As we celebrate Women’s History Month this March, I am delighted to welcome guest authors Jeanette Mladenovic, MD, MBA, and the executive board from the Gender in Equity in academic Medicine and Science (GEMS) Alliance—an “organization of organizations” that places great emphasis on Action Step 5.8 from the 2021 Macy Conference recommendations:
Action Step 5.8 from the 2021 Macy Conference Recommendations Report: Health system and health professions education (HPE) leaders and educators must establish equity in compensation and review their assessment and advancement policies to eliminate bias and inequities in retention, promotion, and tenure for faculty.
GEMS Alliance first launched last month with a February 3rd webinar, which I invite you to view for more information and context about the organization. In the following blog post, Dr. Mladenovic and her executive board highlight the four gaps known to impede gender equity in academic medicine and science. We at the Macy Foundation celebrate the successful launch of GEMS Alliance and the many ways in which their work aims to promote diversity, equity, and belonging in health professions education.
On National Women’s Physicians Day, February 3rd, a new organization was launched: the Gender Equity in academic Medicine and Science (GEMS) Alliance is an organization of organizations whose vision is to catalyze alignment, collaboration, and innovative approaches to achieve gender equity. We are focused first in our schools of medicine where the culture is evident, learned, and passed on. We recognize that for decades abundant data have demonstrated the myriad barriers, biases, and structural systems that impede gender equity in our profession(s). GEMS Alliance is focused on tackling four identified gaps that must be addressed in order to achieve gender equity.
The Pipeline to Medical School and Science: While women now represent 50% of students in medical school (and over 50% of PhD students in biological sciences), the women admitted do not reflect our diverse communities. If we fail to correct this pipeline of women underrepresented in medicine (URiM), we cannot achieve equity in our schools, across our specialties, as faculty, and as leaders. As they reflect our communities, these students are not a monolith, and may have unique lived experiences, challenges, and limited exposure to the medical school admission processes. While committed to the rigors of this profession, they also face structural and systemic barriers to success. We need to tackle these issues directly to increase URiM women admitted to medical school and to support their future career trajectories, as these women are critical to reaching gender and health equity.
The Gender Segregation in Medical Careers: Historically, women have gravitated toward specialties that might be considered “women friendly,” sometimes because the fit is perfect; other times because they have been encouraged to do so in lieu of other opportunities; or because they themselves have decided the sacrifice is too great to choose differently. The result is the emergence of fields that are predominantly women, while others remain predominantly male. This occupational segregation affects future professional opportunities and compensation, and it robs patients of a diverse physician workforce. The continuum, beginning early in medical school, requires a concerted effort to ensure career advising that does not reinforce gender stereotypes; to create visibility and access to role models; and to adapt the culture of training programs such that women are distributed appropriately across specialties.
The Leadership Gap in Academic Medicine, Science, and Healthcare in General: Achieving equity requires significant representation at the leadership level, which then serves as a tipping point for cultural change. In higher education, when women lead, they hire more women and salaries are higher and more equitable. The percentage of women in leadership at the highest levels in our medical schools, where critical decisions and policies are made and resources are controlled, has remained relatively stagnant now for some three decades. These leadership roles require not only addressing the issues of recruitment and retention at these highest levels, but more importantly assuring that we have adequate numbers of women who ascend to senior academic ranks, from which these positions are currently filled. Challenges remain in academic promotions, and salary and resource equity, along with the well-documented biases that affect women’s careers both inside and outside of academia. Thus, it is critical we reach a tipping point in leadership.
The Unequal Burdens for Women: The crux of equity is that individuals be provided what is needed for their success. Women who carry the physiological and/or time burdens of family and home care differ from their male counterparts. The pandemic has only accentuated these differences, potentially leading to irrevocable harm to our academic workforce. Because of these differing expectations society places on women, women desperately need support tailored to their specific needs if they are to engage in the rigors of medical school; enter training in their chosen field; and achieve success in academia, research, and leadership. Students, residents, and faculty need programs that support their work requirements, are readily accessible and reliable, and are affordable for students and residents. Acknowledging this basic gender difference and creating solutions that work and allow choice is critical to achieving equity in our schools, our profession, and our workforce.
Many organizations support the goal of gender equity in academic medicine and science. GEMS Alliance was founded by six such organizations: American Medical Women’s Association (AMWA); American College of Physicians (ACP); Center for Women in Academic Medicine and Science (CWAMS); Council of Medical Specialty Societies (CMSS); The Hedwig van Ameringen Executive Leadership for Academic Medicine® (ELAM); and the National Medical Association (NMA). Representing the majority of all physician members of our academic medicine communities, the founding organizations of GEMS Alliance believe that by aligning our efforts we stand a better and timelier chance of success. Several additional organizations specifically target women physicians and scientists; we hope these groups will join us to help realize our vision. Now is the time to implement programs, policies, and approaches that will achieve the gender equity that is so critical in academic medicine and science for the patients of today and of tomorrow.
Jeanette Mladenovic, MD, MBA, GEMS Alliance Executive Board Chair
Helen Burstin, MD, MPH, MACP
Eliza Chin, MD, MPH, MACP
Amy S. Gottlieb, MD, FACP
Reshma Jagsi, MD, DPhil
Shikha Jain, MD, FACP
Darilyn V. Moyer, MD, FACP, FRCP, FIDSA
Nancy D. Spector, MD
Rachel Villanueva, MD, FACOG