Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Female representation in the Canadian physician anesthesia workforce: a historical analysis

PURPOSE

According to an analysis of data from the Canadian Institutes for Health Information (CIHI) National Physician Database, the proportion of female anesthesia physicians is substantially lower than the proportion of female physicians in the total physician population. The goal of this study was to identify trends in female representation in the major subgroups of anesthesia providers, including specialists certified by the Royal College of Physician and Surgeons of Canada (RCPSC), international medical graduates, and family physician anesthetists (FPAs).

METHODS

We examined the sex distribution of the existing physician workforce, including anesthesia providers working in urban and rural Canada, using the CIHI National Physician Database (1996-2018). We also examined the sex distribution of physicians entering the workforce using the Canadian Post-MD Education Registry database and calculated descriptive statistics.

RESULTS

The proportion of female physicians increased steadily over time in all groups; nevertheless, the numbers of female FPAs and rural anesthesia providers continued to lag relative to all Canadian physicians (9.4%, 9.4%, and 26.7%, respectively, in 1996; 18.7%, 21.1%, and 42.1%, respectively, in 2018). Of the graduates from RCPSC training programs in 1996, 28% were female, whereas by 2018, 33.5% of graduates were female.

CONCLUSIONS

Female physicians were underrepresented in all subgroups, but the proportions were lowest among FPAs and rural physicians. Given that greater sex diversity in clinical teams is associated with better outcomes, and in light of ongoing workforce shortages, the barriers that prevent female physicians from entering and/or remaining in the anesthesia workforce need to be understood and ameliorated.

Intent to Leave Associated More Strongly with Workplace Belonging Than Leadership Behaviors of Supervisor in Women Health Care Professionals

Background: The attrition of health care professionals from institutions has historically been high, with reports of higher rates in women than men. High attrition jeopardizes the institution's financial stability, quality of patient care, and scholarly contributions to advancing health care. The disproportionate loss of women reduces the diversity of perspectives and skills needed to meet patient needs. Attrition risk has been demonstrated to relate to both the leadership behaviors of supervisors and the sense of belonging in the workplace. Toward informing health care institutions about strategies for curtailing high attrition, we sought to assess the relative strength of the association of attrition risk with leadership behaviors of supervisors versus workplace belonging. Methods: Attendees of a continuing education course on women's leadership skills in health care were surveyed about the intent to leave (ITL) their institution within 2 years, perceived leadership behaviors of their supervisor, and experiences of workplace belonging. Dimensions of workplace belonging were identified by factor analysis. The strength of association of ITL with supervisor's leadership behaviors and each workplace belonging dimension was analyzed in a multivariable ordinal logistic regression model. Results: Women comprised 94% of survey participants. In the regression analysis, lower ITL was associated strongly with more frequent experiences of institutional culture supporting workplace belonging, modestly with more favorable perceptions of supervisor's leadership behaviors, and not with frequency of experiences of interpersonal relationships supporting workplace belonging. Conclusions: An institutional culture that supports workplace belonging is particularly important for reducing attrition risk in health care professionals. For health care institutions seeking to improve retention of its professionals and women in particular, our findings point to investing in a culture of workplace belonging that involves a diverse workforce, an environment in which its professionals feel heard, supported, and empowered and are provided strong career advancement opportunities.

Gender Inequity in Institutional Leadership Roles in US Academic Medical Centers: A Systematic Scoping Review

Importance

Academic medical centers have focused their efforts on promoting gender equity in recent years, but the positive outcomes associated with those efforts remain to be seen in recruiting and retaining diverse institutional leadership.

Objective

To evaluate the current state of gender inequity in institutional leadership roles, such as deans, department chairs, and residency and fellowship program directors, at US academic medical centers.

Evidence Review

A search for articles published from January 1, 2019, to August 5, 2022, on gender inequity in institutional leadership roles at academic medical centers was performed using the PubMed, CINAHL, and ERIC databases. Studies were screened for inclusion by sets of 2 independent reviewers (with disagreements resolved by a third reviewer) and evaluated for risk of bias. The Methodological Expectations of Cochrane Intervention Reviews Standards were followed for conducting the review, and the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed for reporting results.

Findings

A total of 8120 articles were retrieved, of which 6368 were screened by title and abstract, 6166 were excluded, and 202 underwent full-text review. Ultimately, 94 studies reported on institutional leadership roles, including deans (5 studies [5.3%]), department chairs (39 studies [41.5%]), division chiefs (25 studies [26.6%]), and program directors (67 studies [71.3%]), with some overlap. A total of 678 participants were deans (564 men [80.5%] and 132 women [19.5%]), 8518 were department chairs (7160 men [84.1%] and 1358 women [15.9%]), 3734 division chiefs (2997 men [80.3%] and 737 women [19.7%]), and 9548 program directors (7455 men [78.1%] and 2093 women [21.9%]). Even in specialties with 50% or more female faculty, none had equal representation of women as department chairs and division chiefs. Gender inequities were particularly pronounced in surgical specialties.

Conclusions and Relevance

This systematic scoping review suggests that even though emphasis has been placed on addressing gender inequities in academic medicine, considerable disparities remain at the leadership level. While certain positions and specialties have been observed to have more female leaders, niches of academic medicine almost or completely exclude women from their leadership ranks. Importantly, even female-dominated specialties, such as obstetrics and gynecology, have substantial inequity in leadership roles. It is past time for organizational and systems-level changes to ensure equitable gender representation in academic leadership.

Differential Sources of Distress in Clinical and Research Trainees: A Focus on Work and Role Relationships

Objective

To examine the experience of clinical and research trainees within an academic medical center setting to identify and compare factors influencing their wellbeing.

Participants and Methods

A cross-sectional, anonymous survey was conducted from June to July 2022 at a large academic medical center. Responses from clinical and research trainees were analyzed for this study. The survey assessed participant wellbeing using the Well-Being Index (WBI), in addition to perceptions of individual and organizational factors. Data were analyzed to identify correlates of elevated WBI scores and differences in clinical and research experience.

Results

Ordinal logistic regression analysis identified low sense of recognition (odds ratio [OR], 0.59; 95% CI, 0.44-0.79), low role clarity (OR, 0.58; 95% CI, 0.42-0.80), moral distress (OR, 1.61; 95% CI, 1.24-2.10), and social isolation or loneliness (OR, 2.79; 95% CI 1.69-4.61) as significantly associated with high WBI scores, accounting for 48.8% of predicted variance. Additionally, distressed clinical trainees (WBI≥2) reported lower control over their work (P<.001) and significantly higher perceived stress from heavy workload (P<.05) and long hours (P<.01), compared with distressed research trainees. Distressed research trainees reported lower levels of trust in their supervisor (P<0.01), lower perceived organizational support (P<.05), and lower role clarity (P<.05), compared with distressed medical trainees. Low recognition, moral distress, and perceived stress from social isolation and loneliness were experienced similarly between groups.

Conclusion

Our study indicates that trainees experience high levels of distress, although the sources differ. To effectively address these challenges, organizations should implement interventions targeted to address specific stressors of each group.

Faculty development committee: Evolution through engagement and empowerment

Introduction

Burnout and faculty disengagement are critical challenges in academic emergency medicine (EM), with burnout rates as high as 70% among emergency physicians. These issues, worsened by the COVID-19 pandemic and workforce shifts, lead to decreased professional satisfaction and increased attrition. Addressing these concerns is vital to fostering a supportive, equitable, and growth-oriented environment for faculty.

Objective

The faculty development committee (FDC) was established to empower faculty to address professional development, inclusivity, transparency, and wellness through innovative and collaborative initiatives.

Methods

Faculty needs were identified based on data from a biannual department culture survey. Findings revealed key areas for improvement, including career advancement, wellness, and equity, among others. A faculty-driven approach was used to design and implement initiatives, including a mentorship program, educational curriculum, equity assessments, and flexible scheduling policies. The biannual survey and informal feedback solicitation were used to evaluate outcomes and refine interventions.

Results

The mandatory mentorship program accelerated promotions, including the historic advancement of female faculty to full professor roles. The faculty education curriculum enhanced breadth of knowledge and clinical skills, leading to increased satisfaction with educational opportunities (45% in 2022 vs. 35% in 2020). Transparent policies on leadership roles and salary equity improved inclusivity and fairness. Flexible scheduling accommodations, including age and pregnancy/lactation status-based shift exemptions, expanded vacation and holiday options, and extended parental leave, improve work-life balance and faculty engagement. Surveys demonstrated improvements in departmental culture and satisfaction.

Conclusion

The FDC effectively addressed wellness, equity, and professional growth in an academic EM group by implementing faculty-centered and faculty-driven solutions. The committee's work has fostered a supportive, inclusive, and development-focused environment, serving as a model for addressing similar challenges in academic institutions.

Perceptions of Lactation Experience Among Neurology Faculty and Impact of Lactation Time on Academic Achievement at U.S. Academic Medical Centers

Objective: To investigate the perceptions of lactation experiences of neurology faculty and the impact of lactation time on academic achievement. Materials and Methods: This was a cross-sectional study utilizing a survey administered across 19 academic neurology centers in the United States. Respondents self-identified as having children and answered questions about lactation at work. Demographic information; academic achievement including publications, guest speakerships, awards, leadership roles, and funding; and perception of lactation experience were analyzed. Results: Among 162 respondents, 83% took lactation time at work. Thirty-seven percent reported lack of employer support for lactation, 46% were dissatisfied with their lactation experience, 59% did not receive compensation for lactation time, 62% did not have blocked clinical time, 73% reported relative value units were not adjusted to accommodate lactation, and 43% reported lack of access to private lactation space. Women spent on average 9.5 months lactating per child and desired 2.4 further months of lactation. There was no difference in all measures of self-reported academic achievement between women who did and did not take lactation time when measured across all career stages. Conclusions: Although a majority of respondents took lactation time at work, perceptions of employer support for lactation were low, and expectations for work productivity were not adjusted to accommodate lactation time. Taking lactation time at work did not decrease self-reported academic achievement. System-level best practices designed to support lactating faculty should be developed to guide academic institutions.

New Directions For Women's Health: Expanding Understanding, Improving Research, Addressing Workforce Limitations

In the United States, the field of women's health faces critical challenges. This article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, emphasizes the need for a holistic, lifespan approach to women's health that considers biological sex, gender, and intersecting social factors. We identify three key challenges: broadening the understanding of women's health beyond reproductive issues, improving the research ecosystem, and addressing workforce limitations. With innovative policies and investments across all areas of health, attention to structural determinants, and emphasis on the upstream factors affecting women's lives, significant improvements in women's health outcomes and substantial societal benefits can be achieved in 2025 and beyond.

Gender Differences in Self-Assessment Among Clerkship Medical Students Despite Equivalent Academic and Clinical Performance

OBJECTIVE

The authors aimed to determine if medical students' self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators.

METHODS

Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as "below," "at," or "above expected level." Ratings were coded numerically, and statistical analysis was performed using Student's T-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance.

RESULTS

Female students (n = 123) rated their performance significantly below male peers (n = 114) in medical knowledge (female - 0.05 vs male 0.13), clinical reasoning (- 0.02 vs 0.06), differential diagnosis (- 0.09 vs 0.00), balancing work and studying (- 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students.

CONCLUSIONS

Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.

Understanding the experience of Latinas in medical education: A qualitative study

BACKGROUND

Despite increased recruitment of Latina medical students, the percentage of Latina physicians has remained stagnant, suggesting unique retentive barriers affecting this population. Discriminatory experiences involving bias may contribute to difficulties in the retention and advancement of Latinas in medicine. This qualitative analysis aimed to explore thematic barriers prevalent among Latinas throughout their medical training in the United States.

METHODS

An anonymous online survey was distributed to Latinas in the continental United States from June 22 to August 12, 2022. Eligibility criteria included self-identifying as Hispanic/Latina, female/woman, and being currently enrolled in or graduated from medical school, residency, or fellowship in the United States in the past 10 years. Content and thematic analyses were done on 602 responses across seven open-ended survey questions.

RESULTS

Data were categorized into three main themes: (1) barriers stemming from limited social, cultural, and financial capital; (2) experiences of discrimination, bias, and perceptions of being undervalued; and (3) burdens resulting in notable mental health challenges such as depression and anxiety. Many women questioned their place in medicine throughout training and the value of the sacrifice and trauma endured.

CONCLUSION

This is the first qualitative study evaluating the experiences of Latinas throughout medical training, revealing that they experience disproportionate barriers and discriminatory experiences from both colleagues and patients. Despite calls to enhance institutional climates of diversity, there continues to be an acute need for the reform of medical education to promote an inclusive culture and provide adequate mentorship to marginalized trainees.

Gender equity in oncology: Progress, challenges, and the path forward in urologic oncology and oncologic specialties

Women now comprise over 50% of medical school graduates and over one-third of practicing physicians in the United States. Despite this progress, significant barriers to career advancement and leadership persist, particularly in male-dominated fields like urology and oncology. Women physicians are linked to improved patient outcomes and are critical to addressing the projected physician shortage, which is expected to be exaggerated in oncology specialties. This review highlights progress, challenges, and future directions for gender equity in urology, urologic oncology, and oncology subspecialties. Urology and urologic oncology have seen growth in female representation, whereas radiation oncology remains stagnant, and medical oncology has reached near gender parity among trainees. However, leadership roles across all these fields continue to reflect gender inequities. Key barriers include the gender pay gap, insufficient maternal leave policies, workplace harassment, and lack of mentorship and sponsorship for women physicians. Moving forward, efforts to advance gender equity must include transparent pay structures, supportive maternal leave, and robust antiharassment policies. Promoting women in leadership and fostering mentorship are also essential to retaining and advancing women in these fields. By addressing these issues, the health care community can progress toward gender equity, strengthen the physician workforce, and improve patient outcomes. Institutional and national advocacy is crucial for creating an equitable and effective medical community.

Enhancing an Experience-Based Patient-Initiated Mistreatment Training

PROBLEM

Mistreatment of health care workers and learners by patients and their families is prevalent at all levels of training. This mistreatment has negative consequences and disproportionately affects women and historically marginalized and excluded groups.

APPROACH

The authors designed and piloted a preliminary practice-based curriculum consisting of a discussion of literature, a framework for responding to mistreatment in the moment, and interactive simulated mistreatment encounters with trained patient actors. Feedback was generally positive, but participants consistently requested greater diversity in the representation of mistreatment. Using funds from the Josiah Macy Jr. Foundation Catalyst Award for Transformation in Graduate Medical Education, the authors expanded and improved the curriculum to meet the needs of a diverse population of learners. Effectiveness of the curriculum was measured using pre- and post-curriculum surveys.

OUTCOMES

The curriculum was delivered over multiple sessions from January 2022 to March 2024 with grant-funded interventions starting in January 2024. Participants included medical students, house officers, and faculty, and 678 participants completed pre-curriculum surveys. Upon implementation of grant-funded interventions, post-curriculum surveys showed improvements in respondents' self-reported plan to use skills demonstrated in the session (4.76 to 4.85, P = .006) and plan to address mistreatment with their teams moving forward (4.75 to 4.81, P = .045).

NEXT STEPS

All health care workers and learners deserve to feel safe, respected, and welcome in their work and in training. The foundation of this curriculum will support expansion to meet the needs of all patient-facing health care workers and learners at the pilot institution and beyond.

A cross sectional analysis of residents by race/ethnicity and specialty from 2020-2023

BACKGROUND

Minorities are underrepresented in all areas of medical education relative to the United States general population, and minority physicians are more likely to practice in disadvantaged areas and in primary care settings. Many individual and structural factors contribute to this discrepancy. We aimed to demonstrate how resident race/ethnicity representation differs across the various resident specialties.

METHODS

We used publically available data from the Association of American Medical College's Report on Residents data series and averaged the four academic years from 2019 to 2020 through 2022-2023. We then calculated the odds ratio (OR) of self-reported race/ethnicity (alone and in combination) in thirty-four specialties.

RESULTS

Across the four-year study period, there were, on average, 147026 unduplicated resident trainees. The average number of duplicated residents by self-identified ethnic category (alone and in combination) include: American Indian or Alaska Native (839, 0.6%), Asian (31627, 21.5%), Black or African American (7935, 5.4%), Hispanic, Latino, or of Spanish Origin (10900, 7.4%), Native Hawaiian or Other Pacific Islander (296, 0.2%), White (76289, 51.9%), Other (4879, 3.3%), Unknown (522, 0.4%), and Non-US Citizens (23914, 16.3%). Across race/ethnicity, there are differences in ORs of representation in different specialties. Key findings include high representation in Public Health and Preventative Medicine by Black and African American (OR=3.7) and Native Hawaiian (OR=2.6) residents, and Family Medicine in Native Americans (OR=1.9), Native Hawaiian (OR=1.7), Black (OR=1.5), and Hispanic (OR=1.3) residents. Psychiatry also had high ORs of representation in minority residents.

CONCLUSION

This study illustrates relative resident ethnic representation across training specialties. Minorities ethnicities were more likely to be represented in primary care and public health domains. This has implications for creating a physician workforce suitable to serve the United States Population.

Challenges of Motherhood for Anesthesiologists: A Scoping Review

Despite advancements in gender representation, female anesthesiologists continue to encounter challenges in career advancement that may be further impacted by motherhood. This scoping review examines personal and systemic barriers and facilitators to career advancement for anesthesiologists facing infertility, pregnancy, and childcare. The review identified 22 relevant studies across five themes: the timing of pregnancy and parental leave, breastfeeding and lactation needs, childcare and gender norms, job reentry and career advancement opportunities, and work-life balance and physician well-being. Recommendations from these studies include establishing clear parental leave policies, providing adequate lactation spaces and protected break times, addressing gender disparities in leadership roles, and prioritizing physician well-being. To implement these recommendations effectively, institutions and departments should develop and disseminate role-specific policies that promote career advancement and satisfaction through equitable support of pregnant and parent anesthesiologists.

The impact of the pandemic on female physicians: "I just don't think I will ever feel the same"

BACKGROUND

TheCOVID-19 pandemic profoundly affected female physicians, exacerbating existing gender disparities both at home and in the workplace. We aimed to understand how the effects of the pandemic continued to impact female physicians.

METHODS

We conducted a qualitative study of 24 female physicians through focus groups consisting of 4 to 6 participants. Focus group transcripts were coded deductively.

RESULTS

Key themes were identified, including lack of wellbeing, unsafe working conditions, increased work burden, lack of childcare, and the critical role of flexibility in scheduling. Lack of wellbeing, increased work burden, and the need for flexibility had persisted years after the pandemic.

CONCLUSIONS

The findings emphasize the need for institutional support to address these challenges and retain a robust, diverse workforce in medicine.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents

BACKGROUND

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians.

OBJECTIVE

This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians.

DESIGN

This study evaluated 12 months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature.

SUBJECTS

Mayo Clinic internal medicine residents.

MAIN MEASURES

Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time.

KEY RESULTS

Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked (p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001). There was no difference in message turnaround time, total messages, or number of results received.

CONCLUSIONS

Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.

Remote Practice of Infectious Diseases Through Telemedicine: Improving Access for Patients and Appeal for Physicians

The specialty of infectious diseases (ID) is facing headwinds in attracting new physicians into training and clinical practice, leading to workforce shortage and rising burnout among existing ID physicians. The distribution of ID physicians across the country is skewed, and many Americans do not have access to ID expertise. Novel care models are needed to ensure the longevity of the ID specialty and patient access to ID care. ID telemedicine provides a new opportunity for ID physicians with the benefits of residing in one's preferred geographic location, eliminating the need to commute, and structuring the workday to improve work-life balance. This viewpoint, which includes personal experiences in transitioning from in-person to remote ID practice, describes the extent of challenges facing the ID specialty and how telemedicine can reduce burnout among ID physicians, attract more physicians into the specialty, and improve access to ID care.

Gender Parity Among Vascular Surgeons: Progress and Attrition

INTRODUCTION

Improving representation of women in medicine and surgery has been tempered by higher rates of attrition from residencies and from academic medicine among women compared to men. The attrition of women from the practicing vascular surgery workforce has not been studied.

METHODS

We utilized the Center for Medicare and Medicaid Services' Doctors and Clinicians database to study vascular surgery employment patterns from 2015 to 2022. We examined gender balance within the workforce and attrition rates among male and female vascular surgeons. We utilized a logistic regression to calculate the odds of attrition by gender.

RESULTS

The percentage of female vascular surgeons grew from 11% to 16% between 2015 and 2022, with each graduating class since 2005 having between 20% and 38% women. Yet, female surgeons were 2.05 (95% confidence interval: 1.36-3.08) times more likely to leave practice than their male counterparts when controlling for graduation year and practice in academic medicine.

CONCLUSIONS

The proportion of women in vascular surgery is increasing as more women graduate into the specialty. Despite increasing representation, women are more likely than men to leave the workforce.

Gender and work-life balance: Results of a national survey of pediatric hospitalists

In medicine, difficulty integrating work and home can lead to decreased job satisfaction, diminished well-being, and increased turnover. Understanding the experience of pediatric hospitalists can provide insights into building a stable, long-term workforce. We aim to examine gender differences in work-life balance and parental leave for physicians practicing Pediatric Hospital Medicine.

METHODS

This was a cross-sectional survey study of 1096 pediatric hospitalists. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associated variables and work-life balance satisfaction. We analyzed free responses on parental leave to provide nuance to quantitative survey data.

RESULTS

Five hundred and sixty-five respondents (52% response rate) completed the survey with 71% women. 343 (62%) prioritize work-life balance in career decision-making. Women report taking on more household responsibilities than their partners (41.4% vs. 8.4%; p < .001) including a larger percentage of caregiving and domestic tasks. Female gender and performing <50% caregiving were associated with decreased work-life balance satisfaction; performing <50% domestic tasks increased satisfaction. Median parental leaves were 4 weeks, with men taking significantly shorter leaves (3.5 vs. 6 weeks; p < .001) and more "paid back" time off.

CONCLUSION

Work-life balance is an important factor in career decisions for men and women. Women perceive carrying a larger load at home. Qualitative results suggest that parental leave may be inadequate in length and salary support for men and women. This study adds insights into work-life integration in PHM.

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement

BACKGROUND

The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.

METHODS

A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.

RESULTS

Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare.

CONCLUSIONS

This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.

Sustainability of the Subspecialty of Anesthesiology Critical Care: An Expert Consensus and Review of the Literature

While considerable literature exists with respect to clinical aspects of critical care anesthesiology (CCA) practice, few publications have focused on how anesthesiology-based critical care practices are organized and the challenges associated with the administration and management of anesthesiology critical care units. Currently, numerous challenges are affecting the sustainability of CCA practice, including decreased applications to fellowship positions and decreased reimbursement for critical care work. This review describes what is known about the subspecialty of CCA and leverages the experience of administrative leaders in adult critical care anesthesiologists in the United States to describe potential solutions.

Women Surgeons: Barriers and Solutions

BACKGROUND

Underrepresentation and undertreatment of women in surgery continues to be highly prevalent, with major barriers to improvement. The aim of the study was to review the current state of women surgeons in Poland.

METHODS

Information from the various Polish databases on women surgeons in 9 medical universities in general, oncological, vascular, thoracic, and cardiac surgery was retrospectively evaluated. Demographics of residents and staff surgeons, academic ranks and leadership positions at universities, in surgical societies and on scientific journals editorial boards were analyzed. Descriptive statistics were used.

RESULTS

In 2020, 61% of 3,668 graduates of Polish medical universities were women. In 5 surgical specialties, 11.9% (1,243 of 10,411) of the surgeons were women, with the lowest numbers in cardiac (5.6%), and in vascular surgery (6.4%); 40.4% of general surgery residents were women, less in vascular (18.4%) and thoracic surgery (24%), more in oncological surgery (28.7%). In 35 surgical departments of 9 universities, all department chairs were men, all full professors were men; 7% of associate professors and 16% of assistant professors were women. Rectors of all universities were men; 27% of the vice-rectors were women. In the senates and university councils, 39% and 35%, respectively, were women. Presidents, vice presidents, and secretaries of surgical societies and Editor-in-Chief of 4 surgical journals were all men.

CONCLUSIONS

Polish women surgeons face major difficulties with representation in surgery, in departmental, institutional, and societal leadership, and on scientific journal editorial boards. A multifaceted approach to correct these serious inequalities is urgently needed.

Gender Differences in the Path to Medical School Deanship

Importance

Women account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy.

Objective

To identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship.

Design, Setting, and Participants

In this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis.

Main Outcome and Measures

Career and leadership development experiences were elicited using a semistructured interview guide.

Results

We interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms.

Conclusions and Relevance

This qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.

Gender Disparity in Full Professor Rank Among Academic Physicians: A Systematic Review and Meta-Analysis

PURPOSE

The gender gap in promotion in academic medicine is well established. However, few studies have reported gender differences in promotion adjusted for scholarly production and national or international reputation, namely, career duration, publications, grant funding, and leadership positions. The authors performed a systematic review and meta-analysis of the differences between men and women in achieving benchmarks for promotion and analyze where such differences lie geographically and within specialties.

METHOD

A systematic search of Academic Search Premier, Business Source Complete, Cochrane Library, ERIC, GenderWatch, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science was conducted from inception to August 17, 2022. All studies that reported the number of male and female full professors on medical school faculty were included. The primary outcome was the adjusted odds ratio (AOR) for promotion to full professor for women compared with men.

RESULTS

Two hundred forty-four studies met the inclusion criteria. The unadjusted OR for promotion to full professor for women was 0.38 (95% confidence interval [CI], 0.36-0.41). Sixteen studies reported an AOR. The pooled AOR of promotion for women to full professor was 0.60 (95% CI, 0.46-0.77). The AOR for promotion to full professor was 0.55 (95% CI, 0.34-0.88) in surgery and 0.80 (95% CI, 0.57-1.11) in internal medicine. Statistical heterogeneity was high ( Q = 66.6, I2 = 79.4%, P < .001). On meta-regression, 77% of the heterogeneity was from studies outside the United States, where more disparity was reported (AOR, 0.29; 95% CI, 0.22-0.38).

CONCLUSIONS

Most studies continued to find decreased promotion of women. Gender disparity was particularly notable in surgery and in studies from outside the United States. The results suggest that differences in promotion were due to differences in productivity and leadership and to gender bias.

Trends Among Women in Academic Medicine Faculty Ranks

Introduction: Similar proportions of women and men have entered medical school since 2003. However, career advancement and promotion for women continues to be fraught with disparities and inequalities. Building on current literature, this study explores the rates of change of female faculty in faculty ranks over the last 10 years to gain a more comprehensive view of the faculty trends of women in academic medicine. Methods: Using the Faculty Administrative Management Online User System database, counts by gender and faculty rank at each Association of American Medical Colleges (AAMC) academic medical school were obtained. Statistical analysis was done using generalized estimating equations modeling to assess rates of change for each gender from 2012 to 2021. Results: Higher proportions of female faculty are concentrated at the Instructor and Assistant Professor level and lower proportions at the Associate Professor and Professor rank compared to male faculty. Over the study period, female faculty showed increased rate change compared to male faculty of 1.007 (95% confidence interval [CI]: 1.002-1.012) for Associate Professor rank and 1.012 (95% CI: 1.007-1.016) for Professor rank. At the Instructor and Assistant Professor levels, female faculty decreased at a relative rate of 0.980 (95% CI: 0.969-0.990) and 0.995 (95% CI: 0.992-0.997) each year, respectively. Conclusion: Female faculty continue to be concentrated at the junior faculty rank. Rate changes at the senior faculty rank for female faculty have slightly improved over the last 10 years compared to male faculty. However, this improvement is minimal, and work is still needed to achieve true gender equity in academic medicine.

Challenges in Medicine, Magnified by the Pandemic: A Dual Battle for Female Physicians

INTRODUCTION

 We aimed to understand how the pandemic impacted work hours and employment status of female physicians.  Methods: An anonymous survey of female physicians was distributed through social media and email lists from 12/2021 to 2/2022. Primary outcomes were changes in physicians' work schedules and employment status. Analyses included descriptive statistics of closed-ended items and qualitative content analysis of open-ended responses.

RESULTS

 We restricted our analysis to four specialties: obstetrics and gynecology, internal medicine, anesthesia, and pediatrics (n=626). The majority (92%) of respondents had caretaking responsibilities; 43% changed work schedules to accommodate those responsibilities. Around 17% of physicians changed jobs. The most common reasons for job changes included: negative work environment, lack of work-life balance, burden of work, and lack of efforts to mitigate COVID-19.  Conclusion: The pandemic highlighted the need for flexibility, improvements in workplace culture, and financial incentives to increase retention.

Perceptions of gender equity in emergency medicine in Canada

INTRODUCTION

Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine.

METHODS

We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements.

RESULTS

A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians.

CONCLUSION

In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.

Workplace Belonging of Women Healthcare Professionals Relates to Likelihood of Leaving

Purpose

There is a high rate of attrition of professionals from healthcare institutions, which threatens the economic viability of these institutions and the quality of care they provide to patients. Women professionals face particular challenges that may lower their sense of belonging in the healthcare workplace. We sought to test the hypothesis that workplace belonging of women healthcare professionals relates to the likelihood that they expect to leave their institution.

Methods

Participants of a continuing education course on women's leadership skills in health care completed a survey about their experiences of belonging in workplace and their likelihood of leaving that institution within the next 2 years. An association between workplace belonging (measured by the cumulative number of belonging factors experienced, scale 0-10) and likelihood of leaving (measured on a 5-point Likert scale) was evaluated using ordinal logistic regression. The relative importance of workplace belonging factors in predicting the likelihood of leaving was assessed using dominance analysis.

Results

Ninety-nine percent of survey participants were women, and 63% were clinicians. Sixty-one percent of participants reported at least a slight likelihood of leaving their healthcare institution within the next 2 years. Greater workplace belonging was found to be associated with a significant reduction in the reported likelihood of leaving their institution after accounting for the number of years having worked in their current institution, underrepresented minority status, and the interaction between the latter two covariates. The workplace belonging factor found to be most important in predicting the likelihood of leaving was the belief that there was an opportunity to thrive professionally in the institution. Belonging factors involving feeling able to freely share thoughts and opinions were also found to be of relatively high importance in predicting the likelihood of leaving.

Conclusion

Greater workplace belonging was found to relate significantly to a reduced likelihood of leaving their institution within the next 2 years. Our findings suggest that leaders of healthcare organizations might reduce attrition of women by fostering workplace belonging with particular attention to empowering professional thriving and creating a culture that values open communication.

Supporting Our Physician Parents (SOPPort): A pilot program for parental wellness at the Massachusetts General Hospital

Physician parents encounter unique challenges in balancing new parenthood with work responsibilities, especially upon their return from parental leave. We designed a pilot program that incorporated 1:1 parental coaching to expectant and new physician parents and provided stipends for lactation support and help at home. Additional initiatives included launching a virtual new parent group during the COVID-19 pandemic and starting an emergency backup pump supplies program. There was positive feedback for our Parental Wellness Program (PWP), which was used to secure expanded funding. Pilot results showed that our program had a meaningful impact on parental wellness, morale, productivity, and lactation efforts.