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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 7  |  Issue : 4  |  Page : 203-205

What's new in academic international medicine? The gender gap in emergency medicine


1 Department of Emergency Medicine, Providence St Joseph Hospital, Eureka, California, USA
2 Department of Emergency Medicine, International Division, SUNY Downstate Medical Center/Kings County Hospital Medical Center, Brooklyn, New York; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

Date of Submission09-Dec-2021
Date of Acceptance19-Dec-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Taryn Clark
Department of Emergency Medicine, International Division, SUNY Downstate Medical Center/Kings County Hospital Medical Center, Brooklyn, New York; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijam.ijam_155_21

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How to cite this article:
Dymond C, Clark T. What's new in academic international medicine? The gender gap in emergency medicine. Int J Acad Med 2021;7:203-5

How to cite this URL:
Dymond C, Clark T. What's new in academic international medicine? The gender gap in emergency medicine. Int J Acad Med [serial online] 2021 [cited 2022 May 18];7:203-5. Available from: https://www.ijam-web.org/text.asp?2021/7/4/203/333407



In our end-of-the-year issue, we are pleased to partner with Women in Medicine to showcase their conference highlights. Women in Medicine remains one of our core collaborators in our mission of advancing the art and science of academic international medicine through diversity, equity, and inclusion. Women in Medicine focuses specifically on closing the gender gap in the professional American medical health-care system. They do this through education, research, collaboration, and raising awareness about key issues facing women in medicine. Given our shared goals, we would like to take this space to discuss one specific inequity in American academic medicine.

Emergency medicine (EM) is one of the most popular specialties, ranking number four in 2019, behind internal medicine, family medicine, and pediatrics.[1] However, while the development of EM programs has grown exponentially in the last decade, the number of female residents in EM has fallen, according to a recent report in the American Journal of Emergency Medicine.[2] Current data suggest that only 26%–35% of EM trainees are female; across the board, female trainees in all residency programs make up 46%.[2],[3] This is much more representative of the percentage of female to male students within US medical schools, which is currently 50%.[4] As recently as the 2019 application cycle, out of more than 3000 EM applicants, 66% were male. These statistics are similar to the current resident pool, where male residents account for 63% of the active positions. The predominance of male physicians to female physicians is still drastically skewed in the EM workforce, as well. 72% of current practicing EM physicians are male and 28% are female.[3] EM has been established as a specialty since the 1970s, with almost all graduates from early programs being males, but this does not account for the drastic gender gap 50 years later.

This leads to two questions: how do the women currently in EM fare and why are not more women choosing EM as a specialty?

First, women in EM are often held to male-dominated cultural norms. In a study that looked at the gender gap in evaluations given to EM trainees, analysis of faculty comments showed that stereotypically masculine traits were desired in EM residents.[5] A recent study looked at EM milestone evaluations, which are used to evaluate performance, and evaluated eight EM training programs comprised of 359 residents evaluated by 285 faculty members, with an overall accumulation of 33,456 milestone evaluations. Although men and women initially scored the same on milestone evaluations, by year 3 of training, women were evaluated lower on all 23 subcompetencies, including procedures. The difference between men's and women's average scores was the equivalent of 3 additional months of training. The authors suggest that, given the uniform trend, this likely suggests implicit bias rather than lack of competency or skill.[6] Another example, from outside the medical world, demonstrated that women receive more critical, unconstructive feedback and is often associated with words with negative stereotypes, such as “abrasive,” which is commonly used to describe women and almost never to describe men.[7]

In addition to the burden of unfair implicit biases in expectations and evaluations, female physicians in EM also deal with recurrent microaggressions. Microaggressions are verbal and nonverbal insults or stereotypes that target a marginalized group. They are frequent occurrences and are often unconscious, unintentional, and go unnoticed by the aggressor. Women in EM frequently experience microaggressions which range from demeaning addresses, such as honey or sweetheart, to being misidentified because of gender; for example, over 50% of female EM physicians report being mistaken for non-clinician staff daily, while men do not report this experience.[8],[9] Male physicians often have difficulty in identifying witnessed gender-specific microaggressions, suggesting that the microaggressions that women experience daily at work not only are not experienced by their male counterparts but also go unnoticed and unrecognized by men physicians.[10] Common gender-specific microaggressions include sexism, pregnancy, and childcare-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded or marginalized.[10]

This discrimination has real effects on female careers, with data showing that women are underrepresented as speakers at national conferences, as presenters at academic grand rounds, and as members of editorial boards.[11],[12],[13] Their recommendation letters are shorter in length, they receive fewer formal introductions on the speaker podium, and are less likely to be promoted to leadership positions or to be nominated for or receive achievement awards.[14],[15] Consequently, women in EM are less likely to be full professors, even after accounting for multiple variables.[16] In EM departments and academic institutions, only 7.5% of department chairs and less than one-third of academic positions and program director positions are held by female physicians.[17]

Not only women are less likely to hold advanced positions within the administration or academic institutions, they are also consistently paid less than their male colleagues who hold similar positions. In medicine, the gender pay gap is 90 cents per every $1. From data as recent as last year, there is a gender pay gap in medicine of between $50,000 and $100,000 across all ranks and specialties.[18] It is even higher for faculty in leadership positions.[19] Specifically in academic EM, there is still greater than $50,000 salary difference between male and female academic EM physicians.[20]

These factors may influence how many women go into EM as a specialty. Dealing with implicit bias in medical school experiences and graded rotations, the burden of microaggressions, the lack of females in leadership roles, and the pay gap likely all contribute to the lack of women choosing EM and may contribute to women considering leaving the field earlier than their male colleagues. Female physician reports higher rates of burnout, and mid-career female physicians are significantly more likely than their colleagues to consider leaving EM.[21]

Many suggestions have been made, including improving evaluation systems, addressing microaggressions, blinding promotion committees to gender, improving mentorship opportunities for women, and implementing flexible family leave policies.[22] Changing the culture of EM to be more supportive of women and to appreciate a diversity of traits, not traditionally male-dominant characteristics, will also likely lead to improved quality of career for female physicians. It will take concerted, continued efforts of groups such as Women in Medicine and the American Academy of Emergency Medicine to make meaningful differences for our future EM physicians.

Conflict of interest

Dr. Clark is Principal Editor of the journal.

Ethical conduct of research

The authors declare that this editorial does not require Institutional Review Board/Ethics review or approval.



 
  References Top

1.
ACGME Residents and Fellows by Sex and Specialty, 2019 | AAMC. Available from: https://www.aamc.org/data-reports/interactive-data/acgme-residents-and-fellows-sex-and-specialty-2019. [Last accessed on 2021 Nov 30].  Back to cited text no. 1
    
2.
Partiali B, Oska S, Barbat A, Folbe A. The representation of women and underrepresented minorities in emergency medicine: A look into resident diversity. Am J Emerg Med 2021;44:241-3.  Back to cited text no. 2
    
3.
Ehrhardt T, Shepherd A, Kinslow K, McKenney M, Elkbuli A. Diversity and inclusion among U.S. emergency medicine residency programs and practicing physicians: Towards equity in workforce. Am J Emerg Med 2021;46:690-2.  Back to cited text no. 3
    
4.
More Women than Men are Enrolled in Medical School | AAMC. Available from: https://www.aamc.org/news-insights/more-women-men-are-enrolled-medical-school. [Last accessed on 2021 Nov 30].  Back to cited text no. 4
    
5.
Mueller AS, Jenkins TM, Osborne M, Dayal A, O'Connor DM, Arora VM. Gender differences in attending physicians' feedback to residents: A qualitative analysis. J Grad Med Educ 2017;9:577-85.  Back to cited text no. 5
    
6.
Dayal A, O'Connor DM, Qadri U, Arora VM. Comparison of male vs. female resident milestone evaluations by faculty during emergency medicine residency training. JAMA Intern Med 2017;177:651-7.  Back to cited text no. 6
    
7.
The One Word Men Never See in their Performance Reviews. Available from: https://www.fastcompany.com/3034895/the-one-word-men-never-see-in-their-performance-reviews [Last accessed on2021 Nov 30].  Back to cited text no. 7
    
8.
Molina MF, Landry AI, Chary AN, Burnett-Bowie SM. Addressing the elephant in the room: Microaggressions in medicine. Ann Emerg Med 2020;76:387-91.  Back to cited text no. 8
    
9.
Brown C, Daniel R, Addo N, Knight S. The experiences of medical students, residents, fellows, and attendings in the emergency department: Implicit bias to microaggressions. AEM Educ Train 2021;5:S49-56.  Back to cited text no. 9
    
10.
Periyakoil VS, Chaudron L, Hill EV, Pellegrini V, Neri E, Kraemer HC. Common types of gender-based microaggressions in medicine. Acad Med 2020;95:450-7.  Back to cited text no. 10
    
11.
Hutchinson D, Das P, Lall MD, Hill J, Fares S, Khosa F. Emergency medicine journal editorial boards: Analysis of gender, H-index, publications, academic rank, and leadership roles. West J Emerg Med 2021;22:353-9.  Back to cited text no. 11
    
12.
Carley S, Carden R, Riley R, May N, Hruska K, Beardsell I, et al. Are there too few women presenting at emergency medicine conferences? Emerg Med J 2016;33:681-3.  Back to cited text no. 12
    
13.
Boiko JR, Anderson AJ, Gordon RA. Representation of women among academic grand rounds speakers. JAMA Intern Med 2017;177:722-4.  Back to cited text no. 13
    
14.
Trix F, Psenka C. Exploring the color of glass: Letters of recommendation for female and male medical faculty. Discourse and Society 2016;14:191-220. [doi: 10.1177/0957926503014002277].  Back to cited text no. 14
    
15.
Files JA, Mayer AP, Ko MG, Friedrich P, Jenkins M, Bryan MJ, et al. Speaker introductions at internal medicine grand rounds: Forms of address reveal gender bias. J Womens Health (Larchmt) 2017;26:413-9.  Back to cited text no. 15
    
16.
Bennett CL, Raja AS, Kapoor N, Kass D, Blumenthal DM, Gross N, et al. Gender differences in faculty rank among academic emergency physicians in the United States. Acad Emerg Med 2019;26:281-5.  Back to cited text no. 16
    
17.
Cheng D, Promes S, Clem K, Shah A, Pietrobon R. Chairperson and faculty gender in academic emergency medicine departments. Acad Emerg Med 2006;13:904-6.  Back to cited text no. 17
    
18.
Closing the Gender Pay Gap in Medicine | AAMC. Available from: https://www.aamc.org/news-insights/closing-gender-pay-gap-medicine. [Last accessed on 2021 Nov 30].  Back to cited text no. 18
    
19.
Butkus R, Serchen J, Moyer DV, Bornstein SS, Hingle ST; Health and Public Policy Committee of the American College of Physicians; et al. Achieving gender equity in physician compensation and career advancement: A position paper of the American College of physicians. Ann Intern Med 2018;168:721-3.  Back to cited text no. 19
    
20.
Wiler JL, Rounds K, McGowan B, Baird J. Continuation of gender disparities in pay among academic emergency medicine physicians. Acad Emerg Med 2019;26:286-92.  Back to cited text no. 20
    
21.
Lall MD, Perman SM, Garg N, Kohn N, Whyte K, Gips A, et al. Intention to leave emergency medicine: Mid-career women are at increased risk. West J Emerg Med 2020;21:1131-9.  Back to cited text no. 21
    
22.
Emergency Medicine Workforce Needs More Women Physicians – ACEP Now. Available from: https://www.acepnow.com/article/emergency-medicine-workforce-needs-women-physicians/. [Last accessed on 2021 Nov 30].  Back to cited text no. 22
    




 

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