, 95% CI, 1.01 to 1.04, P < .001) in the combined FB and NFB settings. These significant associations persisted when examining the NFB and FB settings individually. In both settings overall, brachytherapy planning was more likely in male providers (OR, 1.75, 95% CI, 1.10 to 2.76, P = .02) and also more likely for providers practicing in metropolitan regions compared with those practicing in rural areas (OR, 3.01, 95% CI, 1.23 to 7.39, P = .02). CONCLUSION Male gender predicts for utilization of IMRT planning, whereas female gender predicts for utilization of 3DCRT planning. Future research is warranted to better understand the role that provider gender and rurality play in the selection of radiation planning techniques for Medicare patients.
Article
Objective To investigate the contribution of financial stress to physician burnout and satisfaction among women physiatrists. Relationships among education debt and compensation with demographic, sociologic, and workplace factors were also assessed. Design This was a cross‐sectional survey study of women physicians in the field of physical medicine and rehabilitation (PM&R) in the United States. The survey consisted of 51 questions covering demographic information (current and maximum education debt, race/ethnicity, years out of training, practice type and setting, hours worked, family structure, and domestic duties), work/life satisfaction, and burnout. The association between current/maximum debt and demographic characteristics, work/life satisfaction, and physician burnout were examined. Results Of the 245 U.S. women attending physiatrists who met inclusion criteria, 222 (90.6%) reported ever having education debt (median category $101 000‐150 000) and 162 (66.1%) reported current debt (median category ≤ $50 000). Of these participants, 218 (90.5%) agreed that they would have fewer burnout symptoms if they were able to do more work that is core to their professional mission and 226 (92.2%) agreed that feeling undervalued at work is linked to physiatrists’ burnout symptoms. Greater debt was seen in those who identified as Black/African American, were fewer years out of training, practiced general physiatry, and had both inpatient and outpatient responsibilities. Greater current debt had a significant relationship with measurements of work/life dissatisfaction. Burnout was associated with higher debt, lower compensation, more hours worked per week, and fewer hours of exercise performed per week. Conclusions This study examined women physiatrists’ perceptions of financial stress and found that greater education debt was associated with personal life dissatisfaction, career regret, and burnout. Further research is needed to address related causes and solutions.
Article
Objective Although women attend medical school and residency at similar rates to men, they experience lower levels of academic career advancement than men. To inform national gender equity efforts, the authors conducted a qualitative study to explore potential gender differences in the career experiences of junior research faculty at a premier research institution.Methods Focus group discussions were conducted among women and men junior research faculty at the School of Medicine at an urban public research university. Participants were early mentored career development award recipients (K-awardees). Two same-gender focus groups of nine women and six men were conducted. Discussions focused on two domains: barriers to maintaining a research career and facilitators for research career development. Data were analyzed using ATLAS.ti and content analysis methods.ResultsBoth women and men identified a challenging funding environment, difficulty bridging the salary gap, and lack of institutional support as barriers to maintaining their research careers. Women perceived two primary barriers to their career advancement that were different from their male counterparts: They were more likely to feel undervalued at the institution and to experience significant strains related to both childbearing and childcare. Women also reported receiving inadequate mentorship, having poor negotiation skills, and experiencing a lack of negotiation opportunities.Conclusions Academic research institutions should consider interventions that provide financial, emotional, and practical support to women research faculty, particularly during their childbearing and childrearing years.
Article
Background: Several studies in critical care and neurology demonstrate women under-representation in professional societies; representation trends within the Neurocritical Care Society (NCS) are unknown. We examined longitudinal gender parity trends in membership and leadership within NCS. Methods: A retrospective study of NCS membership and leadership rosters was conducted. To determine gender, self-reported binary gender was extracted. For individuals without recorded gender, a systematic Web-based search to identify usage of gender-specific pronouns in publicly available biographies was performed. According to previously published methods, available photographs were utilized to record presumed gender identification in the absence of available pronoun descriptors. We analyzed available data longitudinally from 2002 to 2019 and performed descriptive statistical and linear regression analyses. Results: In overall membership, the proportion of women members demonstrated an average 11% increase between 2005 and 2018 (95% confidence interval (CI) - 8.1 to 30.1, p = 0.08). The proportion of women Board of Directors (BOD) members increased significantly over time to 50% in 2019. There was an increase in women Officers from 0% in the first 3 years (2002-2004) to 40% in 2019, with two women Presidents out of 17 from 2002 to 2019. For available Executive Committee rosters, there was a statistically significant nearly 3% increase per year (95% CI 1.5-4; p = 0.0007) in the proportion of women members. Rosters for Committee members and chairpersons were also incomplete, but in an analysis of the available data, there was a statistically significant increase of 5% per year analyzed (95% CI 0.5-9.7; p = 0.04) in the proportion of women Committee members. We also found a statistically significant 4.3% increase per year analyzed (95% CI 2.4-6.1; p = 0.003) in the proportion of women Committee chairpersons. Conclusions: This is the first study of longitudinal gender parity trends within neurocritical care. We report that from 2002 to 2019, the NCS has undergone a significant increase in women representation in general membership, committee membership, and leadership positions.
Article
Although women are increasingly represented in academic medicine, gender inequities persist in senior positions. Endowed chairs are among the most distinguished roles in a university setting and typically provide funding that can support salary, novel research, or staff for the chair holder.¹ Previous research has documented gender differences in compensation, funding, authorship, and leadership positions in medicine.²⁻⁴ To our knowledge, no prior studies have examined whether inequities exist in the allocation of endowed chairs within academic medicine. Thus, we examined the gender distribution of endowed chairs in departments of medicine and determined if gender is associated with holding an endowed chair after controlling for other relevant characteristics.
Article
Even after 20 years of near gender parity among medical students, the gender composition of physician specialties varies dramatically with some becoming increasingly female-predominant while others remain overwhelmingly male. In their analysis of physician workforce data, the authors demonstrate that despite large increases in the number of female physicians over 4 decades, the degree of gender segregation between specialties has not declined. The authors describe lessons from the highly gender-segregated U.S. workforce as a whole to understand these demographic patterns in the physician workforce. Echoing U.S. workforce findings, women physicians are becoming overrepresented in certain specialties and this appears be associated with a relative decline in earnings for physicians in these specialties over time. The authors found a strong negative relationship between the proportion of female physicians in a specialty and its mean salary, with gender composition explaining 64% of the variation in salaries among the medical specialties.Female physicians face biases in the workplace and fall behind male peers in leadership attainment, academic advancement, and earnings. Tenacious gender stereotypes and the conflation of gender and status contribute to these biases and reinforce occupational gender segregation. The clustering of women in certain specialties means these specialties will be disproportionately affected by gender bias. Recognizing the consequences of gender demographics within physician specialties is important to maintain the strong and diverse physician workforce needed to support the health care needs of the populations who depend on these specialties for care.
Article
Introduction Visiting professorship is an enjoyable activity that is also influential in academic promotional processes as evidence of the invitee’s national reputation. Little is known, however, about the factors considered when selecting visiting professors (VPs) or whether this practice reflects objective criteria. We sought to characterize the process and diversity of participants in visiting professorships within academic radiation oncology (RO) to determine whether opportunities are equitably distributed. Methods Surveys were distributed to Program Directors (PDs) of every 2018 ACGME-accredited RO residency program. PDs were asked to identify all VPs over the past 2 years and to describe their departments’ decision-making processes. Publicly available demographic and academic characteristics were obtained for each VP, and results were compared by VP gender and hosting program (HP) 2019 Doximity rank using χ2 test for categorical data and t test for continuous data. Results PD response rate was 60/93 (65%). 6 surveys were ≥50% incomplete and excluded. Over a 2-year timeframe, 51/54 departments hosted 233 VPs, of whom 29% were women. The mean number of hosted VPs (5, range 1 –19) and gender distribution (35% women, range 0 –100%) did not significantly differ by HP rank (p =0.17 and 0.65, respectively), nor did the selection criteria for which VPs were primarily chosen (subject matter expertise, teaching reputation, and resident interest). Women received significantly lower honoraria amounts than men (p =0.035) despite no significant differences by gender in academic rank (p =0.71), VP department rank (0.19), or M-index (0.83). Conclusion Although sample size is limited, this study suggests that academic RO programs have a relatively equitable approach to selecting VPs that emphasizes trainee education and reflects the gender diversity of RO faculty more generally. Care should be taken to ensure that these similarly qualified women are offered the same amount of honoraria as their male colleagues.
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Importance: Limited evidence exists on salary differences between male and female academic physicians, largely owing to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes, or limited geographic representation. Objective: To analyze sex differences in earnings among US academic physicians. Design, setting, and participants: Freedom of Information laws mandate release of salary information of public university employees in several states. In 12 states with salary information published online, salary data were extracted on 10 241 academic physicians at 24 public medical schools. These data were linked to a unique physician database with detailed information on sex, age, years of experience, faculty rank, specialty, scientific authorship, National Institutes of Health funding, clinical trial participation, and Medicare reimbursements (proxy for clinical revenue). Sex differences in salary were estimated after adjusting for these factors. Exposures: Physician sex. Main outcomes and measures: Annual salary. Results: Among 10 241 physicians, female physicians (n = 3549) had lower mean (SD) unadjusted salaries than male physicians ($206 641 [$88 238] vs $257 957 [$137 202]; absolute difference, $51 315 [95% CI, $46 330-$56 301]). Sex differences persisted after multivariable adjustment ($227 783 [95% CI, $224 117-$231 448] vs $247 661 [95% CI, $245 065-$250 258] with an absolute difference of $19 878 [95% CI, $15 261-$24 495]). Sex differences in salary varied across specialties, institutions, and faculty ranks. For example, adjusted salaries of female full professors ($250 971 [95% CI, $242 307-$259 635]) were comparable to those of male associate professors ($247 212 [95% CI, $241 850-$252 575]). Among specialties, adjusted salaries were highest in orthopedic surgery ($358 093 [95% CI, $344 354-$371 831]), surgical subspecialties ($318 760 [95% CI, $311 030-$326 491]), and general surgery ($302 666 [95% CI, $294 060-$311 272]) and lowest in infectious disease, family medicine, and neurology (mean income, <$200 000). Years of experience, total publications, clinical trial participation, and Medicare payments were positively associated with salary. Conclusions and relevance: Among physicians with faculty appointments at 24 US public medical schools, significant sex differences in salary exist even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue.
Article
It is unclear whether male and female physician researchers who perform similar work are currently paid equally. To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors. A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address. The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary. A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research. The mean salary within our cohort was $167,669 (95% CI, $158,417-$176,922) for women and $200,433 (95% CI, $194,249-$206,617) for men. Male gender was associated with higher salary (+$13,399; P = .001) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12,194 higher than observed. Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.