The 2013 class of medical students has a special distinction. While women have been pursuing medicine in increasing numbers in the past several decades, this the first class that contains more women than men. The trend raises a number of questions about the future of the profession.
How far do women physicians still have to go to gain parity with their male counterparts?
A 2012 study by University of Michigan professor Dr. Reshman Jagsi found that over their careers, women doctors lose $350,000 to the gender wage gap. That study controlled for work hours, area of specialty, and all other career and life choices and found that women still made about $12,000 less each year than similarly qualified men doing the exact same type and amount of work.
Similarly, in a number of studies, women report a high rate of gender-based discrimination and sexual harassment, compared with their male counterparts, and in some cases, harassment affected women’s choices of specialties and ranking of programs. According to a 2000 survey of more than 3000 full-time faculty members at 24 randomly selected U.S. medical schools, about half of the female faculty experienced some form of sexual harassment.
Will medicine and medical education need to undergo a culture shift?
In “Changing the Culture of Academic Medicine” Dr. Linda Pololi examines the medicine though the lens of female faculty. Interviews with these physicians revealed a number of disturbing observations, among them:
- Faculty who profess a love of teaching, research and clinical practice experience a high level of burnout, contemplate leaving academic medicine and would not recommend to others that they become physicians.
- Faculty note an erosion of idealism among medical students and wonder what the implications are for their future practice of medicine.
- Faculty also reported a startling level of unethical behavior among medical researchers.
CIR members’ responses to a 2012 survey on resident values corroborate those findings. Of the 324 respondents, 83 percent of the women respondents said they had witnessed colleagues lose sight of values they once held. Female residents rated burnout and quality of life as their number two concern when thinking about their future in medicine. Male residents rated it fourth.
How can we develop leadership that matches the demographics of the profession?
While women may start to surpass men in the early stages of the medical career, physician leadership is still male dominated. One other key concern in Dr. Pololi’s research is the advancement of women to leadership positions. Women still represent a small fraction of physician leaders in both academic medicine and the healthcare industry yet the record numbers of female medical students show this fact is not due to pipeline issues. How can we ensure that the growth of women in the profession continues up the leadership chain?
These questions raise many concerns about the future of the profession for all physicians. CIR Vitals found that doctors and policymakers are working hard to find legislative, collective bargaining and professional development solutions to these challenges.
Gender Equity in Academic Medicine: What are the Remedies?
According to the U.S. Census Bureau, in 2011, women who worked full time earned, on average, only 77 cents for every dollar men earned. The figures are even worse for women of color. African-American women earned only approximately 64 cents and Latinas only 55 cents for each dollar earned by a white male.
Women physicians are no exception. While women have made great strides in academic medicine, the persistent gender wage gap is hard to ignore. While there are no legislative or policy prescriptions that specifically address gender inequities in medicine, there are some national and local remedies that apply to all workplaces.
The Lilly Ledbetter Fair Pay Act
The Lilly Ledbetter Act, signed by President Obama in January 2009, makes clear that pay discrimination claims on the basis of sex, race, national origin, age, religion and disability “accrue” whenever an employee receives a discriminatory paycheck, as well as when a discriminatory pay decision or practice is adopted.
Ledbetter was one of the few female supervisors at a Goodyear Tire plant in Alabama, where she worked for
close to 20 years. She filed a complaint after learning that her male colleagues were getting paid much higher salaries for doing the same work that she did. While she won back pay initially, the case was overturned by a higher court, and the Supreme Court ruled that employees cannot challenge ongoing pay discrimination if the employer’s original discriminatory pay decision occurred more than 180 days earlier, even when the employee continues to receive paychecks that have been discriminatorily reduced. The 2009 Act restores longstanding anti-discrimination provisions dating back to the Civil Rights Act of 1964.
The Paycheck Fairness Act
This bill, introduced by Senator Barbara Mikulski (D-MD) and Representative Rosa DeLauro (D-CT), would make it harder for employers to hide pay discrimination, help train women and girls about salary negotiation, support government collection of critical wage data, and reward employers that have good pay practices. The bill has been introduced multiple times in both chambers but has been blocked by House GOP members.
The Employment Non- Discrimination Act (ENDA)
ENDA would prohibit employment discrimination based on sexual orientation and gender identity in most American workplaces. The legislation is scheduled for a vote in the House and the Senate this fall. If passed, it would extend fair employment practices to gay, lesbian, bisexual and transgender people.
Harnessing the Power of Collective Bargaining to Change Residency Culture
CIR members understand the power that comes with the ability to advocate for themselves and their patients through collective bargaining. In addition to negotiating over concerns such as salaries, work conditions and availability of medical equipment, many housestaff have used their bargaining power to help establish a more equitable workplace.
Many of the contract benefits focus on the challenges faced by residents who begin families during their training. For women
who wish to have children, deciding whether to conceive during residency can be a difficult decision. It’s often a choice between delaying training, managing the hectic work schedule and possibly damaging relationships if their programs are unsupportive or, on the other hand, postponing motherhood and risking lowered fertility, pregnancy complications and reliance on technology.
From maternity leave to child care, residents have used the power of collective bargaining to begin to change the culture of residency that makes the decision all the more difficult.
In Boston, residents at Cambridge Health Alliance have negotiated six months of maternity leave to help foster a culture where residents can take leave without fear of repercussions. Boston Medical Center housestaff negotiated for a new mother room that features pumping machines, a refrigerator and a couch. Residents also have access to the Parents in a Pinch program, which provides affordable backup childcare when regular childcare options fall through.