Celebrating Women in Medicine: Progress, Challenges, and a New Kind of Power – Renal and Urology News

National Women in Medicine Day, celebrated earlier this month, “acknowledges the vital roles that female physicians play in patient care, medical research and leadership within the health care field,” according to the American Medical Association (AMA).¹

Established on February 3, 2018, (on the birthday of Dr Elizabeth Blackwell, who became the first US woman to earn a medical degree in 1849), the Women in Medicine Day observance “underscores the importance of fostering gender diversity and equitable opportunities in the medical profession, ensuring that the legacy of pioneering women physicians endures,” states the AMA website.¹

Despite the vital role played by women in today’s health care system, female physicians still face many challenges. These challenges were highlighted at the fifth annual Women in Medicine Summit, a continuing medical education conference hosted late last year by Women in Medicine (WIM), a Chicago-based nonprofit organization. Since then, WIM has also worked with Sheryl Sandberg, author of the best-selling book Lean In: Women, Work and the Will to Lead and the creator of the nonprofit organization Lean In, to create professional networking and mentoring groups for female physicians.

To mark Women in Medicine Day as well as International Women’s Day on March 8, this report offers highlights of the latest Women in Medicine Summit along with details of WIM’s newly created Lean In Circles and other initiatives aimed at empowering and advancing women in medicine.

Addressing Systemic Challenges

The first Women in Medicine Summit was organized in 2019 by Shikha Jain, MD, an associate professor of medicine in the Division of Hematology and Oncology at the University of Illinois in Chicago. Dr Jain subsequently founded the Women in Medicine organization. After hearing many of her female colleagues tell stories about the challenges and barriers they had faced early in their careers — challenges that she herself had also faced — Dr Jain determined that many of these problems were systemic and needed to be identified and addressed as such. She noted that many of these pressures are even greater for female physicians with intersectional identities, such as women of color.

As Dr Jain explained, “We wanted women to have a space to come together and talk about challenges. We wanted to provide tools, education, and opportunities for people to work towards changing the systems within their own institutions and organizations while also pursuing professional development and personal growth.”

Systemic challenges that still affect women in medicine include:

Gender Bias

Female physicians encounter gender bias from both other medical professionals and patients, which often manifests as an overall lack of respect for their expertise and accomplishments. Gender bias is often expressed unconsciously. For example, women in medicine are less likely to be called by their professional titles than are men. This under-use of titles and differential use of formality can influence perceived competence and authority.² Various forms of gender bias can also indirectly contribute to the experience of imposter syndrome among women and even to physician burnout.³

Sexual Harassment

Awareness of sexual harassment as a problem in the medical field has grown over the past several years, yet incidents still occur. Dr Jain pointed out that the current systems do a poor job of holding harassers accountable; women who report harassment are often the ones who end up penalized. Trainees and young career professionals may especially be afraid to report harassment, fearing possible career retaliation, and offenders with the highest status are often the most protected.⁴

Balancing Career and Family

Another ongoing challenge for women is balancing their career responsibilities with their personal obligations, such as caring for children and aging parents. Institutions and workplaces differ in terms of the support and flexibility allotted to women during pregnancy and breastfeeding. Even beyond that, women often end up taking on more household and family responsibilities compared to their male counterparts.

Dr Jain pointed out that after a woman has a child, people sometimes make certain assumptions – such as thinking that motherhood will ultimately limit the woman’s career growth and options. These assumptions often affect the advice and opportunities offered — or not offered — to women who are both physicians and mothers. It should not be assumed that women with children can’t or shouldn’t take on demanding career roles, Dr Jain stressed; women should have the opportunity to make their own choices about how to best manage their professional and personal lives.

Compensation and Career Paths

Relatedly, salary gaps persist for women in every medical specialty. It’s not clear to what extent this is mediated by the different financial effects of parenthood on women compared with men, but the effect seems to persist even after accounting for factors such as maternity leave and part-time hours.⁵ Some evidence suggests that, on average, female physicians more often provide preventive care, perform more psychosocial counseling and patient-centered communication, adhere more closely to clinical guidelines, and provide care with better overall patient outcomes.⁶ Yet female physicians are sometimes not compensated for many of the activities that improve both patients’ experience and overall outcomes, like responding to patient online questions, spending more time on documentation, or helping with diversity, equity, and inclusion (DEI) initiatives.⁷

Women are now graduating from medical school at slightly greater numbers than men, although some specialty areas are still somewhat male dominated, such as orthopedics or neurosurgery. However, at the highest levels of medicine, women are significantly underrepresented compared with men — for example, as deans, department chairs, or full professors in academic medicine.⁸ This disparity may be partly because promotions are determined more by factors such as grants obtained and less by other factors that are also important to women, such as mentorship, volunteering, and advocacy work.

Sponsorship Is Key

One of the reasons Dr Jain wanted to found the Women in Medicine Summit and WIM nonprofit was to provide more opportunities for mentorship and sponsorship. Mentorship is key for providing guidance on specific career development steps, said Dr Jain, but sponsorship is also critical and is often absent for many women. Sponsorship goes one step further than mentorship: a sponsor actively advocates for the person being supported. For example, a sponsor may recommend someone for an opportunity in a hospital, and then mentor the person to succeed in that role, or nominate someone for an award or a position at a national organization.^9,10

New Power to Create Change

Female physicians can best tackle these and other challenges by working collaboratively, said 2023 WIM Summit Keynote Speaker Megan Ranney, MD, MPH, an emergency physician, dean of the Yale School of Public Health, and an advocate for innovative approaches in public health. Collaborative efforts can improve an individual’s sense of empowerment and control, which in turn protects against burnout and promotes resilience, she noted. “We can’t control so many things, like viruses that emerge, or actions of the CEO at our hospital, but we can control the coalitions we make,” Dr Ranney said.

By working collectively, physicians and other advocates can achieve what otherwise would not be possible. This is part of the concept of “New Power,” an understanding of power that defines it as being open, participatory, and peer-driven — where power is shared with many, rather than hoarded by a limited few, and channeled for good.¹¹ The “New Power” concept was detailed in the 2018 book New Power: How Power Works in Our Hyperconnected World — and How to Make It Work for You, by Jeremy Heimans and Henry Timms.

“Old Power” models are often authoritarian, competitive, exclusive, formal, and rooted in longstanding institutions, Dr Ranney explained. In contrast, “New Power” is more informally governed as well as more inclusive, collaborative, and transparent, and sometimes more temporary in nature, depending on the specific situation. Dr Ranney noted that this “New Power” approach is very consistent with the way many women intuitively come together and collaborate to solve problems.¹¹

Although using “New Power” models can be very effective, “Old Power” and “New Power” systems exist on a continuum, and it’s critical to be realistic about working with existing structures. “As women in medicine, we are inherently living in an “Old Power” world, and we still need to follow “Old Power” structures,” Dr Ranney stressed.

To illustrate how “New Power” models can scaffold onto “Old Power” structures, Dr Ranney talked about her involvement with the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). In 1996, a congressional spending bill rider prohibited use of Centers and Disease Control and Prevention (CDC) funds for advocating or promoting gun control. In the 20 years that followed, research on firearm prevention ground almost to a halt. In contrast to other public health problems — such as car crashes or HIV deaths — which had improved with the aid of public health research and investment, the rate of firearm deaths was not improving. Dr Ranney said she was urged to stay away from this topic, as it would pose a problem for her career.

Determined to not let the issue drop, Dr Ranney instead connected with others who began talking about the topic publicly via social media and professional publications. When the National Rifle Association (NRA) sent a tweet criticizing “anti-gun” doctors for not “staying in their lane,” it set off an avalanche of tweets, in which many people both inside and outside the medical community shared their personal stories of gun violence.^12,13 Eventually this work led to attention from “Old Power,” leading to over 75 million dollars over 3 years in monetary appropriations from the federal government, with additional donations from philanthropic organizations.

After AFFIRM achieved its initial aim of getting funding from the federal government, group leaders decided to merge with an “Old Power” organization, the Aspen Institute, in order to most effectively use resources. This example illustrates the fluidity of “New Power” movements and the potential need for such movements to scaffold onto existing “Old Power” structures as part of the change-making process.

“We want to organize and empower and work with inclusive communities, but for us to create true impact, we often need to work with universities or politicians or hospitals or the supply chain or other ‘Old Power’ institutions,” Dr Ranney explained.

Other Women in Medicine Initiatives

In addition to its annual summit, the Women in Medicine organization offers other leadership development and education opportunities for both women and male allies, a research lab to promote investigation into relevant topics, as well as a speakers’ bureau of that connects women in medicine with speaking opportunities.  

The 2023 Summit also was the launch point for WIM “Lean In Circles,” formed through a partnership with Sheryl Sandberg’s Lean In organization. Through these Lean In Circles, small groups meet virtually or in-person on a regular basis to share skills, expertise, and inspiration. A number of circles are now meeting on an ongoing basis, and opportunities are still available to found new circles (with the help of training and support from WIM) and to join existing circles.

The Lean In Circles offer a way for women in different fields or areas to collaborate, said Dr Jain. Different circles may have the goal of bringing together specific types of professionals, people from a particular locale, or individuals with certain common interests. This format “creates great opportunities for women to learn from each other, grow their networks, and potentially even help [one another] with professional advancement,” said Dr Jain.

WIM has also launched an auxiliary council, providing women across the country with more opportunities to take on leadership positions and plan events in their respective communities. Later this year, WIM is also launching an online social networking platform for female physicians. As Dr Jain explained, “We wanted to create a safe space for women physicians to have a social and professional network along with educational content.”

The sixth annual Women in Medicine Summit will take place September 13 to 14, 2024, in Chicago.

This article originally appeared on Pulmonology Advisor