SCCM Resource Library-Achieving Parity: Where Do We Start?

Video Transcription

Good morning. I'm Dr. Roshini Sridharan. I'm the Director for the Anesthesiology Critical Care Medicine Fellowship and the Vice-Chair for Education  in the Department of Intensive Care and Resuscitation at the Anesthesiology Institute of the Cleveland Clinic.  I'm also the incoming Chair for the Committee on Diversity, Equity and Inclusion in the Society of Critical Care Medicine, and I'm going to be talking about achieving parity.  Where do we start?  The learning objectives for this session are as follows. By the end of the session, we should be able to elaborate on the various gender-based disparities that exist in health care,  discuss the reasons behind the slow pace to achieving parity, and discuss strategies to close the gap.  When we are faced with a problem, the first question that all of us need to answer is what is the first step when we seek to find a solution to a problem?  The resounding answer to that question is acknowledgement of the presence of the problem.  Now let's look at some data and facts.  This data from the AAMC, published in December of 2021, shows the gap between male and female applicants to U.S. medical schools from 1981 to 2019.  Parity with respect to the number of female applicants was achieved briefly between 2003 and 2005.  As of 2018 and 2019, about 50% or 51% of the applicants were female and about 49% were male.  Now as per the 2018 AAMC data, only about 35% of the physicians in practice were women as compared to 64% men,  despite there being an increasing number of female applicants to U.S. medical schools and increasing number of female graduates from U.S. medical schools.  Looking at the U.S. medical school faculty rosters for gender and rank, women make up only 25% of the MD-only professors in U.S. medical schools.  And only 35% of the Ph.D. and other doctoral degree professors.  Women make 39% of the MD-associate professors in U.S. medical schools.  If we notice this and look at these trends, this gap shows a tendency towards closing as we move down the ranks from professor to associate professor, assistant professors, and instructors.  The part that I want to highlight here is that in the professor rank, we have less than 50% and more so less than 30% women faculty members.  This chart that's published in December 2021 by the AAMC displays a 30-year trend in percentages of permanent, interim, and active chairs and deans at all U.S. medical schools by gender.  And if you look at this chart, women comprise about 2% of all the deans.  Now looking at this chart which is there on our right, this is about looking at U.S. medical school department chairs by chair type and gender.  Looking at the U.S. medical school department chairs by chair type and gender.  Looking at permanent, interim, and acting chairs, we see that women comprise about 5% of all department chairs in 1995 which kind of improved to about 14% in 2010 and we are at 22% in 2021.  Well it might look like these numbers are getting better and the trend is in reality improving but it's nowhere close to where we need it to be to achieve equity and parity.  Now let's look at the leadership and promotion gap that exists.  Carr and colleagues, they looked at retention, rank, and leadership gender disparities or differences that occur in academic medicine.  And they published their results in 2018 in academic medicine.  They looked at about 1,200 faculty members across 24 U.S. medical schools for about 17 years.  And all these schools were balanced for being public or private and also included in the four AAMC geographic regions.  What they found was that despite adjustment for publications and academic output, women are less likely than men to make professor, remain in academic careers, or attain leadership positions.  Looking at a study which was done a little bit more recently and published in 2020, Richter and colleagues looked at women physicians and promotion in academic medicine and this was published in the New England Journal of Medicine.  They looked at over 500,000 graduates from 134 U.S. medical schools over a 35-year period.  And again, not surprisingly, they found that women were less likely to be promoted to the rank of associate or full professor or be appointed as a department chair as compared to men despite being matched for their academic output, their publications, their research output, and clinical revenue that they generate.  Now this problem that we have is not just unique to medical schools or physicians.  About 60% of pharmacy school graduates are women and we know that about 0% retail chain pharmacy CEOs were women and only about 36% of large national pharmacy and drug association CEOs are women.  Now these disparities that we're talking about is not just unique to medicine or healthcare sciences and the story is no different in the corporate world.  In the Women in Workplace report, which was published in 2021 by McKinsey & Company and Leanin.org, we can see that despite having small increases in the number of women in entry-level positions, there's a huge lag in the positions held by women at the level of vice president or at the C-suite levels.  Furthermore, it's important to recognize that women of color and other intersections seem to have more challenges and a wider gap to cover in these scenarios.  There's a myth that's often propagated that women who do not emulate the traditional leadership qualities that are usually attributed to men, including their stoicness, the physical appearance, strength, power, autonomy, and rationality, and those who demonstrate the softer skills and are perceived as being emotional or motherly, especially if she is a mother.  And they somehow assume that she would not do well in the role of a leader or want to pursue a leadership role.  I want to highlight this aspect that was highlighted in the Women in Workplace report that was put out by McKinsey & Company and Leanin.org, where they showed that employees with women managers are more likely to say that their manager had supported and helped them over the past year, especially noticing that this was the year with the pandemic.  There were various actions that were taken by managers to support employees and across all these skills, providing emotional support, checking in, helping them and making sure that the workload was manageable, helping them navigate work-life challenges and helping them take actions to prevent and also to manage burnout.  Women thrived and they excelled in these roles as leaders. And it's important to note that this is 2022 and women have shattered many of these barriers and they've demonstrated excellence in leadership across several spheres and through some of the traditional qualities and attributes of a leader, but also by demonstrating inclusion, care, compassion, empathy, innovation, and collaboration, which by the way, works well for both women and for men leaders.  Now coming on to an important topic of pay equity. It is a sensitive topic and it is one of those things when every time we talk about it, everybody says that, well, that seems like it's really wrong, but then it's been decades and we've not really made a movement towards equity in this particular sphere.  I want to highlight one of these articles, which was published very recently. It was published on Feb. 2022, addressing gender-based disparities in earning potential in academic medicine.  They looked at over 50,000 academic physicians and they found that women had a lower starting salary in 43 out of 45 subspecialties.  They had a lower mean annual salary growth rate in 22 out of the 45 subspecialties and a lower tenure earning potential in 43 out of the 45 subspecialties.  I mean, this is a point, but then this is true and it is a fact that exists and something that all of us need to recognize and work towards making this better.  A slightly older publication looking at sex differences in physician salary in U.S. public medical schools. This was published in JAMA Internal Medicine.  They extracted the salary data for over 10,000 academic physicians at 24 U.S. public medical schools and despite accounting for age, experience, speciality, faculty rank, research, clinical productivity, despite accounting for all of this, there were significant gender differences in the salary.  And the biggest one that which I was shocked when I was reading this, they looked at the earning data from over 80,000 full-time U.S. physicians and they adjusted the salary for hours worked, RVUs generated, practice type, and specialities.  And they found that female physicians earned an estimated $2 million less than male physicians over a simulated 40-year career.  I think I'm going to give a couple of seconds for that to sink in.  Again, not something that's just exclusive to medicine or physicians. It's been shown that women pharmacists made 94 cents to the dollar that men pharmacists earned in 2020.  And it has been consistently shown that women pharmacists earned less than male pharmacists after controlling for human capital stock, job related characteristics, and opinion variables.  And it has been noted also that there is a 6.4% pay gap in favor of male pharmacists.  Again, similar situation with women physical therapists as well, with women physical therapists getting paid 91 cents to the dollar as compared to men who are physical therapists.  Now looking at the gap in authorship. The first article I want to highlight is a special article that was published looking at female authorship in major academic gastroenterology journals over 20 years.  They looked at over 6,000 articles between 1992 and 2012. The female first authors did increase from 9.1% to 29.3% in 2012.  And the female senior authors increased from 4.8% to 14%. Again, nowhere close to equity.  Looking at the trends and comparison of female first authorships in high impact, specifically high impact medical journals, which was published in 2016.  They looked at about over 3,000 articles and journals, including the Annals of Internal Medicine, Archives of Internal Medicine, BMJ, JAMA, Lancet, and NEJM.  Again, over about 20 years, 1994 to 2014, they found that only 34% of the first authors were women and the authorship had increased from 27% to 37%, a marginal increase over 20 years.  And they specifically noticed that in the New England Journal of Medicine, the female first authorship was decreasing, whereas in BMJ, they noticed a trend towards an increasing female first authorship.  Now, specifically looking at critical care publications, this was published recently in 2021 in the Annals of Intensive Care, where they looked at gender disparity in critical care publications and also tried to look at a female first author index.  They looked at over 7,000 articles between 2008 and 2018, between 11 specialty and general journals, and they found that about 30% of the first authors were women, there were only 15% of the senior authors who were women.  And specifically, and an interesting aspect that they were able to note in this is that female senior authorship, when there was a senior author who was a woman, there was a 1.9-fold increase in the likelihood that the first author would be a woman as well.  This is another large study, which was looking at gender differences in authorship, specifically in critical care literature, also fairly recent, published in 2020, where they looked at over 18,000 studies, about 30% of the first authors were women, about 19% of the senior authors were women.  They, again, similar to the previous article we were talking about, there was a substantial increase in the female first authors when the senior author was a woman as well.  And it was, again, interesting to note that the female first authors had a higher probability of publishing in lower-impact journals as compared to men, again, kind of going along with the previous article that we were talking about, the five high-impact journals and the decreasing occurrence of women first authors in NEJM versus an increasing in BMJ.  This kind of goes along with it where they noticed that the female first authors had a higher probability of publishing in the lower-impact journals as compared to men.  Now looking at editorial board memberships and leadership roles in those editorial boards.  Firstly, talking about, you know, sex distribution in editorial board members amongst emergency medicine journals, there were 73 journals, 46 editorial chiefs, out of which, you know, nearly four were women, and out of about 1,400 editorial board members, only about 241 were women.  Similarly, looking at radiology editorial boards, and they also looked at the female first authors in this one, over 3,000 first authors, about 9,000 editorial board members, women were first authors in only about 29% of the studies, senior authors in about 20%, slightly higher than what it was in the previous studies that we quoted.  But when we looked at editorial board members, women merely made only 13% of the editorial board members out of the 9,400 editorial board members who were there.  A more recent study looking at the representation of women among editor-in-chiefs of leading medical journals, this was a cross-sectional study, it was found that women represent only one in five of the editor-in-chiefs of major medical journals.  Overall, only about 21% of editor-in-chiefs were women. There were five categories or specialities in which there were no women editor-in-chiefs at all, including dentistry, anesthesiology, allergy, ophthalmology, and oral surgery and medicine.  And in 27 of the 41 categories, there were less than one third of the women were editor-in-chiefs. For example, for critical care medicine, specifically, I wanted to highlight that, one in 10 for critical care medicine.  Now going on to societal leadership. A fairly recent study published in November 2021 in the Journal of Critical Care, where they looked at gender distribution in boards of intensive care medicine societies.  They analyzed the board members and presidents of all the societies associated with the ESICM. There were 65 presidents and 820 board members, only 10 presidents, about 15%, and 231 board members, 28% of the board members were women.  Now the ESICM is unique in this that we have about 50% women on our board, but the majority of societies, there is less than 30% representation of women on their boards.  So, summing it up and putting it all together, when we are talking about gender equity in medicine and in healthcare sciences, what have we learnt so far?  Really what we have learnt so far is that we are very, very far from it, despite having  small gains over years and in fact over decades, we are nowhere close to parity yet on several  fronts, be it academic promotions, be it leaderships, as being a dean or department chair in first  authorship, in senior authorship, in editorial board membership, being editor-in-chiefs, or in societal leadership. Across all these fronts, we are lagging behind.  Yes, we are making really small progresses, but really nowhere close to where we need to be. The question that begs to be answered is, why are we not there yet?  This has been decades that we have been putting in all these efforts. There have been dramatic changes in the movement towards gender equity from like 1990 to 2018,  but then we have noticed there is some kind of a slowdown in this movement. A couple of reasons that have been postulated as to why this might be happening, part of  it is that people assume that gender equity, inequity exists, but really not in their organization.  That it's kind of an issue in the past, we used to have it, but we did certain things and now it's all gone.  And also an assumption that just putting initiatives in place is equivalent to addressing the problem  that is existing and not re-evaluating and re-looking at those initiatives and the results it has brought forth.  And finally, the assumption that when inequity incidents are brought forth and the data is presented saying that this has nothing to do with gender.  This just kind of happened and it had nothing to do with gender. These are the various reasons that have been postulated as being a reason for not being there yet.  And I mean this just goes to indicate that there is a need for a substantial institutional organization and cultural change.  And it is being noticed time and again that there's a lack of recognition of biases and disparities that exist in daily interactions which need to be highlighted and people need  to be educated about it. So we know, we've established that disparities exist. We've seen across various areas disparities exist. We kind of know why this is still there.  The question is what can we do? So academic advancement. What are the things that we need to do to ensure that women are appropriately advancing on an academic front?  The first and foremost is to educate faculty members on gender related issues and biases that exist to show them that this is a reality.  To create faculty development programs, mentorship programs, and sponsorship programs for women  so they could advance and to recognize their accomplishments and achievements when they do get there.  To have objective criteria for promotion for institutions that is freely accessible so women can see what they need to do to get to the academic level that they need to get to.  Now pay equity. This is another, it's a sensitive issue like I talked about before but it's important to  improve the financial literacy of women during training and also to intentionally focus on their negotiation skills.  It has been noticed that women negotiate less commonly and less successfully than men and women who try to negotiate are not rewarded in the appropriate way.  And it should never be reliant on the individual to recognize the inequities with their paycheck.  It should be on the department leaders to show the transparency in their pay structure and also show specific criteria that contribute to pay raises to make it equitable for all  their faculty members. So overall things that we could do to ensure there's some form of equity in pay and that  we abolish the gender-related pay gaps is to educate and train women on negotiation skills to have transparent departmental pay structures.  There has to be periodic compensation re-evaluations to recognize divergence if it is happening  and time and again there needs to be gender-based pay audits to also pick it up and recognize  if there is a disparity that's happening that is whether it's conscious or unconscious to pick up on those disparities and make adjustments accordingly.  What about authorship and academic productivity? A couple of things that departments and organizations can do is to actually move the education sessions  and meetings to family friendly times to help women attend them and learn from them to have  coaching mentorship sponsorship programs specifically focused on helping them with these efforts to increase their research productivity, academic productivity and their authorship.  Intentional inclusion of women in organizational and societal speaking engagements and to focus  on inclusion of women on guidelines and consensus group and this is another thing that is in abysmal low is the lack of inclusion on women on guidelines and consensus committees and  journals and editorial boards have to focus specifically on including women in their teams and groups. When we are looking at societal leadership, how do we get there?  DEI, diversity, equity and inclusion should be a part of the key objectives for all medical societies.  There should be specific committees that are created to work on these efforts and initiatives that are put forth.  All of these societies should have a goal of having at least 50% women on their boards and you have to delineate initiatives to achieve these goals and look at the results  on what they are able to achieve with their initiatives and if they are not able to achieve  what they intended to with the initiatives to reevaluate, recalibrate based on that results.  Program committees and this is essential for conferences to focus on the avoidance of mantles and to focus on diversity of their speaker panels.  The question is, yes, we talked about a lot of things. Yes, there are inequities. Yes, there are things that we could do, but do these things help?  We've seen that, you know, over the 10 years, it's not a whole lot of change that has happened, but all of these efforts, do they help? The quick answer to it is yes.  And a research-based answer to it is here. You know, this was a study that was published in 1996, where this was in the Department of Medicine  at Johns Hopkins, where they looked at, from 1990 to 1995, they looked at gender-based career obstacles, and they put forth interventions to address those obstacles.  And Fried and colleagues published this in 1996, and they looked at retention, promotion, salary equity, mentorship, and manifestations of bias.  After these interventions were intentionally put in place and followed through over a period of five years, they noticed that promotion from associate professorship increased 550%.  From five in 1990, they have 26 in 1995.  There was 183% increase in retention of women. There was increase in timely promotion. There was decreased gender bias, and there was increased salary equity.  So the answer is, do these efforts help? Absolutely, yes. But if they are put forth in the right way, they're implemented the right way, and the results are followed through  and recalibrated based on what we see. All of these do help to increase parity and improve equity.  I'd like to close up with a quote from Ruth Bader Ginsburg.  As women achieve power, the barriers will fall. As society sees what women can do, as women see what women can do, there will be more women out there doing things  and we'll all be better off for it.  Thank you for the opportunity, and I hope all of you are having a fantastic Congress.

Video Summary

Dr. Roshini Sridharan discusses the gender-based disparities that still exist in healthcare and academia. Despite an increasing number of female applicants and graduates from medical schools, there is still a significant gap in the number of women in medical practice, faculty positions, and leadership roles. The lack of gender equity is also seen in other fields, such as pharmacy and corporate organizations. Dr. Sridharan highlights the need for institutional and cultural changes to achieve parity. She emphasizes the importance of acknowledging the presence of the problem, educating faculty members on gender biases, implementing mentorship and sponsorship programs, promoting transparent pay structures, and focusing on diversity and inclusion. She also discusses the disparities in authorship and academic productivity, as well as the need for women to improve negotiation skills and have equal opportunities for leadership roles. Dr. Sridharan concludes by stating that efforts to address these disparities do make a difference and will lead to a better future for women in medicine and other fields.

Asset Subtitle

Administration, Professional Development and Education, 2022

Asset Caption

Although we are making strides in advancing women and other underrepresented groups in critical care medicine, a lot of work remains to be done. The first step in this process is providing education to trainees in all disciplines on gender and inclusivity. Furthermore, identifying the barriers to achieving parity paves the way to a structured approach for removing these barriers. This session is aimed at creating awareness and providing education on the existing gender culture in critical care medicine and strategies for enhancing inclusivity.

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Area Professional Development and Education

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Workforce

Tag Team Leadership

Year 2022

Keywords

gender-based disparities

healthcare

academia

gender equity

institutional changes

cultural changes

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