AAP Voices Blog

A pediatric emergency medicine attending is running a full resuscitation of a patient status post-Fontan presenting with massive pulmonary emboli. The entire team is looking to her for critical decision making and clear communication. After narrowly escaping cardiac arrest, the patient is stabilized and requires transfer to the cardiac intensive care unit.

A consultant who witnessed the woman attending running the code asks her if she is the charge nurse. The attending is me, Dr. Amanda Stewart. I say I am the ED physician and, in an awkward attempt to rectify his misstep, he gives me a hug.

The unwanted physical gesture only compounds the moment of bias. And this is hardly a rare example of sexism for women who are physicians.

When a woman physician’s expertise is questioned based on her gender, it can feel like questioning the 84 months it took to complete medical school and residency training: 2,555 days, 3,679,200 minutes filled with challenges, sacrifice, and fulfillment to improve the lives of children and their communities through pediatrics.

“As we mark Women in Medicine Month, pediatrics should be leading the way in gender equity. We have made giant strides, but we must do more.”

Sexism in medicine is manifested through discrimination, pay gaps, and lack of women in leadership positions. These gender-based disparities tell women pediatricians that their training, contributions, and their time are not worth the same as their male colleagues. (Of note, we use the term women pediatricians to include both cis and trans physicians who identify as women).

Though pediatrics is one of the few specialties that has more women representation, with about 70% identifying as women, according to the American Medical Association, it still perpetuates unrelenting gender-based inequalities. As we mark Women in Medicine Month, pediatrics should be leading the way in gender equity.

We have made giant strides, but we must do more.

Women represent over 50% of medical school matriculants, however, they only account for 41% of academic faculty and 25% of full professors, the Association of American Medical Colleges reports. In 2018, women accounted for only 18.0% of medical school department chairs, 26.2% of pediatric chairs and 16.8% of deans, an article in AAP Pediatrics reveals.

Disparities in leadership are, of course, magnified for women of color. Family and lifestyle are easy scapegoats for these disparities, however, research has shown that they do not adequately account for these gaps. Leadership bias, microaggressions, pay gaps and inadequate policies -- all rooted in sexism -- contribute to holes in the leadership pipeline and put women on the sideline for promotions, positions, and valuable projects.

Academic medicine must re-examine how it measures leadership. Charisma, charm, and confidence are often conflated with competency, and these characteristics are aligned with sexist gender roles that can propel men toward leadership positions and leave women stagnant in their career trajectories. Three-hundred-sixty-degree evaluations that include technical skills, emotional intelligence, adaptability, integrity, and competence can provide a more holistic picture of performance.

In addition, research-related tasks are more promotable than service-related tasks. Women are more likely to do service-related tasks for the benefit of the group. This is work that is time-consuming but often has little visibility. Even when executed effectively, it is often non-promotable and thus creates a tax of unrewarded extra responsibilities, similar to the minority tax placed on underrepresented-in-medicine faculty in the name of efforts to achieve diversity. Academic centers must create systems to incorporate service work in career advancement and also equally distribute these tasks across genders.

Those making hiring and promotions decisions should be aware of, and have strategies to combat, the gender backlash that women face when engaging in negotiations. When women try to make themselves more visible at work, which is crucial for getting ahead, they can face backlash for violating expectations about how women should behave, Harvard Business Review found.

Microaggressions tear away at bandwidth, at best, and, at worst, cause burnout that leads to disengaging from medicine altogether. Creating a culture of upstanders with a toolbox of interventions for microaggressions can take the load off women physicians.

National research shows pay gaps for women in pediatrics after adjusting for confounding variables. Female pediatricians earned about 76% of what their male counterparts earned in 2016, according to an article published in Pediatrics. That gap can cost women $280,000 over their careers. Academic centers and departments should institute pay parity report cards delineated by gender and race for accountability and increased transparency.

Policies that promote work-life integration are essential for creating a level playing field for career advancement across genders. Parental leave policies also should include caregivers and cover foster care placement and adoption, as this Pediatrics article notes. More robust family leave, sick leave and child-care support can also help redistribute familial responsibilities, especially in times of COVID-19.

There must be no-tolerance policies for sexual harassment and protection from retaliation for reporting. Health-care organizations can join TIME’S Up Healthcare and state their commitment to practice and policy change in the name of gender equity.

People of all genders and in all roles can play their part by supporting their women colleagues, actively listening when they speak, and calling out sexist behavior from others.

With more women entering medicine, the demographics of the pediatric workforce will continue to change and, hopefully, so will mindsets. This was demonstrated by a 5-year-old who recently was in the emergency department and whispered to their mom, “See, I told you we’d have a girl doctor.”

Let's make sure that “girl doctor’s” time, talents, and training are valued with equal compensation, work-life integration, leadership opportunities, and a supportive environment. After all, women physicians are worth it.