Gender Equity, Math, and Female Physicians
Yesterday was National Women Physicians Day and a great reminder of the ways in which gender equity is still an aspirational goal - let's talk pay gaps, parental leaves, & discrimination.
Read time: 6-7 mins
Yesterday was National Women Physicians Day! Women physicians are 33% of the physician workforce, and they are growing in presence, especially in the surgical specialties. While the experiences of being a woman physician have improved from the past, significant improvement is needed on the policy front for gender equity.
Is gender equity an issue?
More women physicians are leaving or taking time off from the physician workforce for many reasons - significant increase in burnout, lack of pay equity, lower rates of professional fulfillment, and lack of supportive environment for women physicians.
What does “lack of supportive environment” mean?
Simple: women physicians are more likely to be disrespected, harassed, and experience discrimination.
The National Academy of Medicine highlighted the JAMA study which found
More than 70% of women physicians report experiencing gender discrimination
Women who belong to racial or ethnic minority groups may face additional discrimination at all levels of their careers, impacting their sense of well-being and their perception of work stress
Sources of bias and discrimination include more senior physicians, administrators, peers, allied health professionals, and patients. Gender bias and discrimination, which may be unconscious, can leave victims feeling marginalized and disenfranchised, adversely affecting their self-confidence and career advancement
What about pay equity?
Rand published their 2021 study in Health Affairs finding that:
For a 40-year career, female surgeons earned $2,043,881 less than their male surgeon colleagues. For primary care physicians, the difference is closer to $900,000.
(adjusted for difference in hours worked, clinical revenue, practice type, and specialty)
That would be $22,500 per year for a female primary care physician. If this amount was converted into savings, at an interest of 3.0%, a female primary care physician loses a little less than $800,000 in interest.
For a primary care female physician, total loss = $900,000+$800,000 = $1,700,000For a surgeon, total loss = $2,043,881 + $1,808,898 = $3,852,779
How is parental leave related?
A major issue facing physicians and advanced practice providers is the discrepancy in parental leave policies for mothers and fathers.
Dr. Jessica Slostad, Dr. Shikha Jain, Dr. Marie McKinnon, et al published a recent study in JAMA reviewing the parental leave policies at 90 medical schools across the US. They found:
Birth Parent Partial-Paid Leave: 6 weeks was the median length of parental leave granted, with 24 of 90 Medical Schools not providing any parental leave at a partially paid level.
Birth Parent Paid Leave: 4 weeks was the median length of parental leave granted, with 37 of 90 medical schools not providing any parental leave at a fully paid level.
Just for perspective, US is joined by only 7 countries on the list of countries without paid family leave for mothers: Papua New Guinea, Suriname, Micronesia, The Marshall Islands, Nauru, Palau, Tonga
The lack of paid parental leave greatly impacts a family's ability to care for their new child. This can be a major financial burden for families who are already struggling to pay for child care.
What is Family Medical Leave Act (FMLA)?
FMLA is a benefit that offers unpaid, job-protected leave for 12 weeks (or 26 weeks in 12 month period to care for a family member who is a servicemember). Besides job security, FMLA also offers a continuation of group health insurance coverage at the same level as when the person was not on leave. The criteria are very specific and restricted.
FMLA is covered with pay to some extent in the following states: California, Colorado, Connecticut, the District of Columbia, Massachusetts, New Jersey, New York, Oregon, Rhode Island, and Washington.
What about the fathers?
The policies on paid parental leave, FMLA, pay parity, and gender discrimination also affect fathers. Dr. Feng writes impactfully about the importance of parental leave for mothers as well as fathers.
“Multiple studies show extended paternity leaves also benefit partners, with more robust professional advancement, increased income, reduced postpartum health complications, and better mental health. My wife bristles at the societal assumption that fathers merely “help” mothers, instead of being equal partners in caring for their children.”
Paid parental leave should be offered for both mothers and fathers.
Let’s review a case!
Dr. Johnson (loosely based on a true story) is a junior faculty member and a rising star - she is an exceptional hospitalist, generous to her peers (offers to cover holidays/vacations), award winning-teacher for residents and students, an advisor for the house-staff DEI committee, a local leader for the medical society, and recently published 2 manuscripts in a peer-reviewed journal. She is being “groomed” for a future leadership position in medical school. She has been promised this opportunity as long as she stays on the straight path to success.
She and her partner have decided to expand their family and adopt a new baby. They have waited years and are ecstatic. But, she is nervous. Her medical school does not offer paid parental leave. She used her PTO (paid time off) to care for her father after a stroke that required constant supervision for 4 weeks. There is no paid FMLA policy for her state. She turns to a mentor for advice on how to approach her division chief about this news.
Her male mentor shares in her enthusiasm but offers her advice to see if she can find someone to care for the new child part-time even. This way is his lens, she can continue working partially — maybe filling some per diem shifts for the hospitalists. This would allow her to remain “visible” for the division.
In this scenario, the division and medical school have benefited tremendously from her labors - providing education/mentorship for residents and fellows, keeping good citizenship for the division, increasing visibility in journals, and no requirement of pay if she was to go on leave. Yet, she has not experienced equal benefits - she is going to experience inequity in pay (up to $2 million over her career), teaching opportunities, social connection to coworkers, and promotion opportunities or “visibility.” And this leads to slower progress on the path to leadership, which in turn causes even more inequity over the length of her career.
Final thoughts
The National Academy of Medicine has been calling for a change since 2019, specifically for the availability of child care, lactation facilities and time to use them, and family leaves that allow both women and men adequate time to care for children and other family members throughout their careers.
Furthermore, pay equity is necessary. Pay equity will not solve the lack of parental leave, but it will provide better financial cushioning when childcare costs are not covered.
As for respect - it is a culture change. When we walk through our day, each of us has a responsibility to be an ally for this culture change. Culture eats policy for lunch every day. Be a #upstander!
Addressing pay disparity, paid parental leave, and gender discrimination is no longer optional.
It is not something that we think about it is something we act upon urgently.
Gender equity in the medical field is essential for the well-being of families, the stability of our communities, and the success of our healthcare system. Improving policies for paid parental leave, closing the gender pay gap, and ridding discrimination will have positive effects on all physicians and advanced practice providers. We need policy change at multiple levels - federal and state government, medical schools, and healthcare systems. First, pay equity needs to be a national standard. Second, all states across the US should have paid FMLA. Third, healthcare organizations must change the culture of medicine in a sweeping manner.
In caring for those who care for our loved ones and neighbors, we can progress towards a more equitable and effective healthcare system for everyone.
“There are three classes of human beings: men, women,
and women physicians.”
- William Osler
More reading: JAMA, Workforce Change, AAMC, How to be an ally, amplifier, upstander, sponsor, and confidant, ACC, and ACP