The Otolaryngology Gender Gap: How do we make it disappear?

It’s a fact: An increasing number of American women are entering medicine. In the U.S. today, half of matriculating medical students, and 28 percent of all practicing physicians, are women. Nonetheless, the pervasive gender gap in the medical profession creates a real dilemma for our nation. The negative impact of a less-than-optimally integrated work force affects the health and well-being of our patients—and our society.

The consequences of the gender gap are readily apparent in the most fundamental aspect of any career: compensation. In 2004, the U.S. Census Bureau reported that women physicians earn 63 cents per every dollar that men physicians earn and that no other profession in the U.S. exhibits greater salary disparities by sex. Unfortunately, the field of otolaryngology/head and neck surgery is not spared from similar unequal treatment. A landmark study conducted by Grandis and colleagues in 2004 reported a 15 to 20 percent pay differential for women otolaryngologists after controlling for confounding variables (Arch Otolaryngol Head Neck Surg. 2004;130(6):695-702).

The gender gap also brings with it bias against women, overt harassment, less overt gender stereotyping and women’s struggle to gain acceptance and respect from their male peers. Inbred and institutionalized bias has hindered our entry into leadership roles in our medical societies, on editorial boards, in the halls of academia, and in clinical medical leadership at the local and national levels. The old standby excuse—that childbearing or the social construct of women bearing the greater share of home management and child rearing—is no longer persuasive. Newer models for dealing with these important roles, like more affordable childcare options, have emerged, allowing women to be as productive in their careers as men.

Eliminating the gender gap in health care is particularly challenging because still-prevalent hierarchical structures and paternalistic concepts in medicine dictate how women (and newer/younger) physicians could and should be included. Mentorship programs designed to address these issues have been inherently disingenuous and patently impossible for many, if not most, women.

Other solutions have been equally ineffective in providing the much needed systemic change. Changes stemming from teaching women better negotiating skills, refining the charges of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) committee on Women in Otolaryngology (WIO) or voting that gender discrimination is an ethical violation of the by-laws of the AAO/HNS have been hard to find.

Our professional status quo is built on the age-old power differential, horizontal and vertical segregation and a medical culture built on a model of time and productivity measures that do not fit women’s “style,” which is more collaborative, inclusive and consensus building. We can (and should) proudly point to a few exceptional women who have climbed the ladder (almost) to their goal, but we must also acknowledge that these women are the exceptions, not the rules, in their fields. Sometimes, when women strive for acceptance in traditionally male-dominated surgery, they may have to embrace the institutionalized norms and consequently lose some of the needed advantages that a woman can bring to the table.

What to do? Useful and impactful conclusions are admittedly difficult. I will offer but a few suggestions. I have borrowed these ideas from other organizations that are aggressively and successfully tackling this pernicious and pervasive problem of gender discrimination.

1. Implement gender mainstreaming. This is a globally accepted strategy, an approach developed by the United Nations Development Programme to achieve significant change in gender equality. Their belief is that gender equality cannot be achieved just by adding marginal (and marginalizing) programs for women, such as the WIO committee of the AAO/HNS. Mainstreaming requires changes in policies and resource allocations so that they, too, reflect the perspectives, interests and views of both women and men. Policy development, research, advocacy, legislation, resource allocation and planning must all be undertaken, implemented and monitored with the goal of gender equity embedded into the core goals of any project and program. From the choosing and training of residents to the production of our body of scientific literature to the economic issues facing us as practitioners and providers of care for our patients, gender issues need to be addressed as core to advancement of our shared goals.
2. Conduct self-study for culture change. The role of the academic departments in which residents are trained to become full-fledged participants in our specialty cannot be underestimated or understated. Guided self-study with the help of individuals and organizations that have had success in overcoming these barriers would be a good first step. Examination and thoughtful adjustments of resident selection, training processes and attention to work-life balance issues are necessary. Faculty hiring practices, allocation of resources, promotion opportunities and support, schedules of conferences and meetings, and salary/benefit compensation issues would be studied in depth. Finally, leadership structure and style and their effects on the integration and productivity for all faculty would be a necessary step in addressing cultural change. Creating a time line with manageable, focused goals would be set.
3. Adopt a successful model for culture change. Physicians often talk about adopting best practices when it comes to clinical care. This strategy can also be useful when one commits to cultural change. An excellent model, which has had success in creating safe social climates in schools by reducing relational aggression among children, is the Ophelia Project (www.opheliaproject.org). Dissemination of grass roots change is well demonstrated by committed constituents.

Otolaryngologists have always been at the forefront of innovation and change. We have an extraordinary pool of talent that can lead the way. Women make up 50 percent of the current medical school class, and we can and should welcome them into our specialty with open arms and support systems in place. If we are serious about recruiting and retaining the best talent that is sure to come our way, we have to be ready. As a small specialty, we have the opportunity to become a model. Let us begin!

References:

• Evidence From Census 2000 About Earnings by Detailed Occupation for Men and Women. U.S. Census Bureau, 2004.
• Grandis JR, Gooding WE, Zamboni BA, et al. The gender gap in a surgical subspecialty: analysis of career and lifestyle factors. Arch Otolaryngol Head Neck Surg. 2004;130:695-702.

Linda Brodsky, MD, is a pediatric otolaryngologist and president of Pediatric ENT Associates in Buffalo, N.Y. She is professor of otolaryngology and pediatrics, non-emerita, and former director of the Department of Pediatric Otolaryngology at the Women’s and Children’s Hospital of Buffalo. She is an advocate for the next generation of women in medicine. For more information, visit www.lindabrodskymd.com or read www.thebrodskyblog.com.