Women in medicine need to amplify one another, find their “posse,” request coaches and sponsors, and craft their own legacy statements, according to an expert who spoke during an AMA webinar in honor of Women in Medicine Month.
“Lead from where you stand, whether it be pediatricians addressing vaccination or emergency medicine physicians talking about disaster preparedness in a hurricane. Speak about the health impact of an issue,” Vineet Arora, MD, MAPP, from the University of Chicago said during the webinar. “Use your voice to promote medical truth. ... Celebrate the medical heroes among us.”
Arora started the webinar by asking, “Where are the women in medicine who are leading?” Though roughly half of applicants to medical school are women, only one in five women make full professor and 16% rise to the level of dean of a medical school, she explained. This “leaky pipeline” fails women in medicine at that level, but that does not mean women in medicine are invisible or not leading. One-third of associate deans are women, but we do not hear about them, Arora said. Citing Julie K. Silver, MD, Arora discussed how even in medical press or lay press covering medicine, women are still missing.
Silver went on to show that women are underrepresented in benchmark areas of academia such as award recipients of medical societies. The American Academy of Dermatology, Arora said, touts nearly half of practicing physicians as being women as well as faculty, yet one of their prestigious awards has only been given to women 8.3% of the time. In invitations to grand rounds, women are less likely to give those at other institutions and are less likely to be named visiting professors, Arora showed.
The orthopedics field has the lowest percentage of women compared to any other medical field, Kristy L. Weber, MD, second vice president of the American Academy of Orthopaedic Surgeons, told Healio.com/Orthopedics. Lisa K. Cannada, MD, orthopedic surgeon from St. Louis, noted the lack of women in orthopedics could be due to a preconceived notion that orthopedists have to be big, strong and athletic.
“For example, only 3% of [American Association of Hip and Knee Surgeons] AAHKS members are women, and perhaps that is because they think you need to be big and strong to do total joints, whereas 25% of fellows in [pediatrics] are females,” Cannada told Healio.com/Orthopedics.
According to Weber, this problem becomes perpetuated when younger women in the early stages of medical school do not see as many women in orthopedics as in other specialties, leading them to move toward professions with more women leaders.
“Unfortunately, there is still a perception among many that women can’t or shouldn’t do orthopedics, which we know is simply not true,” Rachel M. Frank, MD, assistant professor in the department of orthopedic surgery at the University of Colorado School of Medicine, told Healio.com/Orthopedics. “Not only can women successfully navigate a career in orthopedics, but they can thrive and become thought leaders in the field.”
Arora attributed at least some of this underrepresentation to a discomfort among women — even women physicians — with self-promotion. In many cases, a physician must be sponsored for recognition like grand rounds and association awards and, in many cases, the best way to get that sponsorship is to ask for it.
“Many of us can find mentors in our workspace. It’s harder to find coaches and sponsors,” she said. “A coach is short-term interaction to help with targeted feedback and problem-solving.” She added, “You need a sponsor to ... use their influence in their field to support their mentee to gain visibility.”
Coaches can help women work through job negotiations, and sponsors can put names forward for grand rounds or society awards. Frank encourages women in orthopedics to find a mentor, regardless of gender, “who will support your growth and development both as a surgeon, and as a person.” However, she admits that finding a mentor for women in orthopedics is not easy.
“As there are relatively few females in leadership positions, both in the various societies, as well as in academic departments, it can be challenging for younger women in the field to have someone to look up to or to guide them through the process,” Frank said.
Once recognized by an institution, women must also recognize the passive ways in which their roles can be minimized, Arora said. Specifically, she showed data in which women are introduced as “doctor” less often than their male peers. Though women introducers were on parity between genders, men introducing women called female physicians “doctor” 50% of the time while they did so for men being introduced 72% of the time.
“This could be a more subtle form of bias, and you might think it’s not much,” Arora said. “We will see bias and we need to stand up in defense of our colleagues.”
Arora showed that this is compounded by “maternal discrimination” in the workplace where four out of five physician women reported discrimination and one-third reported discrimination based on being a mother. Pay discordance, consideration for promotion, disrespect by support staff and exclusion from administrative decisions were all heavily impacted by maternal discrimination, she showed. In addition, women who reported maternal discrimination had 74% higher rate of burnout.
“[Women] want to do an excellent job as a mother and they want to do an excellent job as an orthopedic surgeon and there are only so many hours in a day, so sacrifices have to be made if you are not going to get the help that you need at home or at work,” Weber said.
Lastly, Arora pointed to internal threats to women’s success — stereotype threat, the likeability penalty and imposter syndrome, as well as women not supporting one another through “Queen Bee Syndrome” — that can further reinforce the lack of visible women leadership in medicine.
“Women need to support other women, especially women who have gone through their careers and they have been successful and they have achieved leadership positions,” Weber said. “It is important to support other women because the field will not change until there are a much higher percentage of women in leadership positions, whether that is locally in terms of a department or in national leadership positions, etc.”
Arora cited medical school observation data in which men scored 1.5 levels higher than women, which is equivalent to 4 months of additional training. The only correlation being the difference in gender, which led researchers to hypothesize this could be due to stereotype threat. Other research looking at critiques of medical residents’ performance showed mixed messages to women addressing their levels of confidence, assertiveness and aggressiveness.
Even the women quoted in her presentation, Arora said, often responded to her with statements that played down their leadership roles, yet they all lead from where they stand.
“The truth is that we are and we have to accept that and fight the internal voice in our head and go out and lead,” Arora said. “We all have to overcome this to lead.”
She suggested women take on a role of amplification for one another. If each woman consistently gives credit to other women for the strides they’ve made, the research they’ve done or the stance they’ve taken, that amplification will be heard and cut off the chance for someone else to take the credit. Instead, women are often seen to be each other’s worst enemies, with women bullies directing much of their antagonism toward other women.
“We have enough battles to fight that we have to work together, and here’s this genius strategy we can operate on,” Arora said. “It’s important we step out from hiding and say, ‘I’m here and I’m ready to lead.’”
To do so, Arora says to women in medicine: “Find your posse.”
The Ruth Jackson Orthopedics Society is a formal group with the goal of mentoring young women and introducing them to other successful and engaged women in the orthopedic profession, according to Weber. Similarly, Frank noted the Perry Initiative introduces young women to the fields of orthopedics and engineering. However, Cannada noted there are still few programs directed exclusively toward women.
In 2004, Cannada began hosting an annual Women in Trauma Breakfast — now a luncheon at the Orthopaedic Trauma Association Annual Meeting — where women orthopedists could interact, build relationships and provide advice.
“I started the program because there were few women in orthopedic trauma back then, and I felt this way they can find mentors and ... I wanted women to find a positive environment,” she said.
Each woman in medicine should craft her own legacy statement, stand by it and find her support system to make it happen, Arora concluded. In this, you should create your image as a leader and set the goals that you want to achieve.
“This legacy statement centers you to think about what’s your compelling future and inspires you to change your present,” she said. “Think about your legacy because you are writing it every day.”
Healio.com has covered women in medicine for decades in various forms, and these themes recur time and again. See the articles below for how things have changed and how women in medicine continue to fight similar battles to their predecessors. – by Katrina Altersitzand Casey Tingle
“The focus of our discussion ... was about encouraging [women and underrepresented individuals] that are earlier in their careers to utilize those tools in order to gain the advantages of being able to become leaders in their field and to have greater satisfaction with their career and career development,” Norah Terrault, MD, MPH, said. Read More
“A lack of women rural physicians especially limits access to care for women patients, who often prefer women clinicians and appear to complete more screening tests when seen by women,” Julie Phillips, MD, MPH, of the Michigan State College of Human Medicine in Grand Rapids, and colleagues wrote. Read More
“Even in a modern academic cohort of medical faculty, experiences with sexual harassment and discrimination are not uncommon, and they are more frequent among women,” Reshma Jagsi, MD, DPhil, associate professor and deputy chair of radiation oncology at University of Michigan Medical School, told HemOnc Today. “I do not think this is a castigation of academic medicine specifically. It is a sobering reminder of how far we have to go as a society. This is a broader issue.” Read More
“Fixing the pay gap between male and female physicians in academic medicine requires more than just studies showing that it exists; concerted efforts are needed to understand and eliminate the gap,” Vineet M. Arora, MD, MAPP, wrote in an accompanying commentary. “Fixing the gap will also require the courage and leadership of women academic physicians — the ‘Dr. Lilly Ledbetters’ out there — to advocate to eliminate it. It is time that the ‘woman card’ be worth the same amount as the ‘man card.’” Read More
Representation of women, minorities in physician workforce improving, still a long way to go
“Continued efforts are needed to increase the diversity of the physician workforce in the United States, particularly the specialties with the lowest representations of women, blacks or Hispanics,” the researchers concluded. Read More
Barriers to Women Entering the Field of Orthopedic Surgery
In conclusion, women are more underrepresented in orthopedics than in any other specialty. ... One possible way to overcome the previously cited barriers and combat the misconceptions about orthopedic surgery is to provide medical students with opportunities to identify people in the field to whom they can better relate while simultaneously providing practitioners the opportunity to contradict misperceptions about orthopedic surgery. Read More
Women in orthopedic surgery: Raise the bar, narrow the gap
More women enter the profession of medicine every year. However, there has not been an equal increase in the number of women entering the field of orthopedic surgery. The same questions and concerns about the limiting factors of orthopedic surgery seem to come up every year as well. Read More
Although a male-dominated field, more women are pursuing an orthopedic career
The history of orthopedics in the United States has been highlighted by the work of women. In 1937, Ruth Jackson, MD, became the first female board-certified orthopedic surgeon in the country. She wrote The Cervical Syndrome, which for years was a standard orthopedic text. The research of Jacquelin Perry, MD, DSc (Hon), revolutionized gait analysis, and her 1992 book Gait Analysis: Normal and Pathological Function remains a highly regarded text. Despite these role models, historically few women have entered the field of orthopedics. Other specialties have becoming increasingly diverse, while orthopedic surgery has seen a minimal increase in its female membership. Read More
National symposium focuses on increasing the number of women in surgical careers
“Lack of exposure means there are not role models for medical students interested in a career in orthopedics,” Lisa K. Cannada, MD, said. “Certainly, one cannot look for a female department chairperson of orthopedics and, if there are not women faculty in orthopedics who truly are role models and mentors, we cannot make an impact. For those female residents and orthopedic surgeons, the time is now to realize that any positive exposure and communication to women in medicine can make an impact. I encourage all women in orthopedics to take the time to make a difference.” Read More
Women in orthopedics: Facing the challenges, reaping the rewards
“The women of the Ruth Jackson Society are living testament that women could be orthopedic surgeons, professors, wives, mothers, athletes and achieve all the accomplishments and activities that life and our specialty had to offer,” Peggy L. Naas, RN, MD, MBA, said in this RoundTable. Read More
Breaking down barriers: Women make their mark in orthopedics
The history of women in orthopedic surgery begins with Ruth Jackson, MD, who was the first practicing female orthopedist in the United States. She discovered the rewards of orthopedics while working with polio patients under the guidance of Arthur Steindler, MD, at the University of Iowa. Read More
Vineet Arora, MD, MAPP, can be reached at 5841 S. Maryland Ave., MC 2007, Chicago, IL 60637; email: firstname.lastname@example.org.
Lisa K. Cannada, MD, can be reached at 621 S. New Ballas Rd., St. Louis, MO 63141; email: email@example.com.
Rachel M. Frank, MD, can be reached at 2000 S. Colorado Blvd., The Colorado Center Tower One, Suite 4500, Denver, CO 80222; email: firstname.lastname@example.org.
Kristy L. Weber, MD, can be reached at Perelman Center for Advanced Medicine, South Tower rm 10-179, 3400 Civic Center Blvd., Philadelphia, PA 19104; email: email@example.com.