Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Medicine Physicians

Women at the top: a qualitative study of women in leadership positions in emergency medicine in Canada

OBJECTIVES

For the last two decades, more than half of Canadian medical students have been women, with an increasing number of medical trainees choosing emergency medicine as their careers. Despite a proportional increase of women in full-time faculty positions in emergency medicine, women are still underrepresented in leadership. The purpose of this study is to explore the experiences of women leaders in emergency medicine to identify common themes that may have contributed to their acquisition of leadership roles.

METHODS

Participants included women emergency medicine physicians in Canada who currently or previously held a leadership position. Data were collected through semi-structured interviews. Inductive thematic analysis was performed on the interview transcripts. Transcribed data were coded and categorized into recurrent themes. A narrative summary of the most impactful themes was presented.

RESULTS

Twenty participants were interviewed. Most participants perceived career opportunities were due to chance, related to personal skill set, or required additional training. Participants highlighted the importance of mentorship and sponsorship. Gender expectations and traditional gender roles were perceived as having a negative impact on career leadership success. Participants acknowledged the need for women in leadership to empower younger generations of women to become leaders. For future emergency medicine leaders, participants suggested applying for leadership positions early, networking, and seeking mentorship. Potential supportive changes to leadership structures included explicit parental leave policies, flexible scheduling, and job sharing to encourage women leaders.

CONCLUSION

To date, there has been no Canadian specific study exploring the factors contributing to the success of women leaders in emergency medicine. This study examines career advancement of women leaders in emergency medicine and provides useful insight to those aspiring to grow their careers, as well as to mentors and sponsors of women in emergency medicine.

FOAM authorship: Who's teaching our learners?

Background

Free open-access medical education (FOAM) is extremely popular among learners and educators despite lacking the traditional peer review process. Despite the potential for inaccurate, low-quality, or biased content, little has been published describing FOAM authors.

Methods

We performed a cross-sectional analysis of 12 months of content from the top 25 blogs in the 2020 Social Media Index from August 2020-2021. We recorded the number of posts per site and descriptive characteristics of authors, including gender affiliation, conflicts of interest (COI) statements, and type of practice (academic, community, or hybrid).

Results

We identified 2141 posts by 1001 authors. More than half were produced by six websites: EM Docs (266), Life in the Fast Lane (232), EMCrit (188), ALiEM (185), Don't Forget the Bubbles (181), and Rebel EM (174). Most content (1680 posts, 78.5%) lacked a COI statement. Authors were mostly academic (89%), mostly held MD degrees (67.4%), and were mostly men (59.7%). Geographically, most FOAM authors reside in the United States (59.5%), Canada (22.42%), or the United Kingdom (9.4%).

Conclusions

Of all the posts in the top 25 sites in 2020, more than half came from six sites, and authors were largely North American men in academics with MD degrees. Learners, content creators, and educators should consider the ways in which a more diverse authorship pool might bring value to the FOAM educational experience.

Emergency physician gender and head computed tomography orders for older adults who have fallen

OBJECTIVE

Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen.

METHODS

This was a secondary analysis of a prospective observational cohort study conducted in 11 hospital emergency departments (EDs) in Canada and the United States. The primary study enrolled patients who were 65 years and older who presented to the ED after a fall. The analysis evaluated treating physician gender adjusted for multiple clinical variables. Primary analysis used a hierarchical logistic regression model to evaluate the association between treating physician gender and the patient receiving a head CT scan. Secondary analysis reported the adjusted odds ratio (OR) for diagnosing intracranial bleeding by physician gender.

RESULTS

There were 3663 patients and 256 physicians included in the primary analysis. In the adjusted analysis, women physicians were no more likely to order a head CT than men (OR 1.26, 95% confidence interval 0.98-1.61). In the secondary analysis of 2294 patients who received a head CT, physician gender was not associated with finding a clinically important intracranial bleed.

CONCLUSIONS

There was no significant association between physician gender and ordering head CT scans for older emergency patients who had fallen. For patients where CT scans were ordered, there was no significant relationship between physician gender and the diagnosis of clinically important intracranial bleeding.

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey

Objective

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers.

Methods

This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing.

Results

We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender.

Conclusions

Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

"I am the doctor": gender-based bias within the clinical practice of emergency medicine in Canada-a thematic analysis of physician and trainee interview data

OBJECTIVES

While women comprise about half of current Canadian medical students and physicians, only 31% of emergency medicine physicians identify as women and women trainees are less likely to express interest in emergency medicine compared to men. Gender-based bias continues to negatively impact the career choice, progress, and well-being of women physicians/trainees. Although instances of gender-based bias are well documented within other medical specialties, there remains a gap in the literature addressing the role of gender specific to the Canadian emergency medicine clinical environment.

METHODS

Using a qualitative study with a thematic analytical approach, participants were purposively and snowball sampled from a cross-section of centers across Canada and included emergency medicine attending physicians and trainees. A thematic analysis using an inductive and deductive approach was undertaken. All data were double coded to improve study trustworthiness. Descriptive statistics were used to characterize the study population.

RESULTS

Thirty-four individuals (17 woman-identifying and 17 man-identifying) from 10 different institutions across 4 provinces in Canada participated in the study. Six themes were identified: (1) women experience gender bias in the form of microaggressions; (2) women experience imposter syndrome and question their role in the clinical setting; (3) more women provide patient care to women patients and vulnerable populations; (4) gender-related challenges with family planning and home responsibilities affect work-life balance; (5) allyship and sponsorship are important for the support and development of women physicians and trainees; and (6) women value discussing shared experiences with other women to debrief situations, find mentorship, and share advice.

CONCLUSIONS

Gender inequity in emergency medicine affects women-identifying providers at all levels of training across Canada. Described experiences support several avenues to implement change against perceived gender bias that is focused on education, policy, and supportive spaces. We encourage institutions to consider these recommendations to achieve gender-equitable conditions in emergency medicine across Canada.

How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review

PURPOSE

Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine.

METHOD

The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted.

RESULTS

Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes.

CONCLUSIONS

These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.

The Gender Landscape of Academic Pediatric Emergency Medicine: An Observational Study of Leadership Positions as Described by Fellowship Programs' Online Presence

OBJECTIVES

Although many areas of medicine are male dominated, pediatric emergency medicine (PEM) is a female-dominated subspecialty. Despite this, executive leadership within PEM remains male dominated. The aim of this study was to describe the gender landscape of the key positions within academic PEM fellowship programs within the United States, as described by PEM fellowships' online presence.

METHODS

Using the 2021-2022 Electronic Residency Application Service American Association of Medical Colleges Pediatric Fellowships ( services.aamc.org/eras/erasstats/par/ ) application service, we were able to identify published information from 84 academic PEM fellowship programs in the United States. Each program's Web site was evaluated to determine which individuals held the position of chief or chair, medical director, and fellowship director. These individuals' genders were then cross-referenced with the National Provider Inventory database.

RESULTS

There were 154 executive leadership roles (division chief or medical director) in total. The executive leadership role was significantly different by gender ( z score: 2.54, P < 0.01), with greater male representation (n = 61; 62.9%) among identified executive leadership roles (n = 97). There were significantly more men for the medical director role ( z score: 2.06, P < 0.05). Female representation was greater than male in the fellowship program director role (n = 53; 67.9%) among listed roles ( z score: -3.17, P < 0.001). This gender landscape among key leadership positions was not influenced by the geographic location of the PEM fellowship program.

CONCLUSIONS

Although PEM is a female-dominated specialty, executive leadership positions continue to be male dominated. To promote improved gender representation within leadership positions in PEM, PEM fellowship programs must provide consistent and easily accessible executive leadership descriptions within their online storefront.

Factors associated with emergency physician income

Objective

Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income.

Methods

We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income.

Results

From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767.

Conclusions

This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.

Burnout and Workplace Incivility Among Emergency Medical Services Practitioners: A Preliminary Report

OBJECTIVE

Burnout has detrimental consequences for health care organizations, clinicians, and the quality of care that patients receive. Prior work suggests that workplace incivility (negative interpersonal acts) contributes to burnout. While workplace incivility is linked to EMS practitioner job dissatisfaction, absenteeism, and planned attrition, the relationship between workplace incivility and burnout has not been evaluated among EMS practitioners. This study aimed to characterize the prevalence and association of burnout and workplace incivility among EMS practitioners.

METHODS

A cross-sectional survey of EMS personnel in King County, Washington was performed in January to March of 2021 with burnout as the primary outcome and workplace incivility as a secondary outcome. Multivariable logistic regression was used to evaluate associations between outcomes and EMS practitioner factors that included age, sex, race/ethnicity, years of EMS experience, and current job role.

RESULTS

835 completed surveys were received (response rate 25%). The prevalence of burnout was 39.2%. Women were more likely to have burnout than men (59.3% vs. 33.7%, aOR 2.2, 95% CI 1.3-3.7). Workplace incivility was experienced weekly by 32.1% of respondents, with women more likely to experience incivility compared to men (41.9% vs. 27.2%, aOR 2.0, 95% CI 1.2-3.3). Respondents who experienced frequent workplace incivility were more likely to have burnout than those who did not experience frequent incivility (61.9% vs. 38.1%, OR 4.0, 95% CI 3.0-5.5).

CONCLUSIONS

The prevalence of burnout and workplace incivility were concerning among EMS practitioners, with women more likely to experience both compared to men. EMS practitioners who experienced frequent workplace incivility were also more likely to have burnout than those who did not experience frequent incivility.

Inclusivity in Leader Selection: An 8-Step Process to Promote Representation of Women and Racial/Ethnic Minorities in Leadership

At a systemic level, organizations need to take intentional steps to build inclusion, equity, and diversity at all levels. In accordance with this need, organizations have been catalyzed by national conversations surrounding gender and racial/ethnic discrimination to generate sustainable change that addresses the disenfranchisement of women and racial/ethnic minorities. Although progress toward addressing the systemic issues that perpetuate these inequities has been made in recent years, research indicates that underrepresentation at the leadership level persists in academic medicine. Further, those in more senior roles are more likely to select, sponsor, and/or mentor individuals like themselves, thereby depriving minority populations of experiences directly correlated with career development and advancement. Hence, the authors posit a focus on the characteristics and competencies of a leader along with a structured selection process is an effective intervention to reduce bias and support inclusion by recalibrating the representation of leadership within academic medical centers. To this end, the authors developed a sequential 8-step leader selection process informed by their model of leadership characteristics and competencies. This process includes a policy update, selection of interview panels, training of panelists, screening the candidate pool, structured interview guides, final candidate slates, assessments of final candidates, and development of newly selected leaders. By following this process, the authors' organization has seen an increase in the representation of women and racial/ethnic minority leaders, an increase in employees' favorable perceptions specific to representation, and data indicative of developing and maintaining an internal diverse leadership candidate pipeline. Ultimately, inclusion makes stronger and more resilient organizations. By following a standardized process grounded in leadership characteristics and competencies, academic medical centers can see changes in their leadership that mirror the populations they lead and serve. Using such processes can lead to the kind of systemic change needed to create inclusive environments.

Race, racism, and antiracism in emergency medicine: A scoping review of the literature and research agenda for the future

OBJECTIVES

The objective was to conduct a scoping review of the literature and develop consensus-derived research priorities for future research inquiry in an effort to (1) identify and summarize existing research related to race, racism, and antiracism in emergency medicine (EM) and adjacent fields and (2) set the agenda for EM research in these topic areas.

METHODS

A scoping review of the literature using PubMed and EMBASE databases, as well as review of citations from included articles, formed the basis for discussions with community stakeholders, who in turn helped to inform and shape the discussion and recommendations of participants in the Society for Academic Emergency Medicine (SAEM) consensus conference. Through electronic surveys and two virtual meetings held in April 2021, consensus was reached on terminology, language, and priority research questions, which were rated on importance or impact (highest, medium, lower) and feasibility or ease of answering (easiest, moderate, difficult).

RESULTS

A total of 344 articles were identified through the literature search, of which 187 met inclusion criteria; an additional 34 were identified through citation review. Findings of racial inequities in EM and related fields were grouped in 28 topic areas, from which emerged 44 key research questions. A dearth of evidence for interventions to address manifestations of racism in EM was noted throughout.

CONCLUSIONS

Evidence of racism in EM emerged in nearly every facet of our literature. Key research priorities identified through consensus processes provide a roadmap for addressing and eliminating racism and other systems of oppression in EM.

Three decades of demographic trends among academic emergency physicians

Purpose

To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time.

Methods

Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups.

Results

The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n = 3, 1.40% in 1990 to n = 326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N = 9, 4.21% in 1990 and N = 266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00).

Conclusions

Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.

Racial and Gender Diversity Among Students and Faculty in EHAC-Accredited Environmental Health Sciences Programs: Trend Analysis from 2009 to 2021

Diversity in the environmental health sciences (EHS) workforce is crucial in providing culturally sensitive services to diverse communities. This may be influenced by academic faculty training a diverse student body in the field of environmental health. This study aimed to characterize the diversity of students and faculty in EHS programs accredited by the National Environmental Health Science and Protection Accreditation Council (EHAC). A retrospective analysis was conducted on secondary data obtained from annual surveys administered to program directors in EHAC-accredited academic programs that included both undergraduate and graduate EHS degrees. The database covered surveys on gender and race that were conducted by EHAC for 12 academic years spanning 2009-2010 to 2020-2021. Results show most students (undergraduate and graduate) were female (54.4% and 52.1%, respectively) and white (61.0% and 50.7%, respectively). Increasing trends were observed over the last 12 years (2009-2021) in female undergraduate (from 53.7% to 59.8%) and graduate (from 47.1% to 60.3%) students and in non-white undergraduate students (from 40.0% to 48.2%). Most faculty (teaching in undergraduate and graduate programs) were male (64.4% and 64.3%, respectively) and white (77.9% and 92.1%, respectively). Increasing trends were observed from 2009 to 2021 in female faculty teaching undergraduate (from 27.7% to 42.2%) and graduate (from 31.3% to 42.1%) students. Native American, Alaska Native, Native Hawaiian, and Pacific Islander are consistently the most underrepresented racial groups in both undergraduate and graduate students and faculty. This study provides baseline data on the diversity of students and faculty in EHAC-accredited programs, which is important in informing future research and efforts to increase such diversity. Gender and racial disparity in EHS students and faculty needs to be addressed to provide necessary support to women and non-White constituents by institutional change in culture through active recruitment and by stronger collaboration between professional organizations and minority groups.

Diversity of leadership in academic emergency medicine: Are we making progress?

BACKGROUND

Faculty who identify as women or racial/ethnic groups underrepresented in medicine (URiM) are less likely to occupy senior leadership positions or be promoted. Recent attention has focused on interventions to decrease this gap; thus, we aim to evaluate changes in leadership and academic promotion for these populations over time.

METHODS

Successive cross-sectional observational study of six years (2015 to 2020) of data from the Academy of Administrators/Association of Academic Chairs of Emergency Medicine- Benchmark Survey. Primary analyses focused on gender/URiM differences in leadership roles and academic rank. Secondary analysis focused on disparities during the first 10 years of practice. Statistical modeling was conducted to address the primary aim of assessing differences in gender/URiM representation in EM leadership roles/rank over time.

RESULTS

12,967 responses were included (4589 women, 8378 men). Women had less median years as faculty (7 vs 11). Women and URiM were less likely to hold a leadership role and had lower academic rank with no change over the study period. More women were consistently in the early career cohort (within 10 years or less as faculty) : 2015 =-75.0% [95% CI:± 3.8%] v 61.4% [95% CI:± 3.0%]; 2020 =-75.1% [95% CI: ± 2.9%] v 63.3%, [95% CI:: ± 2.5%]. Men were significantly more likely to have any leadership role compared to women in 2015 and 2020 (2015 = 54.3% [95% CI: ± 3.1%] v 44.8%, [95% CI: ± 4.3%]; 2020 = 43.1% [95% CI:± 2.5%] v 34.8 [95% CI:± 3.1%]). Higher academic rank (associate/professor) was significantly more frequent among early career men than women in 2015 (21.1% [95% CI:± 2.58%] v 12.9%; [95% CI:± 3.0%]) and 2020 (23.1% [95% CI:± 2.2%] v 17.4%; [95% CI:± 2.5%]).

CONCLUSIONS

Disparities in women and URiM faculty leadership and academic rank persist, with no change over a six-year time span. Men early career faculty are more likely to hold leadership positions and be promoted to higher academic rank, suggesting early career inequities must be a target for future interventions.

"I just assume they don't know that I'm the doctor": Gender bias and professional identity development of women residents

Background

The increasing entry of women into medicine, a traditionally male-gendered institution, has revealed much about the gendered politics of medical practice. Women are required to negotiate conflicting gender-normative roles and expectations as they develop their professional identities. Relatively little is known with regard to the study of gender identity and professional development in emergency medicine (EM), with even fewer studies specifically examining women EM residents.

Methods

This was a qualitative, semistructured interview study conducted at the Emory University Emergency Medicine Residency. Women residents in their first, second, and third years of training were recruited for participation through residency listservs. Interviews were completed using a virtual platform until thematic saturation was reached. Interviews were recorded, professionally transcribed, and coded by two study investigators. The study team met throughout the process to identify codes and themes from the interviews.

Results

A total of 11 interviews were completed. Participants self-identified as Black (five), White (two), biracial (two). and South Asian (two) and represented all levels of training. Participants identified challenges to providing clinical care and conveying their competency related to their gender and role as physicians in training. Common challenges included role confusion and questioning of their decisions by both patients and colleagues. They identified other aspects of their identity as facilitators for care delivery, specifically race as a facilitator when caring for race-concordant patients. Participants described strategies developed to navigate gender-specific challenges including routinely providing justification for their clinical decisions. Participants also described a need for interventions at the departmental and institutional levels to improve allyship and bystander behaviors.

Conclusion

Women residents actively negotiate tensions between their gender and role as physicians and develop multifaceted strategies to address challenges in care delivery. Because residency training is a challenging yet formative time in developing one's professional identity, it is important to consider interventions that support women residents and the unique challenges they face.

Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine

BACKGROUND

Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the health care organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians.

METHODS

This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively.

RESULTS

A total of 771 of 3130 faculty completed the survey (response rate 24.6%). A total of 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6).

CONCLUSIONS

Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.

Salary disparities based on gender in academic emergency medicine leadership

OBJECTIVE

There are significantly fewer women than men in leadership roles in health care. Previous studies have shown that, overall, male physicians earn nearly $20,000 more annually than their female physician colleagues after adjusting for confounding factors. However, there has not been a description of physician leadership compensation in relation to gender.

METHODS

This was a successive cross-sectional observation study design of 154 emergency departments in the United States from 5 years (2013, 2015-2018) using Association of Academic Chairs in Emergency Medicine and Academy of Administrators in Academic EM survey data. The primary variable of interest, leadership role, was attained by recoding the survey responses to assign primary job duty into four main categories: no leadership role, operations leadership, education leadership, and executive leadership.

RESULTS

Overall, 8820 responses were included. Across all survey years, the mean (±SD) percentage of women in any leadership role was significantly less than men (44.5% [95% CI: 42.8, 46.2%] vs. 55.3% [95% CI: 54.1, 56.5%]). Women in leadership roles worked more clinical hours than men in the same position (female median = 1008, male median = 960). Women also had significantly lower salaries than men at each of the 5-year time points that data are reported, with unadjusted mean salary differences of -$54,409 per year for executives, -$27,803 for operational leaders, and -$17,803 for education leaders.

CONCLUSIONS

Female physicians hold fewer leadership roles in academic emergency medicine (EM), and when they do, they work more clinical hours and are paid less than male physicians. As a specialty, EM should continue to investigate and report on gender achievement disparities as work is done to rectify the system inequalities.

Analysis of Physician Compensation Studies by Gender, Race, and Ethnicity

Purpose:

This report investigated physician compensation studies by gender, race, and ethnicity.

Methods:

Published U.S. physician compensation studies were assessed.

Results:

Of the 47 data sets within 46 studies, 36 analyzed compensation by gender and 32 (88.9%) found disparities. Thirteen and eight analyzed for race and ethnicity, with disparities found in four (30.8%) and none, respectively. The sample sizes of the four data sets with differences by race were among the largest in the subset.

Conclusion:

Most studies demonstrate pay disparities for women, but not for people who identify with underrepresented race/ethnic groups; however, small sample sizes may affect results.

Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations

BACKGROUND

Disparities in salary and advancement of emergency medicine (EM) faculty by race and gender have been consistently demonstrated for over three decades. Prior studies have largely focused on individual-level solutions. To identify systems-based interventions, the Society for Academic Emergency Medicine (SAEM) formed the Research Equity Task Force in 2018 with members from multiple academies (the Academy of Academic Chairs in Emergency Medicine [AACEM], the Academy of Academic Administrators in Emergency Medicine [AAAEM], the Academy for Women in Academic Emergency Medicine [AWAEM], and the Academy for Diversity and Inclusion in Emergency Medicine [ADIEM]) and sought recommendations from EM departmental leaders.

METHODS

The task force conducted interviews containing both open-ended narrative and closed-ended questions in multiple phases. Phase 1 included a convenience sample of chairs of EM departments across the United States, and phase 2 included vice-chairs and other faculty who lead promotion and advancement. The task force identified common themes from the interviews and then developed three-tiered sets of recommendations (minimal, target, and aspirational) based on participant responses. In phase 3, iterative feedback was collected and implemented on these recommendations from study participants and chairs participating in a national AACEM webinar.

RESULTS

In findings from 53 interviews of chairs, vice-chairs, and faculty leaders from across the United States, we noted heterogeneity in the faculty development and promotion processes across institutions. Four main themes were identified from the interviews: the need for a directed, structured promotion process; provision of structured mentorship; clarity on requirements for promotion within tracks; and transparency in salary structure. Recommendations were developed to address gaps in structured mentorship and equitable promotion and compensation.

CONCLUSIONS

These recommendations for AEM departments have the potential to increase structured mentorship programs, improve equity in promotion and advancement, and reduce disparities in the AEM workforce. These recommendations have been endorsed by SAEM, AACEM, AWAEM, ADIEM, and AAAEM.

Priority strategies to improve gender equity in Canadian emergency medicine: proceedings from the CAEP 2021 Academic Symposium on leadership

OBJECTIVES

Gender inequities are deeply rooted in our society and have significant negative consequences. Female physicians experience numerous gender-related inequities (e.g., microaggressions, harassment, violence). These inequities have far-reaching consequences on health, well-being and career longevity and may result in the devaluing of various strengths that female emergency physicians bring to the table. This, in turn, has an impact on patient healthcare experience and outcomes. During the 2021 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, a national collaborative sought to understand gender inequities in emergency medicine in Canada.

METHODS

We used a multistep stakeholder-engagement-based approach (harnessing both quantitative and qualitative methods) to identify and prioritize problems with gender equity in emergency medicine in Canada. Based on expert consultation and literature review, we developed recommendations to effect change for the higher priority problems. We then conducted a nationwide consultation with the Canadian emergency medicine community via online engagement and the CAEP Academic Symposium to ensure that these priority problems and solutions were appropriate for the Canadian context.

CONCLUSION

Via the above process, 15 recommendations were developed to address five unique problem areas. There is a dearth of research in this important area and we hope this preliminary work will serve as a starting point to fuel further research. To facilitate these scholarly endeavors, we have appended additional documents identifying other key problems with gender equity in emergency medicine in Canada as well as proposed next steps for future research.

Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine

Gender inequity is pervasive in medicine, including emergency medicine (EM), and is well documented in workforce representation, leadership, financial compensation, and resource allocation. The reasons for gender inequities in medicine, including academic EM, are multifactorial and include disadvantageous institutional parental, family, and promotion policies; workplace environment and culture; implicit biases; and a paucity of women physician leader role models, mentors, and sponsors. To address some of the challenges of gender inequities and career advancement for women in academic EM, we established an innovative, peer-driven, multi-institutional consortium of women EM faculty employed at four distinct hospitals affiliated with one medical school. The consortium combined financial and faculty resources to execute gender-specific programs not feasible at an individual institution due to limited funding and faculty availability. The programs included leadership skill-building and negotiation seminars for consortium members. The consortium created a collaborative community designed specifically to enrich career development for women in academic EM, with a formal organizational structure to connect faculty from four hospitals under one academic institution. The objective of this report is to describe the creation of this cross-institutional consortium focused on career development, academic productivity, and networking and sharing best practices for work-life integration for academic EM women faculty. This consortium-building model could be used to enhance existing institutional career development structures for women and other physician communities in academic medicine with unique career advancement challenges.

The role of women's consortia in the advancement of women in academic emergency medicine

Prior literature has suggested that there are major barriers to the advancement of women in academic emergency medicine (EM) and that few evidence-based solutions exist to resolve this inequity. In this issue of Academic Emergency Medicine, XX et al. (1) describe the creation of a consortium of women physicians across four departments of EM in the northeastern United States with the aim of addressing persistent gender inequities in the academic EM workforce.^1-3 By combining resources, consortium leaders developed programming on various topics, including career advancement skills, leadership and recognition, mentorship and sponsorship, research, peer support, coaching, and work/life strategies. Not only does the accompanying piece include specifics around curriculum development, but the authors provide a pragmatic guide for the development of women's consortia at other institutions. (1).

Here to chair: Gender differences in the path to leadership

OBJECTIVE

Career paths leading to department chair positions are elusive. Women represent only 11% of academic emergency department (ED) chairs. It is unclear whether the pathway to chair is different for men and women; the characteristics, achievements, and qualifications among those who become ED chairs is unknown.

METHODS

This study is a cross-sectional analysis of curriculum vitae (CV) of current ED chairs in departments with Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs. Former women chairs were included due to paucity of current women chairs. Statistics were calculated using bivariate and multivariate analysis.

RESULTS

Of 163 eligible chairs, 88 CV (54%) were obtained, including six former women chairs. A majority (86.4%) self-identified as White/Caucasian, 21.5% were women, 46% were chief residents, 28.4% completed additional postgraduate degrees, and 21.8% were fellowship trained. At time of chair appointment, 58% were professor rank, 53.5% held ED operations roles, and 32% served as vice chair. Women were more likely to be in educational (53% vs. 22%) versus operational (26% vs. 61%, p = 0.02) roles. Women obtained more advanced degrees (47% vs. 25%, p = 0.02), were awarded more nonfederal grants (median = 7 vs. 3, p = 0.04), and achieved more national committee leadership (median = 4 vs. 1, p = 0.02). There were no gender differences in fellowship training, awards, leadership training programs, publications, federal grants, or national/international lectures after adjusting for years in practice.

CONCLUSION

While the majority of chairs held prior leadership roles in ED operations, only one in five women chairs did, suggesting gender differences in the path to chair attainment. These differences in paths may contribute to persistent gender disparities in ED chairs and may be influenced by career path choices, implicit bias, and structural barriers.

Experiences of underrepresented faculty in pediatric emergency medicine

OBJECTIVE

The aim of this study is to elucidate the unique challenges faced by pediatric emergency medicine (PEM) physicians from racial/ethnic groups underrepresented in medicine (URiM).

METHODS

This study is a subanalysis of data from 18 URiM faculty from a sample of 51 semistructured key informant interviews with PEM faculty in the top NIH-funded pediatric departments and highest-volume pediatric EDs in the country. Faculty are from eight hospitals representing a spectrum of geographic locations including the northeastern, midwestern, western, and southern regions of the country.

RESULTS

Of 18 study participants, the majority were Black (72.2%) and female (83.3%). Three main thematic categories were identified: challenges related to race, support systems, and suggested strategies to improve diversity and inclusion in PEM. A common race-related experience was microaggressions from colleagues and patients. Additionally, when attempting to lead and assert themselves, URiM women in particular were perceived as "angry" and "intimidating" in a way that non-URiM peers were not. As a result of these negative experiences, participants described the need to go above and beyond to prove themselves. Such pressure produced stress and feelings of isolation. Participants combatted these stressors through resilience strategies such as formal mentorship and peer and family support. Participants indicated the need to increase diversity and create more inclusive work environments, which would benefit both URiM physician wellness and the diverse patients they serve.

CONCLUSION

Those URiM in PEM face subtle racial discrimination at an institutional, peer, and patient level. The stress caused by this discrimination may further contribute to physician burnout in PEM. While URiMs adopt individual resilience strategies, their unique challenges suggest the need for departmental and institutional efforts to promote greater diversity and inclusion for physician wellness, retention, and quality patient care.

Using the Rank Equity Index to measure emergency medicine faculty rank progression

BACKGROUND

Faculty diversity is a high-priority goal for academic emergency medicine (EM). Most administrators currently monitor faculty diversity using aggregate data, which may obscure underrepresentation by rank. We apply the Rank Equity Index (REI) to EM faculty data to assess rank progression.

METHODS

We calculated the REI (% faculty cohort higher rank/% faculty cohort lower rank) for EM faculty. We performed REI analyses by faculty gender (women, men) and race/ethnicity (White, Black, Hispanic/Latinx, Asian). We compared professor/assistant professor, professor/associate professor, and associate professor/assistant professor to establish rank parity for gender and race/ethnicity. Parity is an REI of 1.0.

RESULTS

REI analysis by gender demonstrates that women faculty did not achieve parity at any rank comparison in any study year. REI analysis by race/ethnicity demonstrates that all faculty of color are below parity at the assistant to associate professor promotion. Latinx faculty are at parity for associate professor to professor, but Asian and Black faculty do not achieve parity in any comparison. Intersecting gender and race/ethnicity in the REI analysis demonstrates that Asian women have the lowest REIs among all faculty ranks and races/ethnicities. Men of all races/ethnicities achieved parity in two of three rank comparisons, except for Black men, who did not achieve parity in any comparison.

CONCLUSIONS

REI analysis demonstrates EM women faculty and faculty of color are not achieving rank parity and are disadvantaged at the first tier of promotion. A preliminary longitudinal trend analysis suggests little progress. Asian women and Black men experience the most rank inequity. REI analysis identifies a need for focused faculty development to enhance our most vulnerable faculty's rank progression, suggesting that targeted recruitment and retention efforts of women faculty of all races/ethnicities and faculty of color, in particular, will improve diversity at every tier of faculty rank.

The experiences of medical students, residents, fellows, and attendings in the emergency department: Implicit bias to microaggressions

OBJECTIVES

Microaggressions and implicit bias occur frequently in medicine. No previous study, however, has examined the implicit bias and microaggressions that emergency medicine (EM) providers experience. Our primary objective was to understand how often EM providers experience implicit bias and microaggressions. Our secondary objective was to evaluate the types of microaggressions they experience and whether their own identifying characteristics are risk factors.

METHODS

A questionnaire was administered to EM providers across the United States. Outcome measures of experiencing or witnessing a microaggression, overt discrimination, or implicit bias were described using frequencies, proportions, and logistic regressions. Where a univariate association between outcome measures and demographic characteristics was found, multivariate regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) was performed. Proportional odds logistic regression models were used to evaluate the specific type of microaggressions experienced and if there was an association with demographic variables.

RESULTS

A total of 277 medical providers (48% trainees-medical students, residents, and fellows-and 52% attending physicians) completed the survey. A total of 181 (65%) respondents reported experiencing a microaggression. Female (OR = 5.9 [95% CI = 3.1 to 11.2]) and non-White respondents (OR = 2.4 [95% CI = 1.2 to 4.5]) were more likely to report experiencing any microaggression. Misidentification, the most common form of microaggression, was more common with trainees compared to attending physicians (proportional OR [POR] = 2.6 [95% CI = 1.7 to 4.0]) and non-White, compared to White, respondents (POR = 2.2 [95% CI = 1.3 to 3.6]). Misidentification as nonclinician staff was associated with gender (POR = 53 [95% CI = 24 to 116]) and 52% of female respondents reported being mistaken for nonclinician staff almost daily. Seventy-six percent of respondents reported being called a vulgar term by a patient and 21% by a staff member.

CONCLUSIONS

EM providers, particularly women and non-Whites, who responded to our survey experienced and witnessed bias and microaggressions, most commonly misidentification, in the ED.

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

IMPORTANCE

The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career.

OBJECTIVE

To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts.

MAIN OUTCOMES AND MEASURES

The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts.

RESULTS

Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]).

CONCLUSIONS AND RELEVANCE

In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Geographic mobility in the emergency medicine residency match and the influence of gender

OBJECTIVES

Women are underrepresented in emergency medicine (EM) leadership. Some evidence suggests that geographic mobility improves career advancement. We compared movement between medical school and residency by gender. Our hypothesis was that women move a shorter distance than men.

METHODS

We collected National Residency Matching Program (NRMP) lists of ranked applicants from eight EM residency programs from the 2020 Main Residency Match. We added the gender expressed in interviews and left the Association of American Medical Colleges (AAMC) number as the unique identifier. Applicant data for matched osteopathic and allopathic seniors in the continental United States was included. We obtained street addresses for medical schools from an AAMC database and residency program addresses from the ACGME website. We performed geospatial analysis using ArcGIS Pro and compared results by gender. NRMP approved the data use and our institutional review board granted exempt status.

RESULTS

A total of 881 of 944 unique applicants met inclusion criteria and included 48.5% (830/1,713) of matched allopaths and 37% of all matched seniors; 48% (420) were female. There was no significant difference between genders for distance moved (p = 0.31). Women moved a mean (±SD) 619 (±698) miles (median = 341 miles, range = 0-2,679 miles); and men, a mean (±SD) 641 (±717) miles (median = 315 miles, range = 0-2,671 miles). Further analysis of applicants traveling less than 50 miles (49 women, 51 men) and by census division showed no significant frequency differences.

CONCLUSION

Women and men travel similar distances for EM residency with the majority staying within geographic proximity to their medical school. This suggests that professional mobility at this stage is not a constraint. Our study findings are limited because we do not know which personal and professional factors inform relocation decisions. Gender is not associated with a difference in distance moved by students for residency. This finding may have implications for resident selection and career development.

The gender pay gap in medicine: A systematic review

BACKGROUND

Women are becoming doctors in greater numbers. Despite this, there is evidence of female doctors' continued differential treatment compared to their male counterparts.

PURPOSE

The aim of this study was to review systematically the extant literature on the gender-based pay gap in medicine across time, different medical specialties, and different countries of clinical practice.

METHODS

Systematic search of three databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies needed to be empirical and contain either an unadjusted or adjusted gender-based finding related to pay.

RESULTS

A total of 46 articles published since 2000 contained a gender-based finding related to physician pay. Thirty-two of these 46 articles presented either adjusted or unadjusted means comparisons (or both) comparing pay between male and female physicians. Eighteen of the 46 articles controlled for one or more variables in examining pay between the two groups. Across almost all studies, female doctors earn significantly less than men, often tens of thousands of dollars less annually, despite similar demographic and work-related profiles. This earnings gap is persistent across time, medical specialty, and country of practice.

PRACTICE IMPLICATIONS

The gender-based pay gap is an ongoing crisis within medicine that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias and the implementation of more supportive policies aimed at better equalizing compensation through greater support and transparency related to salary negotiations, promotional opportunities, and pay scales across various job titles.

Towards gender equity in emergency medicine: a position statement from the CAEP Women in Emergency Medicine committee

As of January 2019, over half of all doctors working in Canada under the age of 40 were women. Despite equal representation in the profession of medicine, women still experience harassment, discrimination, and pay inequity when compared to their male colleagues. Gender discrimination is present at all levels of medical training and negatively impacts women who want to become emergency physicians. The right to gender equity is part of the Canadian Charter of Rights and Freedoms. The World Health Organization states that "gender inequities are socially generated and, therefore, can be changed." CAEP recognizes that gender equity is important to its members and that it intersects with inequities experienced by other minority groups. This position statement from the committee for Women in Emergency Medicine (EM) is intended to support women and those who identify as women who have chosen EM as their career. Furthermore, it is meant to inform and support policy makers as they consider the unique challenges that women face in their pursuit of excellence in EM.

Disparity in Gender Representation of Speakers at National Emergency Medical Services Conferences: A Current Assessment and Proposed Path Forward

INTRODUCTION

Gender disparities between Emergency Medicine physicians with regards to salary, promotion, and scholarly recognition as national conference speakers have been well-documented. However, little is known if similar gender disparities impact their out-of-hospital Emergency Medical Services (EMS) colleagues. Although there have been improvements in the ratio of women entering the EMS workforce, gender representation has improved at a slower rate for paramedics compared to emergency medical technicians (EMTs). Since recruitment, retention, and advancement of females within a specialty have been associated with the visibility of prominent, respected female leaders, gender disparity of these leaders as national conference speakers may contribute to the "leaky pipeline effect" seen within the EMS profession. Gender representation of these speakers has yet to be described objectively.

STUDY OBJECTIVE

The primary objective of this study was to determine if disparity exists in gender representation of speakers at well-known national EMS conferences and trade shows in the United States (US) from 2016-2020. The secondary objective was to determine if males were more likely than females to return to a conference as a speaker in subsequent years.

METHODS

A cross-sectional analysis of programs from well-known national conferences, specifically for EMS providers, which were held in the US from 2016-2020 was performed. Programs were abstracted for type of conference session (pre-conference, keynote, main conference) and speakers' names. Speaker gender (male, female) was confirmed via internet search.

RESULTS

Seventeen conference programs were obtained with 1,709 conference sessions that had a total of 2,731 listed speaker names, of whom 537 (20%) were female. A total of 30 keynote addresses had 39 listed speaker names of whom six (15%) were female. No significant difference was observed in the number of years males returned to present at the same conference as compared to females.

CONCLUSION

Gender representation of speakers at national EMS conferences in the US is not reflective of the current best estimate of the US EMS workforce. This disparity exists not only in the overall percent of female names listed as speakers, but also in the percent of individual female speakers, and is most pronounced within keynote speakers. Online lecture platforms, as an unintentional consequent of the COVID-19 pandemic, coupled with intentional speaker development and mentorship initiatives, may reduce barriers to facilitating a new pipeline for more females to become speakers at national EMS conferences.

Evaluating Bias in Speaker Introductions at the American Society for Radiation Oncology Annual Meeting

PURPOSE

Introducing a physician without a professional title may reinforce bias in medicine by influencing perceived credibility. We evaluated differences in the use of professional titles in introductions of speakers at recent American Society for Radiation Oncology (ASTRO) Annual Meetings.

METHODS AND MATERIALS

We reviewed recordings from the 2017 to 2019 ASTRO Annual Meetings and included complete introductions of speakers with a doctoral degree. Professional introduction was defined as "Doctor" or "Professor" followed by the speaker's full or last name. We collected use of professional introduction, introducer gender, speaker gender, and speaker professional and demographic variables. Identified speakers were sent surveys to collect self-reported demographic data. Analysis was performed using χ2 tests and multivariable logistic regression (MVA).

RESULTS

Of 3267 presentations reviewed, 1226 (38%) met the inclusion criteria. Overall, 805 (66%) speakers and 710 (58%) introducers were men. Professional introductions were used in 74% (2017), 71% (2018), and 69% (2019) of the presentations. There was no difference in the use of professional introductions for male and female speakers (71% vs 73%; P = .550). On MVA, male introducers were associated with decreased use of professional address (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.26-0.49; P < .001). At the 2019 conference, professional introduction was less likely to be used (2019 vs 2017: OR, 0.68; 95% CI, 0.49-0.96; P = 0.026). Those who self-identified as Asian/Pacific Islander were twice as likely to receive a professional introduction compared with those who identified as white (OR, 1.95; 95% CI, 1.07-3.64; P = .033).

CONCLUSION

Male introducers were significantly less likely to introduce any speaker, regardless of gender, by their professional title, and overall use of professional introductions decreased from 2017 to 2019. Furthermore, no difference in professional introduction use by speaker gender was identified at the recent ASTRO meetings. Implementing speaker guidelines could increase the use of professional introductions and raise awareness of unconscious bias at future ASTRO meetings.

Gender distribution in board memberships of emergency medicine societies

BACKGROUND

Gender gaps have been described regarding the chairpersons in academic emergency departments, the composition of editorial boards and publications in emergency medicine. The objective of this study was to determine the gender distribution of chairpersons and board members of emergency medicine societies worldwide.

MATERIALS AND METHODS

In this cross-sectional analysis, websites of national emergency medicine societies worldwide were screened for the composition of executive boards and the respective chairpersons. The gender of the board members and chairpersons was obtained either by the profile on the respective web site and/or by internet search and gender identification software. Descriptive statistics were performed and results for national societies were stratified by continent.

RESULTS

A total of 61 boards of national emergency medicine societies were analyzed. Detailed information on the board composition was available for 50 societies, of which 27 were from Europe, 10 from Asia, five from Africa, four from North America, three from South America and one from Australasia. A total of 603 persons were included in the analysis. 45 (82%) of the listed societies' presidents were male, while 10 (18%) were female. 385 (70%) of the non-president board members were male. The highest proportion of female board members was seen in Australia/New Zealand with five out of eight persons (62%) followed by South America with 13 out of 29 (45%).

CONCLUSIONS

A marked gender disparity was found for emergency medicine societies worldwide in terms of chair functions as well as board composition. Wide regional differences were found between world regions.

Emergency Medicine Journal Editorial Boards: Analysis of Gender, H-Index, Publications, Academic Rank, and Leadership Roles

INTRODUCTION

Our goal in this study was to determine female representation on editorial boards of high-ranking emergency medicine (EM) journals. In addition, we examined factors associated with gender disparity, including board members' academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years.

METHODS

In this retrospective study, we examined EM editorial boards with an impact factor of 1 or greater according to the Clarivate Journal Citations Report for a total of 16 journals. All board members with a doctor of medicine or doctor of osteopathic medicine degree, or international equivalent were included, resulting in 781 included board members. We analyzed board members' gender, academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years.

RESULTS

Gender disparity was clearly notable, with men holding 87.3% (682/781) of physician editorial board positions and women holding 12.7% (99/781) of positions. Only 6.6% (1/15) of included editorial board chiefs were women. Male editorial board members possessed higher h-indices, total citations, and more publishing years than their female counterparts. Male board members held a greater number of departmental leadership positions, as well as higher academic ranks.

CONCLUSION

Significant gender disparity exists on EM editorial boards. Substantial inequalities between men and women board members exist in both the academic and departmental realms. Addressing these inequalities will likely be an integral part of achieving gender parity on editorial boards.

Equity for women in medicine-neonatologists identify issues

OBJECTIVE

Inequity between genders with regards to leadership achievement, compensation, scholarly productivity, and grant funding exist among physicians. This study explores whether similar inequities exist among board certified neonatologists within the USA.

STUDY DESIGN

A voluntary anonymous survey was distributed to 3575 members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents (15.7% response rate). The survey contained questions assessing clinician characteristics, work environment, compensation, professional productivity, and social factors. Statistical analysis was done using JMP Pro 15.0.0 by SAS.

RESULTS

Female neonatologists, compared to male peers, were less likely to hold leadership positions (OR 0.36, p = 0.005), received lower compensation by an average of $34,916 or 12.47% (p < 0.001), and had 6.71 fewer primary authored publications (p = 0.025) after adjusting for several confounding factors.

CONCLUSION

Gender remains a significant independent factor influencing leadership attainment, compensation, and academic productivity in this cohort of neonatologists.

Heart Failure Admission Service Triage (H-FAST) Study: Racialized Differences in Perceived Patient Self-Advocacy as a Driver of Admission Inequities

Background

Racial inequities in mortality and readmission for heart failure (HF) are well documented. Inequitable access to specialized cardiology care during admissions may contribute to inequity, and the drivers of this inequity are poorly understood.

Methodology

This prospective observational study explored proposed drivers of racial inequities in cardiology admissions among Black, Latinx, and white adults presenting to the emergency department (ED) with symptoms of HF. Surveys of ED providers examined perceptions of patient self-advocacy, outreach to other clinicians (e.g., outpatient cardiologist), diagnostic uncertainty, and other active co-morbid conditions. Service census, bed availability, prior admission service, and other structural factors were explored through the electronic medical record.

Results

Complete data were available for 61/135 patients admitted with HF during the study period, which halted early due to coronavirus disease 2019. No significant differences emerged in admission to cardiology versus medicine based on age, sex, insurance status, education level, or perceived race/ethnicity. White patients were perceived as advocating for admission to cardiology more frequently (18.9 vs. 5.6%) and more strenuously than Black patients (p = 0.097). ED clinicians more often reported having spoken with the patient’s outpatient cardiologist for whites than for Black or Latinx patients (24.3 vs. 16.7%, p = 0.069).

Conclusions

Theorized drivers of racial inequities in admission service did not reach statistical significance, possibly due to underpowering, the Hawthorne effect, or clinician behavior change based on knowledge of previously identified inequities. The observed trend towards racial differences in coordination of care between ED and outpatient providers, as well as in either actual or perceived self-advocacy by patients, may be as-yet undemonstrated components of structural racism driving HF care inequities.

Gender and racial trends among neurology residents: an overview

Diversification of academic medicine improves healthcare standards and patient outcomes. Gender and racial inequalities are major challenges faced by the healthcare system. This article reviews the trends of gender and racial disparity among residents of neurology. This retrospective analysis of the annual Accreditation Council for Graduate Medical Education Data Resource Books encompassed all residents at US neurology residency training programmes from the year 2007 to 2018. The representation of women steadily increased, with an absolute increase of 3% from the year 2007 to 2018. Although the absolute change (%) increased for the White race, Asian/Pacific Islander, Black/African Americans, there was a decrease seen in the Hispanic representation in neurology residents from the year 2011 to 2018. There was no change seen for the Native Americans/Alaskans. Our study concluded that gender and racial disparity persists in the recruitment of residents in neurology. This study highlights the need for targeted interventions to address gender and racial disparity among residents of neurology. Further studies are needed to explore etiological factors to address gender and racial disparity.

The Multifaceted Impact of COVID-19 on the Female Academic Emergency Physician: A National Conversation

COVID-19 has impacted all health care professionals in every aspect of life. Female academic emergency physicians have been uniquely affected and continue to face challenges related to clinical workloads, work-life integration, academic productivity, leadership and visibility within departments, and mental health. This white paper, prepared on behalf of the Academy for Women in Academic Emergency Medicine (AWAEM), describes the differential impact of COVID-19 on female academic emergency physicians explored during a virtual panel discussion at the 2020 Society for Academic Emergency Medicine Annual Meeting. AWAEM convened a virtual panel of women to begin a discussion to share experiences and challenges and formulate consensus guidelines regarding best practices and mitigation strategies. The authors describe the unique ways in which female academic physicians have been affected, identify ongoing and intensified gender gaps, and delineate strategies to address the identified problems. Specific recommendations include individual, as well as, institutional and systems-level approaches to combat the inequities.

Racial and gender disparities in neurology

INTRODUCTION

The USA is a diverse society with representation from different ethnic and racial backgrounds, resulting in under-represented minorities (URMs) in various specialties of medicine. Our objective was to find the statistical ratio of URMs in the academic faculty of neurology.

METHODS

This was a retrospective analysis of the American Association of Medical College database. The database covered neurology faculty members from 2006 to 2017.

RESULTS

This study shows a significant change in racial representation in faculty ranks over the last 12 years. At chairperson rank, white people decreased from 86.4% to 79.8% whereas Asian, Hispanic and multiple races (non-Hispanic) simultaneously increased from 6.4% to 9.3%, 0.9% to 3.1% and 1.8% to 4.7%, respectively. At the professor rank, white people decreased from 87.4% to 81.6%, while Asians and Hispanics increased from 7.1% to 10.5% and from 0.7% to 2.1%, respectively. At the rank of associate professor, white people decreased from 81.1% to 68.3% whereas Asians, Hispanics and unknown races increased from 10.3% to 19.0%, 1.6% to 3.1% and from 2.1% to 3.5%, respectively. For the rank of assistant professor, white people decreased from 64.7% to 56.9% and Asians increased from 20.5% to 25.9%. Gender differences (men vs women) for the ranks of chairperson, professor, associate professor, assistant professor and instructors were 90.3% and 9.7%, 83.1% and 16.9%, 67.1% and 32.9%, 56.8% and 43.2%, and 48.1% and 51.9%, respectively.

CONCLUSION

Over a period of 12 years the racial proportion in academic neurology has changed, but it is not proportionate to their respective increase in the population of the USA. Moreover, the portion of female faculty increased, but they are still under-represented in leadership roles. This racial and gender disparity can be addressed by well-planned interventions.