The Otolaryngology Gender Gap: How do we make it disappear?

It’s a fact: An increasing number of American women are entering medicine. In the U.S. today, half of matriculating medical students, and 28 percent of all practicing physicians, are women. Nonetheless, the pervasive gender gap in the medical profession creates a real dilemma for our nation. The negative impact of a less-than-optimally integrated work force affects the health and well-being of our patients—and our society.

The consequences of the gender gap are readily apparent in the most fundamental aspect of any career: compensation. In 2004, the U.S. Census Bureau reported that women physicians earn 63 cents per every dollar that men physicians earn and that no other profession in the U.S. exhibits greater salary disparities by sex. Unfortunately, the field of otolaryngology/head and neck surgery is not spared from similar unequal treatment. A landmark study conducted by Grandis and colleagues in 2004 reported a 15 to 20 percent pay differential for women otolaryngologists after controlling for confounding variables (Arch Otolaryngol Head Neck Surg. 2004;130(6):695-702).

The gender gap also brings with it bias against women, overt harassment, less overt gender stereotyping and women’s struggle to gain acceptance and respect from their male peers. Inbred and institutionalized bias has hindered our entry into leadership roles in our medical societies, on editorial boards, in the halls of academia, and in clinical medical leadership at the local and national levels. The old standby excuse—that childbearing or the social construct of women bearing the greater share of home management and child rearing—is no longer persuasive. Newer models for dealing with these important roles, like more affordable childcare options, have emerged, allowing women to be as productive in their careers as men.

Eliminating the gender gap in health care is particularly challenging because still-prevalent hierarchical structures and paternalistic concepts in medicine dictate how women (and newer/younger) physicians could and should be included. Mentorship programs designed to address these issues have been inherently disingenuous and patently impossible for many, if not most, women.

Other solutions have been equally ineffective in providing the much needed systemic change. Changes stemming from teaching women better negotiating skills, refining the charges of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) committee on Women in Otolaryngology (WIO) or voting that gender discrimination is an ethical violation of the by-laws of the AAO/HNS have been hard to find.