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State of Women in Medicine: History, Challenges, and the Benefits of a Diverse Workforce Madeline M

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State of Women in Medicine: History, Challenges, and the Benefits of a Diverse Workforce Madeline M State of Women in Medicine: History, Challenges, and the Benefits of a Diverse Workforce Madeline M. Joseph, MD, FAAP, FACEP,a Amy M. Ahasic, MD, MPH, FCCP, ATSF,b Jesse Clark, DO, FAAFP,c Kim Templeton, MD, FAAOS, FAOA, FAMWAd Women in medicine have made progress since Elizabeth Blackwell: the first women to receive abstract her medical degree in the United States in 1849. Yet although women currently represent just over one-half of medical school applicants and matriculates, they continue to face many challenges that hinder them from entering residency, achieving leadership positions that exhibit final decision-making and budgetary power, and, in academic medicine, being promoted. Challenges include gender bias in promotion, salary inequity, professional isolation, bullying, sexual harassment, and lack of recognition, all of which lead to higher rates of attrition and burnout in women physicians. These challenges are even greater for women from groups that have historically been marginalized and excluded, in all aspects of their career and especially in achieving leadership positions. It is important to note that, in several studies, it was indicated that women physicians are more likely to adhere to clinical guidelines, provide preventive care and psychosocial counseling, and spend more time with their patients than their male peers. Additionally, some studies reveal improved clinical outcomes with women physicians. Therefore, it is critical for health care systems to promote workforce diversity in medicine and support women physicians in their career development and success and their wellness from early to late career. aDivision of Pediatric Emergency Medicine, Department of Emergency Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida; bSection of Pulmonary and Critical Care Medicine, Department of Medicine, Norwalk Hospital, Nuvance Health, Norwalk, Connecticut; cCommunity Hospital East, Family Medicine Residency, College of Osteopathic Medicine, Marian University, Indianapolis, Indiana; and dDepartment of Orthopaedic Surgery, University of Kansas, Medical Center, Kansas City, Kansas All authors conceptualized and designed the manuscript, drafted sections of the manuscript, reviewed and revised the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work. DOI: https://doi.org/10.1542/peds.2021-051440C Accepted for publication June 22, 2021 Address correspondence to Madeline M. Joseph, MD, FAAP, FACEP, Department of Emergency Medicine, College of Medicine-Jacksonville, University of Florida, 655 W 8th St, Jacksonville, FL 32209. E-mail: [email protected]fl.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2021 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Downloaded from www.aappublications.org/news by guest on October 2, 2021 PEDIATRICS Volume 148, number s2, September 2021:e2021051440C SUPPLEMENT ARTICLE HISTORY OF WOMEN IN MEDICINE 30% of graduates from some medical “priced out” with rising tuitions and 5 2 Women seem to have always been schools. Traditionally male-only increasing opportunity costs. The 7 healers. In Ancient Egypt, Isis was medical schools also started to accept Black medical schools running before universally worshipped as the women, lauded by some as a step the Flexner report were whittled goddess of medicine, and her toward gender equity in medicine, down to only 2, and graduates priestesses were accepted as but this shift also resulted in many commonly struggled to get ’ 2 physician-healers.1 In Ancient women s medical schools closing or internships or hospital privileges. Greece, Hygeia and Panacea, the merging with existing medical 2 daughters of Aesculapius, were schools. As the feminist movement “sainted mortals” and likely burgeoned in the United States in Around the turn of the century, the practiced as independent the 1970s, there was renewed American Medical Association’s physicians.1 In both Ancient Egypt attention to the role of women in priority to reform medical schools, and Ancient Greece, women medicine and particular attention to standardize, and set minimum appeared to be widely accepted as the paternalistic culture of American requirements for medical education physicians and surgeons.1 From the medicine, in which women who ultimately led to the Flexner report Middle Ages to Colonial America, were patients and nurses were being published in 1910. This report women bore the responsibility for routinely denied the right to was an independent critique of US 2 most medical care in the home.1,2 participate in medical decisions. medical schools and medical This included women in their The proportion of women medical education, supported by the traditional domestic roles and students increased substantially Carnegie Foundation for the women as lay practitioners, but they during the 1970s, representing Advancement of Teaching and >25% of US medical students by the were not typically recognized as 2 2 2 authored by Abraham Flexner. end of the decade. professionals. However, this role Although the number of medical started to change in the schools had already started to STATE OF WOMEN IN MEDICINE midnineteenth century with 1 major decline in the years leading up to milestone, the admittance of the Flexner report, this trend was Acknowledging the state of women Elizabeth Blackwell to medical accelerated by requirements for in medicine is key to understanding school at Geneva College in New longer training periods and higher existing systems and structures that York. Her admittance, however, had tuitions resulting from the higher may influence the trajectory of 3 ’ been intended as a practical joke, costs to medical schools to provide women s progress in medicine, in but she persevered and became the adequate medical education.2 both academic and nonacademic first women to receive a medical Although Flexner himself had stated settings. In addition to educational degree in the United States in 1849. that “privileges must be granted to initiatives for women, data She graduated first in her class and women … on the same terms as collection and analysis are needed ’ 1 then worked in children s hospitals men,” the consequences of the to implement systemic and 4 in London and Scotland, later more stringent educational institution-level interventions to opening the New York Infirmary for standards included a morphing of achieve gender equity and inclusion Women and Children in 1857. the profession into one that was in medicine. Because of the more socially uniform, with variability of practice settings in the Inthelate1800s,therewasasurge declining access of women to United States, it remains difficult to in the number of medical schools. medical education.2 As a result, obtain data from nonacademic These included schools in established women accounted for only 6% of US settings; therefore, much of the data colleges and universities like Johns physicians in 1910, which remained presented here are from academic Hopkins, which opened its medical the same for 50 years.5 environments. However, many of the school in 1893, but also included challenges faced by women in many proprietary and commercial The aftermath of the Flexner report medicine are universal and not 2 medical schools. This increased in creating a more socially unique to their practice setting, so access to medical education opened homogeneous profession also created the concepts presented are broadly the door for women to take on the barriers for immigrants, lower and applicable to academic and professional role of physician, and, by working class Americans, Jewish nonacademic environments. the end of the nineteenth century, Americans, and Black Americans, there were 17 medical colleges for who, along with women, were Since 1983, the Association of womenintheUnitedStates.2 In the discriminated against in their efforts American Medical Colleges has 1890s, women made up as many as to access medical education, or were reported data on women’s Downloaded from www.aappublications.org/news by guest on October 2, 2021 S2 JOSEPH et al representation in all facets of majority only at the instructor level women of color in departmental medicine using a variety of survey (58%).6 Women faculty from an leadership positions. Beyond the data to illustrate women’s underrepresented-in-medicine race or numbers, women faculty in leadership representation as learners, faculty, ethnicity increased only from 12% in positions were more commonly in and leaders in medicine. In 2009% to 13% in 2018, and women offices that are perceived to be September 2020, the Association of at the full professor rank are 74.6% communal and less influential, such as American Medical Colleges white.6 Overall, 49% of medical offices for diversity, equity, and published its 2018–2019 report on schools reported having a formal inclusion; faculty affairs and/or “ the State of Women in Academic position dedicated to women and/or development; and student affairs and/ ” Medicine. This report reveals that gender equity beyond Title IX and/or or admissions. On the other hand, the although women represent just compliance roles, and this position smallest proportions of women > 50% of medical school applicants
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