How Otolaryngology Can Address the Gender Gap

Studies have shown that fewer women than men in healthcare are promoted into leadership positions (Medscape, March 19, 2019, and Laryngoscope, Sep 18, 2019).

Furthermore, women aren’t paid the same or supported financially for research at the same levels as men (J Gen Int Med. June 2018;33:966-968). One study showed that among 23 U.S. medical schools surveyed, 40% lacked programs for recruiting or promoting women (Womens Health Issues. 2017;27:374-381).

This is despite the fact that women comprise a significant portion of the healthcare workforce (Medscape, March 19, 2019). In 2018, for example, more women than men entered U.S. medical schools for the first time in history, according to the Association of American Medical Colleges.

Reasons Gender Disparities Exist

Now that men and women are more equally enrolled in medical schools, gender disparities in leadership should begin to normalize, said Joseph E. Kerschner, MD, dean of the school of medicine and professor of otolaryngology, microbiology, and immunology at the Medical College of Wisconsin in Milwaukee.

But many other reasons have been given for the existence of gender inequities in medicine. One reason is bias, whether it’s overt or unconscious. “Even seemingly small biases have an enormous impact as they accumulate,” said Jennifer A. Villwock, MD, assistant professor of otolaryngology-head and neck surgery at the University of Kansas Medical Center in Kansas City. “Recognizing the problem can actually be the easy part. It’s much more difficult to identify and implement effective solutions.”

Women may choose to delay their professional career development due to other priorities, such as being a mother or the spouse of someone with a demanding career, needing to be a primary caregiver to elderly parents, or devoting their time to a community cause, said Julie Wei, MD, division chief, pediatric otolaryngology/audiology at Nemours Children’s Hospital in Orlando, Fla. “Any desire to live our lives holistically and care for families and relationships mandates that we give up something professionally,” Dr. Wei said. “But this doesn’t have anything to do with our competency, performance, capability, or potential.”

In addition to inequity in leadership positions, many medical facilities lack services employed women need—especially as mothers—and their benefits packages don’t offer time off and the flexibility to care for children.

Cost has been used as justification for not providing the kinds of benefits women would use most often, such as maternity leave beyond the standard sick time or disability leave options that are available to all employees. “Maternity leave can place a burden on other physicians in a practice, such as having to cover for them,” said Erin O’Brien, MD, division chair of rhinology at the Mayo Clinic in Rochester, Minn. “If women work in a practice with a revenue-based compensation model, they will need to return to work quickly in order to be paid. In some practices, women may have to continue paying for overhead while they’re on leave and not earning revenue.”

Furthermore, the board mandates that otolaryngology residents may miss only six weeks of training per academic year. If they miss additional time, they may need to make it up later in residency or after graduation,” Dr. O’Brien said.

Another barrier is that there is no uniform baseline of benefits for women. For example, there is no minimum number of lactation rooms per X number of female employees, no minimum number of women’s restroom stalls per X number of women employed at a hospital, and no minimum number of paid maternity leave weeks. “The strategies and resources needed to optimize these benefits are specific to each institution,” Dr. Villwock said. “Because there is no one-size-fits-all approach, it can be difficult to know where to begin.”

Fixing Disparities Starts at the Top

Without a conscious commitment by current leaders to change what senior leadership looks like, the advancement of women into leadership will continue at a snail’s pace, according to a report by McKinsey & Company. “When chairs, deans, society leaders, and other leaders decide that increasing women in their ranks is a top priority and commit to recruiting women leaders deliberately, then we will see more progress toward gender diversity and gender equity,” said Kelly Michele Malloy, MD, associate professor of otolaryngology-head and neck surgery and associate chief clinical officer for surgical services at the University of Michigan in Ann Arbor.

When chairs, deans, society leaders, and other leaders decide that increasing women in their ranks is a top priority and commit to recruiting women leaders deliberately, then we will see more progress toward gender diversity and gender equity. —Kelly Michele Malloy, MD

In particular, Dr. Malloy recommends asking women to apply for leadership positions and aiming for at least half of candidates to be female. “Promote women and hire women, and not just for early career or entry-level positions,” she said.

To get things started, diversity and inclusion committees can provide data to their institutions regarding salary, promotion, and leadership roles for male and female physicians. Departments should make research, clinical support, salary, and resource allocation transparent to all members, and institutions should offer training and mentorship specifically for women in research, publishing, and leadership, Dr. O’Brien said.

Employers should dedicate resources to making their support of women and other underrepresented groups clear. “This can include specific diversity and inclusion language in strategic departmental and institutional initiatives that have measurable goals, such as [offering] financial support for underrepresented or minority students to do away rotations, ensuring that all faculty complete unconscious bias training, or being intentional about invited grand rounds speakers to ensure they represent diverse backgrounds and experiences,” Dr. Villwock said. “It can also manifest in resources such as lactation rooms, an adequate number of restrooms, pipeline development programs for potential leaders, and maternity/paternity leave policies that minimize potential financial or professional penalties.”

Dr. Kerschner said that equality begins with equal pay. “If you can’t demonstrate that you have pay equity across gender, race, and ethnicity, then anything else you do regarding equity will seem hollow,” he said. “There have been a number of reasons why organizations have not achieved transparent pay equity in the past. However, analytics and best practices now exist that allow this to happen. It does require effort and costs something for an organization to ensure this is happening. The Medical College of Wisconsin has ensured pay equity related to gender and under-represented status for many years; it is doable.”

To achieve pay equity, a detailed internal compliance team evaluates pay metrics annually and prepares a report for senior leadership to identify any areas of discrepancy based on analysis, Dr. Kerschner said.

What You Can Do

Physicians can also make efforts to end gender disparities on an individual level, beginning with being open to learning more about others’ experiences. “We often don’t know what we don’t know,” Dr. Villwock said. “We have to be willing to have difficult and sometimes awkward conversations to better understand the perspectives of everyone involved.”

Dr. Villwock also encourages otolaryngologists to assess their own biases and knowledge gaps. “Everyone needs to learn about unconscious biases—which we all have—and how they can manifest. Shed some light on yours by being aware of your own behavior patterns.”

Speaking up in unison is also key. “Have a united voice on what opportunities and changes should occur at your institution,” Dr. Wei said. “Physicians themselves must champion and not expect change to occur from the top down and from non-physician leaders, but instead lead change.”

The bottom line, Dr. Wei said, is that institutions must forgo the “we must not do anything special for women” attitude and stop fearing that they’ll be accused of giving special treatment to women. Instead, they should acknowledge the extraordinary efforts, perhaps even Herculean at times, that women must achieve and demonstrate just to be noticed to get on the same playing field as male physicians and surgeons, much less in leadership positions in organizational hierarchy at any level.

“It’s past the time of talk and well time for action,” Dr. Kerschner said. “If no specific steps exist, then demand that leadership give these issues more attention.” 

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Karen Appold is a freelance medical writer based in Pennsylvania.