By Shikha Jain, MD, FACP (Chair, Women in Medicine®)
This COVID-19 pandemic has had a profound impact on healthcare workers across the world, with the negative fallout disproportionately affecting women (Soares, et al, 2021). Women are not only losing their jobs, they are leaving the workforce (Luthra and Carrazana, 2021) as the pandemic continues to exacerbate (Johnson, 2020) the glaring gender and racial inequities that remain pervasive throughout medicine.
Over this last year and a half, the pandemic has shined a spotlight on the disparities that already existed across the healthcare spectrum. Historical system-wide policies, often based on implicit bias and a misunderstanding of what gender parity actually entails, have created obstacles that can ultimately derail a career. And there is a legitimate concern that the events of this past year and a half will continue to have a negative impact on our ability to achieve parity in healthcare for decades to come (Woitowich, et al, 2020).
For women in medicine, especially those with intersectional identities (Shamseer, et al, 2021), the unprecedented challenges that have arisen due to the pandemic have been compounded by concurrent stressors and disproportionate responsibilities both at work and at home (Jones, et al, 2020). In a study looking at dual-physician families, women were more likely to report increased concerns regarding job security, finances and health during the pandemic (Soares, et al, 2021). Domestic responsibilities that are typically and, again, disproportionately (Jolly, et al, 2014) allocated to women – such as navigating virtual learning for school-aged children, childcare or caring for aging parents – grew exponentially. A decrease in productivity (Spector and Overholser, 2020) for women in medicine, along with a widening of the leadership gap and the pay gap, are among the most troubling secondary outcomes to have arisen during this pandemic.
It is also important to address the impact on the mental health of women in medicine, who are more likely to be found in frontline clinical positions and whose responsibilities at work and at home have grown, which cannot be overstated. The long-term consequences of the amplified stress this pandemic has stoked are yet to be realized and the medical system is at risk of losing countless brilliant women (Wiener, 2020) due to the perpetuation of an already inequitable system that has now been magnified by a global pandemic. Yet a return to the pre-pandemic status quo is not an inevitability. This could be the watershed moment needed to launch a critical analysis of the deficiencies in our current system; the moment when we begin to build a new, better and more equitable system.
Identifying and accepting that these issues exist, are pervasive throughout the system and are detrimental not only to the workforce but also to the patients served, is the first step in identifying solutions. To truly support the careers of women physicians, now and in the future, it is necessary to first understand the demands competing for a physician’s time and mental energy (Silver, et al, 2020) as well as the barriers that have been created by persistent disparities in the system.
Dr. Julie Silver expertly described the concept of a “fourth shift” that has emerged during the pandemic. Think of the traditional responsibilities that accompany one’s job as the first shift; while responsibilities at home fall into the second shift. The third shift (Santhosh, et al, 2020) covers the often uncompensated and unrecognized gender equity work taken on in “free time.” The fourth shift (Silver, 2021) refers to work done during the pandemic that falls outside of the normal job descriptions, such as being deployed to a COVID-19 unit, conducting vital – but unfunded – pandemic-related research, providing additional mentoring and support to trainees, helping those struggling with pandemic-related concerns or disseminating vital public health messaging about the pandemic.
It is essential that this clinical, administrative and often innovative work is recognized and rewarded, not only as it relates to the pandemic, but beyond. A system where some of the most important work is done without compensation, often to the detriment of the individual’s own career trajectory and chances for promotion, is simply not sustainable.
While nontraditional work and unique initiatives undertaken must be acknowledged and recognized, it is also essential that work, lectures, grants and other opportunities that were canceled due to the pandemic (Arora, et al, 2021) be accounted for and recognized formally on the CV (Arora, et al, 2020). For those in academics, promotion and tenure track extensions should be discussed. To prevent delays, departments could evaluate the career trajectory of faculty members when evaluating for promotion (Marcotte, et al, 2021) as opposed to delaying or adjusting the promotion clock.
An excellent paper by Dr. Leah Marcotte and colleagues (Marcotte, et al, 2020) outlines a strategy to address gender disparities in academic promotions that begins on the first day of a faculty appointment. Interventions, Marcotte says, could include institutional support in the form of research assistants for junior faculty, proactively supporting women to apply for targeted grants or awards and continuing to offer virtual speaking opportunities, even when COVID-19 travel restrictions become unnecessary. Promotions committees should also undergo implicit bias training and consider team-based research as a significant contribution along with the number of first and last author publications.
Advocating for pay equity and transparency were key priorities prior to the pandemic and are even more important now as the disparities in healthcare have grown. Finding solutions for work-life integration, such as emergency childcare and equalizing the disproportionate clinical burden on the female workforce, will be essential for establishing a new, more equitable system. Destigmatizing mental health and developing wellness initiatives are also crucial. To be truly impactful, these types of initiatives require a top-down strategy. The responsibility to fix the system should not fall solely upon the shoulders of women in medicine; both men and women must have a seat at the table.
The Women in Medicine Summit (WIMS) was originally created to empower women by providing education as well as opportunities for networking that could lead to mentoring and sponsorship relationships. The goal was to inspire women to take control of their futures by learning skills that could help them succeed. The summit has evolved to become a nonprofit organization that offers an annual continuing medical education (CME) conference and three longitudinal CME leadership development programs as well as tool kits, an international social media platform, a speakers bureau and research capabilities. Through its personal and professional development programs, WIMS has helped women from across the country achieve leadership success.
By developing content and programming for medical students, trainees and early career physicians, as well as for those already in senior leadership positions, the summit will continue to energize and give voice to women at every stage of their career. And, by creating specific programming for men through the Leadership Inclusive Lab for Male Allies, WIMS will equip male allies to become more inclusive leaders and to work together with their colleagues to fix the system – not the women. Through its educational and motivational programming, WIMS (Madani, et al, 2020) is creating networks of women all across the country and across different points in their professional lives, who will be prepared not only to usher in change but also to inspire others to work beside them. This summit will provide toolkits and action plans that can be taken back to organizations and institutions for the purpose of making meaningful reforms. Members of the steering committee and faculty as well as many of the attendees have published extensively on the topic of gender equity in healthcare. Continuing academic pursuits – conducted both through the WIM Research Lab and through collaborations forged during WIM – will provide further understanding and facilitate this work to address and fix the inequities in medicine and close the gender gap.
In this compendium, you will find pieces written by invited faculty speakers from WIMS 2021, who share their expertise on the evolution of empowerment that has occurred in medicine. You can also discover strategies for achieving equity in healthcare utilizing evidence, science and authentic leadership and learn how to find your voice so that you, too, can be a champion for change.
This past year has stretched physicians and workers across the healthcare spectrum further than ever before. An already broken system was laid bare. Disparities that have existed for years have now become impossible to ignore. It is time to work together to implement solutions and to break down the systemic barriers that continue to perpetuate disparities in medicine. We must use the decades of research that already exist along with our collective lived experiences to rebuild a better, more equitable system. Not only because it is the right thing to do, but because by doing so, we will see benefits to our patients (Parks and Redberg, 2017), our colleagues (Oesch, 2019), our communities (EduMed, 2020) and the healthcare system as a whole. When this pandemic is behind us, we must not return to the pre-COVID-19 status quo that has driven so many accomplished women from medicine. We can do better. And we must.
We invite you to join us at the 2021 Women in Medicine Summit, which will be held virtually Sept. 24 to 25. Be part of the change that is needed for the future of healthcare by equipping yourself with leadership skills and essential tools. Connect with leaders from across the globe, sign up for personal mentorship sessions, pick up tips for personal and professional development and find your voice as we all work toward closing the gender gap in our healthcare system.
- Arora, V.M., Wray, C.M., O’Glasser, A.Y., Shapiro, M., Jain, S. (2020 September 17) Using the Curriculum Vitae to Promote Gender Equity During the COVID-19 Pandemic. Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.2012969117
- Arora, V.M., Wray, C.M., O’Glasser, A.Y., Shapiro, M., Jain, S. (2021 January 20) Leveling the Playing Field: Accounting for Academic Productivity During the COVID-19 Pandemic. Journal of Hospital Medicine. DOI: 10.12788/jhm.3558
- EduMed. (2020 May 27) Diversity in Healthcare: Why Increased Diversity and Supporting Culturally and Linguistically Appropriate Services (CLAS) Leads to Safer, Healthier, and Stronger Communities…and How We Can Help. https://www.edumed.org/medical-careers/diversity-in-healthcare/
- Johnson, K. (2020 November 30) Are More Women Physicians Leaving Medicine as Pandemic Surges? Medscape. https://www.medscape.com/viewarticle/941690#vp_1
- Jolly, S., Griffith, K.A., DeCastro, R., Stewart, A., Ubel, P., Jagsi, R. (2014 March 4) Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers. Annals of Internal Medicine. DOI: 10.7326/M13-0974
- Jones, Y., Durand, V., Morton, K., Ottolini, M., Shaughnessy, E., Spector, N.D., O’Toole, J. (2020 July 20) Collateral Damage: How COVID-19 Is Adversely Impacting Women Physicians. Journal of Hospital Medicine. DOI: 10.12788/jhm.3470
- Luthra, S., Carrazana, C. (2021 May 17) Women in Health Care Are at a Breaking Point – and They’re Leaving. The 19th. https://19thnews.org/2021/05/women-health-care-leaving-breaking-point/
- Madani, K., Pendergrast, T., Sundareshan, V., Jain, S. (2020 December 24) The Women in Medicine Summit: An Evolution of Empowerment in Chicago, Illinois, October 9 and 10, 2020: Event Highlights, Scientific Abstracts, and Dancing with Markers. International Journal of Academic Medicine. https://www.ijam-web.org/showcaptcha.asp?RedirectUrl=article&issn=2455-5568;year=2020;volume=6;issue=4;spage=337;epage=398;aulast=Madani
- Marcotte, L.M., Arora, V.M., Ganguli, I. Toward Gender Equity in Academic Promotions. (2021 July 12) JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2021.3471
- Oesch, T. (2019 February 19) The Gender Leadership Gap in Health Care: Why It Matters and How to Bridge It. Training Industry, Inc. https://trainingindustry.com/articles/leadership/the-gender-leadership-gap-in-health-care-why-it-matters-and-how-to-bridge-it/
- Parks, A.L., Redberg, R.F. (2017 February) Women in Medicine and Patient Outcomes: Equal Rights for Better Work? JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2016.7883
- Santhosh, L., Keenan, B.P., Jain, S. (2020 July 31) The “Third Shift”: A Path Forward to Recognizing and Funding Gender Equity Efforts. Journal of Women’s Health (Larchmont). DOI: 10.1089/jwh.2020.8679
- Shamseer, L., Bourgeault, I., Grunfeld, E., Moore, A., Peer, N., Straus, S., Tricco, A. (2021 March 7) Will COVID-19 Result in a Giant Step Backwards for Women in Academic Science? Journal of Clinical Epidemiology. DOI: 10.1016/j.jclinepi.2021.03.004
- Silver, J.K. The Pandemic Has Created a 4th Shift for Women in Medicine. (2021 March 30) Massachusetts General Hospital Research Institute Blog. https://mgriblog.org/2021/03/30/the-pandemic-has-created-a-4th-shift-for-women-in-medicine/
- Silver, J.K., Larson, A.R., Jagsi, R. (2020 July 31) COVID-19 and the Effect on the Gender Pay Gap in Medicine. The BMJ Opinion. https://blogs.bmj.com/bmj/2020/07/31/covid-19-and-the-effect-on-compensation-and-financial-stress-for-women-in-medicine/
- Soares, A., Thakker, R., Deych, E., Jain, S. (2021 May 30) Impact of COVID-19 on Dual Physician Couples: A Disproportionate Burden on Women Physicians. Journal of Women’s Health. DOI: 10.1089/jwh.2020.8903
- Spector, N.D., Overholser, B. (2020 September 1) COVID-19 and the Slide Backward for Women in Academic Medicine. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2020.21061
- Weiner, S. (2020 November 12) How COVID-19 Threatens the Careers of Women in Medicine. Association of American Medical Colleges. https://www.aamc.org/news-insights/how-covid-19-threatens-careers-women-medicine
- Woitowich, N.C., Jain, S., Arora, V.M., Joffe, H. (2020 September 29) COVID-19 Threatens Progress Towards Gender Equity within Academic Medicine. Academic Medicine. DOI: 10.1097/ACM.0000000000003782
Shikha Jain, MD, FACP (Co-Editor and Chair, Women in Medicine®)
Dr. Shikha Jain is a board-certified hematology and oncology physician. She is an assistant professor of medicine in the Division of Hematology and Oncology at the University of Illinois in Chicago. She is the Director of Communications Strategies in Medicine and the Associate Director of Oncology Communication and Digital Innovation for the University of Illinois Cancer Center. Dr. Jain is the Chief Executive Officer and Co-Founder of the action, advocacy and amplification organization IMPACT and Founder and Chair of the Women in Medicine® nonprofit. Dr. Jain was named one of Medscapes 25 Rising Stars in Medicine in 2020, one of Modern Healthcare’s Top 25 Emerging Leaders in 2019, and was also awarded the Rising Star award by the LEAD Oncology Conference in 2019. She was selected as a ResearcHERS ambassador by the American Cancer Society, and was honored by 500 Women in Medicine. She has been appointed as the 2020 and 2021 Lead of the American Society for Clinical Oncology Women’s Working Group, is a member of the Diversity and Inclusion taskforce, and appointed to the Illinois State Medical Society’s Council on Communications and Membership Advocacy as well as the COVID-19 taskforce. She is on the editorial board of Healio HemOnc Today and is the consulting medical editor for Healio Women in Oncology. She is also the host of the podcast Oncology Overdrive. Dr. Jain’s mentorship and sponsorship have resulted in the advancement of numerous young women and men in medicine across the country. She works tirelessly to promote the dissemination of evidence based scientific information through numerous mediums including social media and has been recognized as a thought leader by Doximity and the OpEd project. She lectures nationally on the importance of social media and communication strategies in healthcare. She is also the founder of the social media group Dual Physician Families. Dr. Jain gave a TEDx talk in 2019 on the gender moonshot and the importance of gender parity in healthcare. She is a nationally renowned speaker and writes for several national publications including USA Today, Scientific American, The Hill, US News, Physician’s Weekly, Doximity, KevinMD, and ASCO Connection. She is a regular contributor to FOX 32 and has also been a guest on ABC7 and WGN and quoted in the New York Times and featured in TIME Magazine. In her clinical practice as an oncologist she tries to incorporate patient education and outreach as often as possible. With the proper tools and guidance, she works with her patients as a team to treat the disease and helps them move through an often difficult process with as little stress as possible. She believes in personalized and individualized care, and also feels the more knowledge a patient has about their own disease, the more informed a decision they are able to make.
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