Hospital Medicine Leaders Offer Tips for Gender Equity

Thomas R. Collins

May 28, 2021

When Marisha Burden, MD, division head of hospital medicine at the University of Colorado School of Medicine, in Aurora, Colorado, would go to medical conferences, it seemed as if very few women were giving talks. Could she be wrong? she wondered.

"I started doing my own assessments at every conference I would go to, just to make sure I wasn't biased in my own belief system," she said in a session at the Society of Hospital Medicine (SHM) 'Converge' 2021 Annual Meeting.

She wasn't wrong.

In 2015, only 35% of all speakers at the annual meeting of the SHM were women, and only 23% of the plenary speakers were women. In the years after that, when the society put out open calls for speakers, the numbers of women who spoke increased substantially, to 47% overall and 45% of plenary speakers.

The results — part of the SPEAK UP study she led in 2020 — show how gender disparity can be improved with a systematic process that is designed to improve it. The results of the study also showed that as the percentages of female speakers increased, the attendee ratings of the sessions did, too.

"You can do these things, and the quality of your conference doesn't get negatively impacted — and in this case, actually improved," Burden said.

That study marked progress toward leveling a traditionally uneven playing field when it comes to men and women in medicine, and the panelists in the session called on the field to use a variety of tools and strategies to continue toward something closer to equality.

Sara Spilseth, MD, MBA, chief of staff at Regions Hospital, in St. Paul, Minnesota, said it's well established that although almost 50% of medical school students are women, the percentage shrinks each step from faculty to full professor to dean — of which only 16% are women. She referred to what's known as the "leaky pipe."

In what she said was one of her favorite studies, researchers in 2015 found that only 13% of clinical department leaders at the top 50 US medical schools were women — they were outnumbered by the percentage of department leaders with mustaches, at 19%, even though moustaches are dwindling in popularity.

"Why does this exist? Why did we end up like this?" Part of the problem is a "respect gap," she said, pointing to a study on the tendency of women to use the formal title of "doctor" when introducing male colleagues, whereas men who introduce women use that title less than half the time.

The COVID-19 pandemic has only made these disparities worse. Women are responsible for childcare much more frequently than men, Burden said, although the pandemic has brought caregiving duties to the forefront.

Spilseth said mentoring can help women navigate the workplace so as to help overcome these disparities. At Regions, the mentoring program is robust.

"Even before a new hire steps foot in the hospital, we have established them with a mentor," she said. Sponsoring — the "ability of someone with political capital to use it to help colleagues" — can also help boost women's careers, she said.

Her hospital also has a Women in Medicine Cooperative, which provides a way for women to talk about common struggles and to network.

Flexible work opportunities — working in transitional care units, being a physician advisor, and doing research — can all help boost a career as well, she said.

She said that at the University of Colorado, leaders set out to reach salary equity in a year and a half — and "it was a painful, painful process." They found that different people held different beliefs about how people were paid, which led to a lot of unnecessary stress as they tried to construct a fairer system.

"On the back end of having done that, while it was a rough year and half, it has saved so much time — and I think built a culture of trust and transparency," she said.

Recruiting in a more thoughtful way can also have big effects, she said. How people are told about opportunities could exclude people without intending to.

"Are you casting a wide net?" she asked.

Adia Ross, MD, MHA, chief medical officer at Duke Regional Hospital, in Durham, North Carolina, said that even in the face of obvious disparities, women can take steps on their own to boost their careers. Those who might be best suited, she suggested, are "rational optimists," those who "see your situation as it is. You are really honest with yourself about your current capabilities, and yet you still feel like there is hope for the future."

She encouraged taking on "stretch assignments," a project or task that is a bit beyond one's current comfort level or level of experience or knowledge.

"It can be a little scary, and sometimes there are bumps along the way," she said.

All of these measures, though incremental, are the way to make bigger change, she said.

"We want to take small steps but big strides forward."

Tom Collins is a freelance writer in South Florida who has written about medical topics from nasty infections to ethical dilemmas, runaway tumors to tornado-chasing doctors. He travels the globe gathering conference health news and lives in West Palm Beach.

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