Psychiatric News Update

Women Making Strides in Academic Psychiatry but Gender Bias, Discrimination Still Too Common

Women talking
U.S. women have made much progress in medicine since 1849 when the first woman obtained an M.D. But 170 years later, a wide gender gap persists in compensation, advancement, and research funding, according to speakers at an Annual Meeting session about gender bias in academic medicine.

Female admissions to medical schools have more than doubled since the passage of Title IX of the Education Amendments of 1972, which prevents federally funded, higher-learning institutions from discriminating on the basis of gender. In fact, women made up 53% of medical school admissions in 2017. In psychiatry, women have made up roughly half of residents for the past 20 years.

Despite the strong representation of female psychiatrists in residency training and early career positions, women faculty in tenured or executive leadership positions have not enjoyed the same success, said speaker Latoya Frolov, M.D., M.P.H., a fourth-year psychiatry resident at University of California, San Francisco (UCSF). In fact, just 10% of psychiatry chairs are female, and only about one-quarter of full professors in psychiatry are women.

“Based on generational changes, seniority, and the number of women in the psychiatry, we would expect about one-third of psychiatry department chairs to be women,” Kristen Berendzen, M.D., Ph.D., another session speaker and a fourth-year psychiatry resident at UCSF, told the attendees.

Unequal pay is another challenge for women. A 2016 JAMA study of more than 10,000 physician faculty salaries found that female physicians were paid $20,000 less on average, even after researchers adjusted for a variety of other factors including years since residency completion, faculty rank, specialty, and indicators of productivity including clinical hours worked. A salary survey by Doximity of 65,000 full-time physicians found that women earned $105,000 less on average, even after adjusting for hours worked, geographic location, provider specialty, and years in practice.

Berendzen also cited various studies revealing a gender gap in research funding. For example, a 2012 study found that fewer than one-third of research grants go to women (30%) and the average size of the grant for men surpasses that of women.

Among medical students, females face gender bias in their performance evaluations. Berendzen pointed to a study of nearly 90,000 clerkship evaluations from core clinical rotations at two medical schools. Published in the May issue of Journal of General Internal Medicine, the findings revealed gender-based differences in the language used to evaluate the students, even among students who received the same grade. Evaluations of female students were more likely to include descriptors of personal attributes such as “lovely,” while male student evaluations tended to focus on competency-related attributes such as “scientific” and “knowledgeable.”

Women also continue to experience sexual harassment and discrimination, said Berendzen. A 2018 study in Journal of General Internal Medicine found that as many as two-thirds of academic female researchers surveyed said they had experienced gender bias or sexual harassment with negative effects on their confidence and career advancement.

“More women than ever are entering medicine, but at all levels of training and practice, they continue to experience harassment and discrimination,” she said. “The #MeToo and #TimesUP movements have created a platform to challenge inappropriate gender-related treatment in the workplace.”

Another significant issue women in medicine continue to face is a lack of family-friendly policies in training programs and at work, Berendzen said. “Family-leave policies are not standardized across institutions, and they are discretionary, meaning they are allowed only at the discretion of management or the institution.”

Women in psychiatry also cite the absence of mentorships and role models—obstacles reported by women in other areas of medicine as well.

In the spirit of problem-solving, audience members broke into small groups to brainstorm for solutions to these issues for women in academic and clinical psychiatry. They came up with the following ideas:

  • Adopt family-friendly policies. Policies such as allowing part-time and flexible career paths for women could increase female physicians in the workforce. Organizations also could provide at least 12 weeks of fully paid maternity leave, lactation rooms, on-site childcare, and paid sick leave to care for children or elderly family members, which women are more likely to take on.

  • Require institution-wide managerial training to address implicit or unconscious bias, discrimination, and sexual harassment. Organizations should provide implicit bias training for all managers, and performance evaluations should include feedback on how well managers are providing mentorship, sponsorship, and promotion opportunities for women. “There should be a message for management: Your promotion could be impacted if you don’t mentor or promote women,” one attendee said.

  • Create fair rotation for “housekeeping”-type responsibilities. Women in academic medicine are more likely than men to serve on committees and provide mentorship, activities that do not necessarily help them advance their careers. Several attendees recommended creating a rotation for these responsibilities, so the work is more evenly distributed among men and women.

  • Create safe reporting mechanisms for harassment. Organizations should implement third-party reporting systems for sexual harassment or assault so that women can come forward without fearing retribution.

  • Provide networking opportunities for all women. APA President Altha Stewart, M.D., who attended the session, pointed out that that the head of human resources at her organization hosts a regular support group for all women faculty members so they can network, problem solve together, and encourage senior faculty to mentor women. “When we are together, we are stronger,” said one attendee.

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