Examining Gender Disparity in Medicine and Setting a Course Forward.

Much has been written recently on gender disparities in medicine and the negative outcomes that result for women. The impetus for examining these disparities is manifold. While we intuitively know that achieving gender equity is simply the right thing to do, there are serious stakes not only for women but also for medicine as a field and for the communities we serve that underlie the decisive need to actualize gender equity. Diversity in human capital brings diversity in thought, which leads to innovation, stronger teams, and better outcomes for patients. But, as it stands in 2019, women are still underrepresented in areas like leadership positions, journal authorship, and speaker invitations and are undercompensated compared with their male peers, leaving them more financially disadvantaged in retirement. We look at 5 articles published in 2018 and 2019 in JAMA Network Open1-5 (Box) that examine disparities in different subsets of medicine or in areas related to careers in academic medicine, disparities that not only limit women’s career trajectories but also have a significant impact on their compensation and subsequently their retirement security. As Weng et al noted,1 inequity in a single context may set a precedent for inequity in others, which then contribute to greater disparity. In the article by Silver et al,2 the authors sought to determine whether women were underrepresented in perspective-type articles in high-impact pediatric journals. The publication of articles is critical to career advancement in academic medicine, so if women are less likely to have opportunities to publish, particularly as first and senior authors, then their career growth can be impeded. The authors examined the gender-related profiles of authors in the 4 highest-impact general pediatric journals and found that women were underrepresented among physician first authors, particularly in articles categorized as scholarly vs articles categorized as narrative. Women were also underrepresented among last authors and coauthors of articles attributed to both male and female physician first authors. When women are underrepresented as authors, they have fewer opportunities to contribute to and influence the field. Ruzycki et al3 analyzed US and Canadian conferences to determine the trend in the proportion of speakers who were women during last decade. Visibility of women as speakers at academic medical conferences is an important part of gender equity, as the article notes, and can have a broad impact on a career. Conferences represent opportunities for networking, mentorship, and career advancement. On the one hand, it was positive that the authors found that proportions of female speakers at these conferences increased from 24.6% in 2007 to 34.1% in 2017.3 On the other hand, although the proportion increased, women are still underrepresented overall, and without a substantial cohort of women, it is more difficult to weaken stereotypes about gender roles.6 When it comes to the accumulation of wealth, small gender-based salary gaps can have a significant impact over a lifetime. Rao et al4 ran a quality improvement study using simulations of salary and additional accumulated wealth to project how gender equity initiatives could help to reduce gender-based differences in salary and time to promotion. The lag in the promotion of women to full professorships is an important piece of salary inequity and thus accumulated wealth. (Women hold 25% of full professor positions and 37% of associate professor positions in the United States.7) Rao et al4 noted that, to account for lower additional accumulated wealth and longer life expectancy, a woman would have to spend $0.60 for every $1 spent by a male counterpart for her resources to last through retirement. The authors found that the salary gap and time to promotion Box. JAMA Network Open Articles on Gender Disparities