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Frintner MP, Leslie LK, Gottschlich EA, Starmer AJ, Byrne BJ, Freed GL. Pediatricians' Career Satisfaction and Wellbeing by Sex Before and During the COVID-19 Pandemic. Pediatrics 2024; 153:e2023063345. [PMID: 38384232 DOI: 10.1542/peds.2023-063345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To compare pediatrician career satisfaction and wellbeing by sex during the coronavirus disease 2019 pandemic with prepandemic years using longitudinal survey data. METHODS Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine career satisfaction and wellbeing from 2012 to 2021 among 2002-2004 and 2009-2011 residency graduates (n = 1760). Mixed effects logistic regression, including key pediatrician characteristics, examined career satisfaction and wellbeing measures for sex (female vs male), pandemic year (2012-2019 vs 2020-2021), and their interaction effect. Adjusted predicted percentage values (PVs) were determined. RESULTS In total, 73.4% of participants identified as female. Adjusting for key pediatrician characteristics, differences were found by sex for satisfaction and 4 of 5 wellbeing measures, by pandemic year for 2 wellbeing measures, and the interaction of sex and pandemic year for 3 wellbeing measures. Female pediatricians reported higher levels of anxiety, sadness, and work stress, with greater differences during the pandemic. For example, female pediatricians (PV = 22.6, confidence interval [CI] = 21.0-24.3) were more likely than male pediatricians (PV = 14.2, CI = 12.0-16.4) to report anxiety during pre-pandemic years, and the difference between female pediatricians (PV = 29.3, CI = 26.7-32.0) and male pediatricians (PV = 12.4, CI = 9.3-15.5) increased during pandemic years (sex by pandemic year interaction, P < .001). CONCLUSIONS Compared with male pediatricians, female pediatricians reported worse anxiety, sadness, and stress at work, and the differences were more pronounced during the pandemic.
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Affiliation(s)
| | | | | | - Amy J Starmer
- Baystate Children's Hospital, Springfield, Massachusetts
| | - Bobbi J Byrne
- Indiana University School of Medicine, Indianapolis, Indiana
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Li H, Rotenstein L, Jeffery MM, Paek H, Nath B, Williams BL, McLean RM, Goldstein R, Nuckols TK, Hoq L, Melnick ER. Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine. J Gen Intern Med 2024; 39:557-565. [PMID: 37843702 DOI: 10.1007/s11606-023-08428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute. OBJECTIVE To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity. DESIGN, SETTING, AND PARTICIPANTS This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021. MAIN MEASURES Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables. KEY RESULTS The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively). CONCLUSIONS Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.
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Affiliation(s)
- Huan Li
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
- Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT, USA
| | - Lisa Rotenstein
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Molly M Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Hyung Paek
- Information Technology Services, Yale New Haven Health System, New Haven, CT, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Robert M McLean
- Northeast Medical Group, Stratford, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lalima Hoq
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA.
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Andreae DA, Massand S, Dellasega C. The physician experience of patient to provider prejudice (PPtP). Front Public Health 2024; 12:1304107. [PMID: 38469272 PMCID: PMC10925775 DOI: 10.3389/fpubh.2024.1304107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/01/2024] [Indexed: 03/13/2024] Open
Abstract
Background Patients can demonstrate prejudice and bias toward minoritized physicians in a destructive dynamic identified as PPtP (Patient Prejudice toward Providers). These interactions have a negative impact on the physical and mental well-being of both those who are targeted and those who witness such behaviors. Study purpose The purpose of this study was to explore the PPtP experiences of attending physicians who identify as a minority based on race, ethnicity, citizenship status, or faith preference. Methods Qualitative methodology was used to collect data using in-depth interviews. 15 attending physicians (8 male, 7 female, aged 33-55 years) who identified as minorities based on ethnicity, citizenship status, or faith practices were interviewed individually. Interviews were conducted using a guide validated in previous studies and content analysis was performed by two trained researchers to identify themes. Results Five themes were identified: A Continuum of Offenses, Professional Growth through Adversity, Organizational Issues, Role of Colleagues, and Consequences for Provision of Care. Findings suggest that although attending physicians learned to cope with PPtP, the experience of being treated with bias negatively impacted their well-being and work performance. Attending physicians also felt that white majority medical students sometimes treated them with prejudice but expressed a commitment to protecting vulnerable trainees from PPtP. Conclusion The experience of PPtP occurs consistently throughout a career in medicine, often beginning in the years of training and persisting into the phase of attending status. This makes it imperative to include strategies that address PPtP in order to successfully recruit and retain minoritized physicians.
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Affiliation(s)
- Doerthe A. Andreae
- Section of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - Sameer Massand
- Division of Plastic Surgery, Department of Surgery, Penn State Health, Hershey, PA, United States
| | - Cheryl Dellasega
- Department of Nursing, College of Medicine, Pennsylvania State University, Penn State Health, Hershey, PA, United States
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Agboola IK, Rosenberg A, Robinson L, Brashear TK, Eixenberger C, Shah D, Pavlo AJ, Im DD, Ray JM, Coupet E, Wong AH. A Qualitative Study of Racial, Ethnic, and Cultural Experiences of Minority Clinicians During Agitation Care in the Emergency Department. Ann Emerg Med 2024; 83:108-119. [PMID: 37855791 PMCID: PMC10843036 DOI: 10.1016/j.annemergmed.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
STUDY OBJECTIVE Racial and ethnic bias in health care has been documented at structural, organizational, and clinical levels, impacting emergency care, including agitation management in the emergency department (ED). Little is known about the experiences of racial and ethnic minority ED clinicians caring for racial and ethnic minority groups, especially during their agitated state. The objective of this study was to explore the lived experiences of racial and ethnic minority ED clinicians who have treated patients with agitation in the ED. METHODS We performed semistructured individual interviews of Black, Latino, and multiracial clinicians who worked at 1 of 3 EDs from an urban quaternary care medical center in the Northeast United States between August 2020 and June 2022. We performed thematic analysis through open coding of initial transcripts and identifying additional codes through sequential iterative rounds of group discussion. Once the codebook was finalized and applied to all transcripts, the team identified key themes and subthemes. RESULTS Of the 27 participants interviewed, 14 (52%) identified as Black, 9 (33%) identified as Hispanic/Latino, and 4 (15%) identified as multiracial and/or other race and ethnicity. Three primary themes emerged from racial and ethnic minority clinician experiences of managing agitation: witness of perceived bias during clinical interactions with patients of color who bear racialized presumptions of agitation, moral injury and added workload to address perceived biased agitation management practices while facing discrimination in the workplace, and natural advocacy and allyship for agitated patients of color based on a shared identity and life experience. CONCLUSIONS Our study found that through their shared minority status, racial and ethnic minority clinicians had a unique vantage point to observe perceived bias in the management of agitation in minority patients. Although they faced added challenges as racial and ethnic minority clinicians, their allyship offered potential mitigation strategies for addressing disparities in caring for an underserved and historically marginalized patient population.
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Affiliation(s)
- Isaac K Agboola
- Department of Emergency Medicine, NorthShore University Health System, Evanston, Illinois; Department of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alana Rosenberg
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
| | - Leah Robinson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Taylor K Brashear
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Anthony J Pavlo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Dana D Im
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jessica M Ray
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
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Oshinowo TO, Rallo MS, Schirmer CM, Chambless LB. Gender Differences in Medicare Practice and Payments to Neurosurgeons. JAMA Surg 2024; 159:35-42. [PMID: 37819669 PMCID: PMC10568441 DOI: 10.1001/jamasurg.2023.4988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/16/2023] [Indexed: 10/13/2023]
Abstract
Importance Despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges. Objective To compare practice metrics and earning potential between female and male neurosurgeons and investigate factors associated with gender disparity in Medicare reimbursement. Design, Setting, and Participants This retrospective cross-sectional study used publicly accessible Medicare data on reimbursements to female and male neurosurgeons for procedural and evaluation and management services delivered in both inpatient and outpatient settings between January 1, 2013, and December 31, 2020. Data were analyzed from December 9, 2021, to December 5, 2022. Main Outcomes and Measures The primary outcome was the mean annual payments received and charges submitted by female and male neurosurgeons for services rendered between 2013 and 2020. Secondary outcomes included the total number and types of services rendered each year and the number of beneficiaries treated. Univariate and multivariable analyses quantified differences in payment, practice volume, and composition. Results A total of 6052 neurosurgeons (5540 men [91.54%]; 512 women [8.46%]) served the Medicare fee-for-service patient population. Female neurosurgeons billed for lesser Medicare charges (mean [SE], $395 851.62 [$19 449.39] vs $766 006.80 [$11 751.66]; P < .001) and were reimbursed substantially less (mean [SE], $69 520.89 [$2701.30] vs $124 324.64 [$1467.93]; P < .001). Multivariable regression controlling for practice volume metrics revealed a persistent reimbursement gap (-$24 885.29 [95% CI, -$27 964.72 to -$21 805.85]; P < .001). Females were reimbursed $24.61 less per service than males even after matching services by code (P = .02). Conclusions and Relevance This study found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons when both performed the same primary procedure. Lower mean reimbursement per service may represent divergence in billing and coding practices among females and males that could be the focus of future research or educational initiatives.
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Affiliation(s)
- Temitope O. Oshinowo
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael S. Rallo
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Clemens M. Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Lola B. Chambless
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Okelo SO, Chesley CF, Riley I, Diaz AA, Collishaw K, Schnapp LM, Thakur N. Accelerating Action: Roadmap for the American Thoracic Society to Address Oppression and Health Inequity in Pulmonary and Critical Care Medicine. Ann Am Thorac Soc 2024; 21:17-26. [PMID: 37934586 DOI: 10.1513/annalsats.202305-412ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Sande O Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Christopher F Chesley
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lynn M Schnapp
- American Thoracic Society, New York, New York
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California; and
- Health Equity and Diversity Committee, American Thoracic Society, New York, New York
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Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Child Adolesc Psychiatr Clin N Am 2024; 33:17-32. [PMID: 37981333 DOI: 10.1016/j.chc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
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Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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Alimi Y, Bevilacqua LA, Snyder RA, Walsh DS, Jackson PG, Betsy JE, Altieri MS. The Elephant in the Room: Racial Microaggressions and Implicit Bias in Surgical Training. Ann Surg 2024; 279:167-171. [PMID: 37565351 DOI: 10.1097/sla.0000000000006074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between race, experience of microaggressions, and implicit bias in surgical training. BACKGROUND There is persistent underrepresentation of specific racial and ethnic groups in the field of surgery. Prior research has demonstrated significant sex differences among those who experience microaggressions during training. However, little research has been conducted on the association between race and experiences of microaggressions and implicit bias among surgical trainees. METHODS A 46-item survey was distributed to general surgery residents and residents of surgical subspecialties through the Association of Program Directors in Surgery listserv and social media platforms. The questions included general information/demographic data and information about experiencing, witnessing, and responding to microaggressions during surgical training. The primary outcome was the prevalence of microaggressions during surgical training by self-disclosed race. Secondary outcomes were predictors of and adverse effects of microaggressions. RESULTS A total of 1624 resident responses were obtained. General surgery residents comprised 825 (50.8%) responses. The female-to-male ratio was nearly equal (815:809). The majority of respondents identified as non-Hispanic White (63.4%), of which 5.3% of residents identified as non-Hispanic Black, and 9.5% identified as Hispanic. Notably, 91.9% of non-Hispanic Black residents (n=79) experienced microaggressions. After adjustment for other demographics, non-Hispanic Black residents were more likely than non-Hispanic White residents to experience microaggressions [odds ratio (OR): 8.81, P <0.001]. Similar findings were observed among Asian/Pacific Islanders (OR: 5.77, P <0.001) and Hispanic residents (OR: 3.35, P <0.001). CONCLUSIONS Race plays an important role in experiencing microaggressions and implicit bias. As the future of our specialty relies on the well-being of the pipeline, it is crucial that training programs and institutions are proactive in developing formal methods to address the bias experienced by residents.
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Affiliation(s)
- Yewande Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - Lisa A Bevilacqua
- Department of General Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | | | - Patrick G Jackson
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - J E Betsy
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Chang JH, Essani V, Maskal SM, Brooks NE, Lee EH, Prabhu A, Lum SS, Walsh RM. Paving a Path to Gender Parity: Recent Trends in Participation of Women in an Academic Surgery Society (Society for Surgery of the Alimentary Tract). J Gastrointest Surg 2023; 27:2705-2710. [PMID: 37907815 DOI: 10.1007/s11605-023-05865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/07/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION The proportion of women surgeons is increasing, although women in surgical leadership and research has not kept pace. The Society for Surgery of the Alimentary Tract (SSAT) pledged its commitment to diversity and inclusion in 2016. Our study sought to evaluate the temporal trend of gender representation in leadership, speakership, and research at SSAT. METHODS Publicly available SSAT meeting programs from 2010 to 2022 were reviewed to assess gender proportions within leadership positions (officers and committee chairs); invited speakerships, multidisciplinary symposia, and committee panel session moderators and speakers; and contributions to scientific sessions (moderator, first author and senior author). Verified individual professional profiles were analyzed to categorize gender as woman, man, or unavailable. Descriptive and trend analyses using linear regression and chi-squared testing were performed. RESULTS A total of 5506 individuals were reviewed; 1178 (21.4%) were identified as women and 4328 (78.6%) as men or did not have available data. The absolute proportion of total female participation increased by 1.05% per year (R2=0.82). There was a statistically significant difference in the total proportion of women participation before and after 2016 (18.5% vs. 27.1%, p<0.01). Increases in the proportion of women were demonstrated in leadership, invited speakerships, multidisciplinary symposia, committee panel sessions, research session moderators, and abstract first authors. The proportion of women senior authors remained stagnant. CONCLUSION Though this upward trajectory in SSAT women participation is encouraging, current trends predict that gender parity will not be reached until 2044.
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Affiliation(s)
- Jenny H Chang
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA.
| | - Varisha Essani
- Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Sara M Maskal
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Nicole E Brooks
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Edward H Lee
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Ajita Prabhu
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Sharon S Lum
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
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Zhou A, Leon C, O’Conor C, Johannesen C, Ranasinghe P. The physician gender pay gap in Maryland: current state and future directions. Ann Med 2023; 55:2258923. [PMID: 37782955 PMCID: PMC10547443 DOI: 10.1080/07853890.2023.2258923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland. METHODS An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics. RESULTS Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01). CONCLUSION The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.
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Affiliation(s)
- Ashley Zhou
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlued Leon
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carolyn O’Conor
- Georgetown University School of Medicine, Washington, DC, USA
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11
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White RD. Examining the Influence of Physician Assistant/Associate Scope of Practice Reforms and Individual Characteristics on Wages. Med Care Res Rev 2023; 80:386-395. [PMID: 37340800 DOI: 10.1177/10775587231165351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
High labor demand for physician assistants/associates (PA) has led to substantial PA workforce and wage growth. During this growth period, states have adopted reforms to reduce PA scope of practice restrictions and reports of significant gender and race wage disparities have emerged. This study examined data from the American Community Survey to investigate the influence of demographic characteristics, human capital, and scope of practice reforms on PA wages from 2008 to 2017. Using an ordinary least squares two-way fixed effects estimator, a significant association between reforms and PA wages could not be established. Rather, wages were found to be strongly associated with human capital and demographic characteristics. Gender and race wage disparities persist, with female PAs earning 7.5% lower wages than male PAs and White PAs earning 9.1% to 14.5% higher wages than racial and ethnic minority PAs. These findings suggest a minimal influence of prior scope of practice reforms on PA wages.
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Affiliation(s)
- Ryan D White
- Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
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12
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Vandenberg MT, Kraus M, Misra L, Hertzberg L, Buckner-Petty S, Padmanabhan A, Tollinche LE, Milam AJ. Racial Disparities in Compensation Among US Anesthesiologists: Results of a National Survey of Anesthesiologists. Anesth Analg 2023; 137:268-276. [PMID: 37097908 DOI: 10.1213/ane.0000000000006484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND A racial compensation disparity among physicians across numerous specialties is well documented and persists after adjustment for age, sex, experience, work hours, productivity, academic rank, and practice structure. This study examined national survey data to determine whether there are racial differences in compensation among anesthesiologists in the United States. METHODS In 2018, 28,812 active members of the American Society of Anesthesiologists were surveyed to examine compensation among members. Compensation was defined as the amount reported as direct compensation on a W-2, 1099, or K-1, plus all voluntary salary reductions (eg, 401[k], health insurance). Covariates potentially associated with compensation were identified (eg, sex and academic rank) and included in regression models. Racial differences in outcome and model variables were assessed via Wilcoxon rank sum tests and Pearson's χ 2 tests. Covariate adjusted ordinal logistic regression estimated an odds ratio (OR) for the relationship between race and ethnicity and compensation while adjusting for provider and practice characteristics. RESULTS The final analytical sample consisted of 1952 anesthesiologists (78% non-Hispanic White). The analytic sample represented a higher percentage of White, female, and younger physicians compared to the demographic makeup of anesthesiologists in the United States. When comparing non-Hispanic White anesthesiologists with anesthesiologists from other racial and ethnic minority groups, (ie, American Indian/Alaska Native, Asian, Black, Hispanic, and Native Hawaiian/Pacific Islander), the dependent variable (compensation range) and 6 of the covariates (sex, age, spousal work status, region, practice type, and completed fellowship) had significant differences. In the adjusted model, anesthesiologists from racial and ethnic minority populations had 26% lower odds of being in a higher compensation range compared to White anesthesiologists (OR, 0.74; 95% confidence interval [CI], 0.61-0.91). CONCLUSIONS Compensation for anesthesiologists showed a significant pay disparity associated with race and ethnicity even after adjusting for provider and practice characteristics. Our study raises concerns that processes, policies, or biases (either implicit or explicit) persist and may impact compensation for anesthesiologists from racial and ethnic minority populations. This disparity in compensation requires actionable solutions and calls for future studies that investigate contributing factors and to validate our findings given the low response rate.
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Affiliation(s)
| | - Molly Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Lopa Misra
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Linda Hertzberg
- Department of Anesthesiology, St Agnes Medical Center, Fresno, California
| | - Skye Buckner-Petty
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Asha Padmanabhan
- Department of Anesthesiology, Bethesda West Hospital, Boynton Beach, Florida
| | - Luis E Tollinche
- Department of Anesthesiology, MetroHealth Medical Center of Case Western Reserve University, Cleveland, Ohio
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
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Chaikof M, Cundiff GW, Mohtashami F, Millman A, Larouche M, Pierce M, Brennand EA, McDermott C. Surgical sexism in Canada: structural bias in reimbursement of surgical care for women. Can J Surg 2023; 66:E341-E347. [PMID: 37402558 PMCID: PMC10322158 DOI: 10.1503/cjs.022121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND It is well established that female physicians in Canada are reimbursed at lower rates than their male counterparts. To explore if a similar discrepancy exists in reimbursement for care provided to female and male patients, we addressed this question: Do Canadian provincial health insurers reimburse physicians at lower rates for surgical care provided to female patients than for similar care provided to male patients? METHODS Using a modified Delphi process, we generated a list of procedures performed on female patients, which we paired with equivalent procedures performed on male patients. We then collected data from provincial fee schedules for comparison. RESULTS In 8 out of 11 Canadian provinces and territories studied, we found that surgeons were reimbursed at significantly lower rates (28.1% [standard deviation 11.1%]) for procedures performed on female patients than for similar procedures performed on male patients. CONCLUSION The lower reimbursement of the surgical care of female patients than for similar care provided to male patients represents double discrimination against both female physicians and their female patients, as female providers predominate in obstetrics and gynecology. We hope our analysis will catalyze recognition and meaningful change to address this systematic inequity, which both disadvantages female physicians and threatens the quality of care for Canadian women.
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Affiliation(s)
- Michael Chaikof
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Geoffrey W Cundiff
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Fariba Mohtashami
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Alexi Millman
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Maryse Larouche
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Marianne Pierce
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Erin A Brennand
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Colleen McDermott
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
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14
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Houtrow AJ. Underreported Sexual Harassment Gives False Impression That the Situation Is Better Than It Is. JAMA Intern Med 2023:2804122. [PMID: 37126320 DOI: 10.1001/jamainternmed.2023.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Amy Joy Houtrow
- Department of Physical Medicine & Rehabilitation and Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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15
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Reisdorff EJ, Masselink LE, Gallahue FE, Suter RE, Chappell BP, Evans DD, Salsberg E, Marco CA. Factors associated with emergency physician income. J Am Coll Emerg Physicians Open 2023; 4:e12949. [PMID: 37064163 PMCID: PMC10090942 DOI: 10.1002/emp2.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
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.
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Affiliation(s)
| | - Leah E. Masselink
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Fiona E. Gallahue
- Department of Emergency MedicineThe University of WashingtonSeattleWashingtonUSA
| | - Robert E. Suter
- Department of Emergency MedicineUniversity of Texas SouthwesternDallasTexasUSA
- Department of Military MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Brad P. Chappell
- Department of Emergency MedicineUniversity of California, Harbor‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Dian D. Evans
- Emory University Nell Hodgson Woodruff School of NursingAtlantaGeorgiaUSA
| | - Ed Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Catherine A. Marco
- Department of Emergency MedicinePenn State Health, Hershey Medical CenterHersheyPennsylvaniaUSA
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16
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Marcelin JR, Khazanchi R, Lyden E, Cawcutt KA, Ha DR, Florez N, Kullar R, Ristagno EH. Demographic Representation Among Speakers and Program Committee Members at the IDWeek Conference, 2013-2021. Clin Infect Dis 2023; 76:897-904. [PMID: 36208201 DOI: 10.1093/cid/ciac816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2016, the IDWeek program committee was charged with ensuring gender equity in speaker sessions. Whether this charge also resulted in more opportunities for historically underrepresented speakers is unknown. METHODS We conducted a retrospective analysis of trends in the demographic composition of IDWeek speakers and program committee members between 2013 and 2021. We used descriptive statistics to summarize data, χ2 tests to compare speaker demographics between 2013-2016 (before 2016) and 2017-2021 (after 2016), and Cochran-Armitage tests for trend. Each speaker slot was considered an independent event. RESULTS A total of 5482 speaker slots were filled by 3389 individuals from 2013 to 2021. There was a linear increase in female speakers from 38.6% in 2013 to 58.4% in 2021 (P < .001). The proportion of white speakers decreased overall from 84.9% in 2013 to 63.5% in 2021. Compared with white speakers, more slots were filled by Asian speakers after 2016 versus before 2016 (20.1% vs 14.8%, respectively; P < .001). Program committee members from 2013-2021 were >80% non-Hispanic white; <5% of committee members identified as black, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, or Hispanic. More program committee slots were filled by women after 2016 than before 2016 (52.7% vs 33.9%; P = .004). CONCLUSIONS Intentional consideration of gender equity by the program committee was associated with equitable gender representation of invited speakers at IDWeek after 2016. Gradually, the proportions of IDWeek speakers from historically excluded racial/ethnic approached their respective proportions in the IDSA membership. White speakers remained overrepresented relative to membership proportions until 2021, and gaps in program committee racial/ethnic demographic representation highlights opportunities for continued inclusion, diversity, access, and equity at IDWeek.
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Affiliation(s)
- Jasmine R Marcelin
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rohan Khazanchi
- Internal Medicine-Pediatrics Residency Program, Brigham & Women's Hospital/Boston Children's Hospital/Boston Medical Center and Departments of Internal Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kelly A Cawcutt
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David R Ha
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA
| | - Narjust Florez
- Lowe Center for Thoracic Oncology at the Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester Minnesota, USA
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17
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Sinclair MK, Chhabra AB. Recruiting, Supporting and Retaining Diversity in Hand Surgery. Hand Clin 2023; 39:33-42. [PMID: 36402524 DOI: 10.1016/j.hcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.
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Affiliation(s)
- Micah K Sinclair
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, Children's Mercy Hospital, University of Missouri Kansas City, University of Kansas Medical Center, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, Hand Surgery, University of Virginia Health, PO Box 800159, Charlottesville, VA 22908-0159, USA
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18
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Holaday LW, Weiss JM, Sow SD, Perez HR, Ross JS, Genao I. Differences In Debt Among Postgraduate Medical Residents By Self-Designated Race And Ethnicity, 2014-19. Health Aff (Millwood) 2023; 42:63-73. [PMID: 36623219 PMCID: PMC9954659 DOI: 10.1377/hlthaff.2022.00446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires significant time and financial investment, and populations that are underrepresented in medicine have also been excluded from building wealth. Understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity. We used 2014-19 data on postgraduate resident trainees from the Association of American Medical Colleges to examine the association between race and ethnicity and debt independent of other demographics and residency characteristics. Black trainees were significantly more likely to have every type of debt than the overall sample and all other racial and ethnic groups (96 percent of Black trainees had any debt versus 83 percent overall; 60 percent had premedical education loans versus 35 percent overall, and 50 percent had consumer debt versus 25 percent overall). American Indian/Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander trainees were more likely to have debt compared with White and Asian trainees. Overall, debt prevalence decreased over time and varied by specialty; however, for Black trainees, debt decreased minimally over time and was stable across specialties. Scholarships, debt relief, and financial guidance should be explored to improve diversity and inclusion in medicine across specialties.
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Affiliation(s)
- Louisa W Holaday
- Louisa W. Holaday , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jasmine M Weiss
- Jasmine M. Weiss, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sire D Sow
- Sire D. Sow, Icahn School of Medicine at Mount Sinai
| | - Hector R Perez
- Hector R. Perez, Montefiore Medical Center, New York, New York
| | - Joseph S Ross
- Joseph S. Ross, Yale University, New Haven, Connecticut
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19
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Naqvi H, Williams RD, Chinembiri O, Rodger S. Workforce and workplace racism in health systems: organisations are diverse but not inclusive. Lancet 2022; 400:2023-2026. [PMID: 36502831 PMCID: PMC9731575 DOI: 10.1016/s0140-6736(22)02395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Habib Naqvi
- NHS Race and Health Observatory, London SW1P 3HZ, UK.
| | | | | | - Sam Rodger
- NHS Race and Health Observatory, London SW1P 3HZ, UK
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20
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Han X, Shen L, Tong J, Jiang F, Liu H, Zhu J. Gender differences in income among psychiatrists in China: Findings from a national survey. Front Public Health 2022; 10:1026532. [PMID: 36544804 PMCID: PMC9761767 DOI: 10.3389/fpubh.2022.1026532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/16/2022] [Indexed: 12/09/2022] Open
Abstract
Background Gender income disparity in healthcare settings is a longstanding issue around the globe, but such evidence among Chinese psychiatrists is scarce. This study investigated whether gender income differences exist among physicians in China. Methods Data came from the 2019 national survey data of 4,520 psychiatrists in major public psychiatric hospitals across China. Self-reported monthly income after tax (in Chinese Yuan, CNY) by participants at all professional ranks was assessed. Average monthly income by gender was reported. Adjusted income differences between male and female psychiatrists were examined using multivariable regression models, adjusting with inverse probability of treatment weights and controlling for psychiatrist demographics (e.g., gender, professional rank, marital status, educational level, and work hours) and hospital fixed effects. Results The unadjusted mean difference in monthly income after tax by gender was 555 CNY (about $86; 95% CI, -825 to -284; mean [SD] for men: 8,652 [4,783] CNY and for women: 8,097 [4,350] CNY) in all psychiatrists. After regression adjustments, the income difference by gender among all psychiatrists reduced substantially and became insignificant. However, gender income difference was still observed among senior-level psychiatrists, where female psychiatrists earned 453 CNY (about $70; 95% CI, -810 to -95) significantly less than male psychiatrists. Conclusion China achieved gender equity in income for psychiatrists overall, the observed income differences among senior level psychiatrists, however, reveal the persistence of gender inequity at the highest level of professional hierarchy. These findings call for policy attention to the issue of gender income disparity among psychiatrists in China's healthcare system.
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Affiliation(s)
- Xinxin Han
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Lijun Shen
- Vanke School of Public Health, Tsinghua University, Beijing, China,School of Medicine, Tsinghua University, Beijing, China
| | - Jiayu Tong
- Institute for Hospital Management, Tsinghua University, Shenzhen, China
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China,Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, China,Institute for Healthy China, Tsinghua University, Beijing, China,*Correspondence: Jiming Zhu
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21
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Nguemeni Tiako MJ, Johnson S, Muhammad M, Osman NY, Solomon SR. Association Between Racial and Ethnic Diversity in Medical Specialties and Residency Application Rates. JAMA Netw Open 2022; 5:e2240817. [PMID: 36367730 PMCID: PMC9652751 DOI: 10.1001/jamanetworkopen.2022.40817] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE The lack of racial and ethnic diversity in the US medical profession is a well-recognized problem, and racial and ethnic representation is highly variable across the medical specialties. Residency selection is a crucial juncture at which diversity and representation in specialties can be increased. OBJECTIVE To identify factors associated with residency application rates for medical specialties by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study of medical student residency applications used American Association of Medical Colleges data on 2019-2020 applicants and information about the racial and ethnic characteristics of practicing physicians (including medical school faculty) and department chairs. A total of 26 320 applicants to medical residency programs, 592 296 practicing physicians, and 2121 department chairs across the US were included. Residency application rates for 18 medical specialties were evaluated. MAIN OUTCOMES AND MEASURES The main outcome was the specialty representation quotient (SRQ), which estimated the extent to which students from a racial or ethnic group were overrepresented (an SRQ >1) or underrepresented (an SRQ <1) in a given specialty compared with the racial and ethnic demographic characteristics of the corresponding graduating class. Covariates included the racial and ethnic demographic characteristics of practicing physicians and department chairs by specialty based on American Association of Medical Colleges data and student academic factors (mean United States Medical Licensing Examination step 1 score, number of research experiences, and AΩA honor society membership among matched students from the previous application cycle). Multivariable logistic regression analysis was used to examine associations between these covariates and application rates by race and ethnicity. RESULTS Among 26 320 specialty-specific applications to medical residency programs in 18 specialties, 90 (0.3%) were from American Indian or Alaska Native students, 6718 (25.5%) were from Asian students, 2575 (9.8%) were from Black students, 1896 (7.2%) were from Hispanic students, and 15 041 (57.1%) were from White students. Among 592 296 practicing physicians, 2777 (0.5%) were American Indian or Alaska Native, 117 358 (19.8%) were Asian, 36 639 (6.2%) were Black, 41 071 (6.9%) were Hispanic, and 394 451 (66.6%) were White. Among 2121 department chairs, 5 (0.2%) were American Indian or Alaska Native, 212 (10.0%) were Asian, 86 (4.1%) were Black, 88 (4.1%) were Hispanic, and 1730 (81.6%) were White. The specialties with the greatest representation among applicants from racial and ethnic groups underrepresented in medicine (URM) were family medicine (SRQ, 1.70), physical medicine and rehabilitation (SRQ, 1.60), and obstetrics and gynecology (SRQ, 1.47). The specialties with the lowest URM representation among applicants were plastic surgery (SRQ, 0.47), otolaryngology (SRQ, 0.53), and orthopedic surgery (SRQ, 0.86). Membership in AΩA was negatively associated with SRQ among American Indian or Alaska Native students only (β = -0.11; 95% CI, -0.17 to -0.05; P = .002). Racial and ethnic representation among practicing physicians was positively associated with SRQ for American Indian or Alaska Native students (β = 6.05; 95% CI, 4.26-7.85; P < .001), Asian students (β = 0.07; 95% CI, 0.06-0.09; P < .001), Black students (β = 0.10; 95% CI, 0.06-0.15; P < .001), and URM students overall (β = 0.05; 95% CI, 0.01-0.08; P = .02). CONCLUSIONS AND RELEVANCE This study's findings suggest that the propensity of medical students, particularly those from racial and ethnic minority groups, to apply to a given specialty for residency was associated with the representation of their racial or ethnic group among the specialty's practicing physicians. Future work to characterize the mechanisms of occupational sorting may guide interventions to improve equity within the physician workforce.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Shawn Johnson
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Nora Y. Osman
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sonja R. Solomon
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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22
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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23
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Lee SG, Blood AJ, Kochar A. Negotiation for the Early-Career Cardiologist. J Am Coll Cardiol 2022; 80:1110-1113. [PMID: 36075682 DOI: 10.1016/j.jacc.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Simin Gharib Lee
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Alexander J Blood
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Newton Wellesley Hospital, Newton, Massachusetts, USA
| | - Ajar Kochar
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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24
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Klein R, Ufere NN, Schaeffer S, Julian KA, Rao SR, Koch J, Volerman A, Snyder ED, Thompson V, Ganguli I, Burnett-Bowie SAM, Palamara K. Association Between Resident Race and Ethnicity and Clinical Performance Assessment Scores in Graduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1351-1359. [PMID: 35583954 PMCID: PMC9910786 DOI: 10.1097/acm.0000000000004743] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. METHOD The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. RESULTS Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. CONCLUSIONS Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.
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Affiliation(s)
- Robin Klein
- R. Klein is associate professor, Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nneka N Ufere
- N.N. Ufere is instructor of medicine, Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Schaeffer
- S. Schaeffer is associate professor, Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine A Julian
- K.A. Julian is professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Sowmya R Rao
- S.R. Rao is statistician, Department of Global Health, Boston University School of Public Health and Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Jennifer Koch
- J. Koch is professor, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Anna Volerman
- A. Volerman is associate professor, Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Erin D Snyder
- E.D. Snyder is professor, Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Vanessa Thompson
- V. Thompson is associate professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Ishani Ganguli
- I. Ganguli is assistant professor, Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sherri-Ann M Burnett-Bowie
- S.-A.M. Burnett-Bowie is assistant professor, Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerri Palamara
- K. Palamara is associate professor, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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25
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WILLIAMS RENEE, WHITE PASCALEM, BALZORA SOPHIE. A TEAM Approach to Diversity, Equity, and Inclusion in Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2022; 20:1625-1630. [PMID: 35623978 PMCID: PMC9329242 DOI: 10.1016/j.cgh.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- RENEE WILLIAMS
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Grossman School of Medicine, New York, New York
| | - PASCALE M. WHITE
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - SOPHIE BALZORA
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Grossman School of Medicine, New York, New York,Association of Black Gastroenterologists and Hepatologists Board of Directors
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26
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Williams R, White PM, Balzora S. A TEAM Approach to Diversity, Equity, and Inclusion in Gastroenterology and Hepatology. Gastroenterology 2022; 163:359-363. [PMID: 35074445 DOI: 10.1053/j.gastro.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Renee Williams
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Grossman School of Medicine, New York, New York
| | - Pascale M White
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophie Balzora
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Grossman School of Medicine, New York, New York
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27
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Dellasega C, Aruma JF, Sood N, Andreae DA. The Impact of Patient Prejudice on Minoritized Female Physicians. Front Public Health 2022; 10:902294. [PMID: 35865248 PMCID: PMC9294398 DOI: 10.3389/fpubh.2022.902294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 01/14/2023] Open
Abstract
Background Patient bias and prejudice directed against physicians from diverse backgrounds is a frequent occurrence in healthcare. Female physicians have long experienced discrimination in the healthcare system based on their gender alone. The dynamic known as Patient Prejudice toward Providers (PPtP) is disproportionately affecting female physicians because it is frequently compounded by sexism. Aim The goal of this study was to explore the impact of PPtP on female resident and attending physicians. Methods Using transcribed one-on-one interviews from a larger study of PPtP affecting resident and attending physicians, ten interviews with female physicians (resident and attending) from diverse ethnic backgrounds and countries of training at a large academic medical center were analyzed. The authors independently reviewed the interviews using an iterative process within and across interviews to inductively identify repeating words, phrases, and concepts relevant to the study aim. Results Demographics of the ten participants included age (mean 34.6 years), ethnicity (6 Asian, 2 Hispanic, 2 African), and country of training (10% IMG vs. 90% US trained). Four of the interviewees were residents and six were attendings. Themes that emerged from the analysis included experiencing "A Gendered Continuum of Abuse," "Establishing a Higher Standard of Competency," "Overcoming the Stereotype of the White Male Physician," "The Physicality of Self Identity," and "The Need to be Protective of Minoritized Trainees." All participants agreed that these perceptions created an adverse environment at the workplace and impacted on patient care. Conclusions Discrimination of physicians based on their gender or their race/ethnicity has been reported. This study highlights the compounded effects of patient prejudice on female minoritized physicians. Organizations and individuals should identify and implement strategies to address the impact of PPtP and sexism in order to create an environment where all women can thrive professionally.
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Affiliation(s)
- Cheryl Dellasega
- Department of Humanities, Penn State College of Medicine, Hershey, PA, United States
| | | | - Natasha Sood
- Penn State College of Medicine, Hershey, PA, United States
| | - Doerthe A. Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake, UT, United States,*Correspondence: Doerthe A. Andreae
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28
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Willett LL. Supporting Physician Pregnancy: What Is Taking So Long? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:958-960. [PMID: 35320127 DOI: 10.1097/acm.0000000000004671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Challenges persist for female physicians and physicians in training who desire to have children. A scoping review in this issue of Academic Medicine identifies 4 major themes that have evolved over time and have surged in numbers as more women have entered the medical profession and as the sociopolitical environment has progressed: the impact of pregnancy on the physician and her colleagues, pregnant physician work productivity, physician maternity leave policies, and physician maternal-fetal health outcomes. The persistence of themes over time should compel the medical profession and society to address the challenges that face female physicians and physicians in training who desire to have children and to find solutions for them. Women should be able to be physicians, have children if they wish, and have the same health care considerations as nonphysician women. Institutional, departmental, and personal support structures must become a priority.
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Affiliation(s)
- Lisa L Willett
- L.L. Willett is professor, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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29
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Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Psychiatr Clin North Am 2022; 45:243-258. [PMID: 35680240 DOI: 10.1016/j.psc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
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Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- American College of Cardiology, 2400 N Street NW, Washington, DC 20037, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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30
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Dhaliwal R, Pereira RI, Diaz-Thomas AM, Powe CE, Yanes Cardozo LL, Joseph JJ. Eradicating Racism: An Endocrine Society Policy Perspective. J Clin Endocrinol Metab 2022; 107:1205-1215. [PMID: 35026013 DOI: 10.1210/clinem/dgab896] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 11/19/2022]
Abstract
The Endocrine Society recognizes racism as a root cause of the health disparities that affect racial/ethnic minority communities in the United States and throughout the world. In this policy perspective, we review the sources and impact of racism on endocrine health disparities and propose interventions aimed at promoting an equitable, diverse, and just healthcare system. Racism in the healthcare system perpetuates health disparities through unequal access and quality of health services, inadequate representation of health professionals from racial/ethnic minority groups, and the propagation of the erroneous belief that socially constructed racial/ethnic groups constitute genetically and biologically distinct populations. Unequal care, particularly for common endocrine diseases such as diabetes, obesity, osteoporosis, and thyroid disease, results in high morbidity and mortality for individuals from racial/ethnic minority groups, leading to a high socioeconomic burden on minority communities and all members of our society. As health professionals, researchers, educators, and leaders, we have a responsibility to take action to eradicate racism from the healthcare system. Achieving this goal would result in high-quality health care services that are accessible to all, diverse workforces that are representative of the communities we serve, inclusive and equitable workplaces and educational settings that foster collaborative teamwork, and research systems that ensure that scientific advancements benefit all members of our society. The Endocrine Society will continue to prioritize and invest resources in a multifaceted approach to eradicate racism, focused on educating and engaging current and future health professionals, teachers, researchers, policy makers, and leaders.
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Affiliation(s)
- Ruban Dhaliwal
- Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Rocio I Pereira
- Denver Health, Denver, Colorado, USA
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado 80204, USA
| | - Alicia M Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee 38103, USA
| | - Camille E Powe
- Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Licy L Yanes Cardozo
- Departments of Cell and Molecular Biology and Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
| | - Joshua J Joseph
- The Ohio State University College of Medicine, Division of Endocrinology, Diabetes and Metabolism, Columbus, Ohio 43210, USA
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31
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Velazquez AI, Gilligan TD, Kiel LL, Graff J, Duma N. Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do? Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35649205 DOI: 10.1200/edbk_350691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
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Affiliation(s)
- Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Julie Graff
- Veterans Affairs Portland Health Care System, Portland, OR
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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32
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Ly DP. Historical Trends in the Representativeness and Incomes of Black Physicians, 1900-2018. J Gen Intern Med 2022; 37:1310-1312. [PMID: 33876377 PMCID: PMC8971221 DOI: 10.1007/s11606-021-06745-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dan P Ly
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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33
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Machut KZ, Kushnir A, Oji-Mmuo CN, Kataria-Hale J, Lingappan K, Kwon S, Dammann CE. Effect of Coronavirus Disease-2019 on the Workload of Neonatologists. J Pediatr 2022; 242:145-151.e1. [PMID: 34748740 PMCID: PMC8572527 DOI: 10.1016/j.jpeds.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the impact of coronavirus disease-2019 (COVID-19) on the neonatology workforce, focusing on professional and domestic workloads. STUDY DESIGN We surveyed US neonatologists in December 2020 regarding the impact of COVID-19 on professional and domestic work during the pandemic. We estimated associations between changes in time spent on types of professional and domestic work and demographic variables with multivariable logistic regression analyses. RESULTS Two-thirds (67.6%) of the 758 participants were women. Higher proportions of women than men were in the younger age group (63.3% vs 29.3%), held no leadership position (61.4% vs 46.3%), had dependents at home (68.8% vs 56.3%), did not have a partner or other adult at home (10.6% vs 3.2%), and had an employed partner (88.1% vs 64.6%) (P < .01 for all). A higher proportion of women than men reported a decrease in time spent on scholarly work (35.0% vs 29.0%; P = .02) and career development (44.2% vs 34.9%; P < .01). A higher proportion of women than men reported spending more time caring for children (74.2% vs 55.8%; P < .01). Reduced time spent on career development was associated with younger age (aOR, 2.21; 95% CI, 1.20-4.08) and number of dependents (aOR, 1.21; 95% CI, 1.01-1.45). Women were more likely to report an increase in time spent time doing domestic work (aOR, 1.53; 95% CI, 1.07-2.19) and a reduction in time on self-care (aOR, 0.49; 95% CI, 0.29-0.81). CONCLUSIONS COVID-19 significantly impacts the neonatology workforce, disproportionately affecting younger, parent, and women physicians. Targeted interventions are needed to support postpandemic career recovery and advance physician contributions to the field.
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Affiliation(s)
- Kerri Z. Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL,Reprint requests: Kerri Z. Machut, MD, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, #45, Chicago, IL 60611
| | - Alla Kushnir
- Department of Pediatrics, Cooper Children's Regional Hospital, Camden, NJ
| | | | | | - Krithika Lingappan
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Soyang Kwon
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
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Larson AR, Englander MJ, Youmans QR, Verduzco-Gutierrez M, Stanford FC, Strong SA, Liu HY, Silver JK. Analysis of Physician Compensation Studies by Gender, Race, and Ethnicity. Health Equity 2022; 6:59-71. [PMID: 36186614 PMCID: PMC9518798 DOI: 10.1089/heq.2021.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Allison R. Larson
- Department of Dermatology, Georgetown University Medical Center and MedStar Health, Washington, DC, USA
| | | | - Quentin R. Youmans
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT San Antonio, San Antonio, Texas, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, Massachusetts, USA
| | - Sheritta A. Strong
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Howard Y. Liu
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hoang K, Evans N, Aghajanova L, Talib H, Linos E, Gold JM. Fertility Benefits at Top U.S. Medical Schools. J Womens Health (Larchmt) 2022; 31:1369-1373. [PMID: 35041526 DOI: 10.1089/jwh.2021.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Female physicians have a higher prevalence of infertility compared with the general population. Physician well-being can be significantly impacted by the physical and emotional challenges associated with this, including the high cost of fertility treatments, which are often not covered by health insurance. There are limited data on the current state of fertility coverage available for physicians. This study examines fertility insurance benefits offered for faculty at top U.S. medical schools. Methods: Between March and April 2021, we reviewed fertility benefits at medical schools ranked in the top 14 for research as identified by the US News & World Report 2021. The summary plan descriptions of benefits were collected from each institution's human resources (HR) website and direct phone call to HR representatives. We examined descriptions of coverage for fertility services including evaluation, treatments, medications, maximum lifetime coverage, and whether a formal diagnosis of infertility was required for benefit eligibility. Results: Fourteen institutions offer benefits for fertility evaluation and 13 offer benefits for treatment. Of the 13 institutions that offer treatment coverage, 11 cover in vitro fertilization, with 6 having limits on the number of cycles. Twelve offer medication coverage. Ten institutions specified maximum lifetime coverage for treatments and medications, ranging from $10,000 to $100,000. Only 1 school provided coverage for elective fertility preservation, and none covered surrogacy expenses. Half of the schools are in states where fertility benefits are mandated. Conclusion: There is wide variation in fertility benefits offered at top medical schools across the country. Many schools offered coverage for fertility evaluation and treatments; however, majority had restrictions and limitations to the benefits, suggesting that there is still inadequate coverage provided. This study's selected sample also does not reflect other medical schools across the country, which may not be as well-resourced in their provision of fertility benefits.
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Affiliation(s)
- Kim Hoang
- Department of Pediatrics, Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford University School of Medicine, Palo Alto, California, USA
| | - Neal Evans
- University Human Resources, Stanford University, Palo Alto, California, USA
| | - Lusine Aghajanova
- Stanford University School of Medicine, Palo Alto, California, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hina Talib
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eleni Linos
- Stanford University School of Medicine, Palo Alto, California, USA.,Department of Dermatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jessica M Gold
- Department of Pediatrics, Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford University School of Medicine, Palo Alto, California, USA
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Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annu Rev Public Health 2022; 43:477-501. [PMID: 35020445 PMCID: PMC9172268 DOI: 10.1146/annurev-publhealth-052620-103528] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.
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Affiliation(s)
- Monica B Vela
- Department of Medicine, Section of Academic Internal Medicine, University of Illinois College of Medicine in Chicago, Chicago, Illinois, USA;
| | - Amarachi I Erondu
- Department of Internal Medicine and Pediatrics, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nichole A Smith
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Peek
- Department of Medicine, Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - James N Woodruff
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
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Mohos A, Frese T, Kolozsvári L, Rinfel J, Varga A, Hargittay C, Csatlós D, Torzsa P. Earning opportunities and informal payment as influencing factors in medical students' speciality choice. BMC FAMILY PRACTICE 2021; 22:258. [PMID: 34969365 PMCID: PMC8716841 DOI: 10.1186/s12875-021-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment. Methods A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. Results Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. Conclusions Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.
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Affiliation(s)
- András Mohos
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary.
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle/Saale, Germany
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4028 Kassai út 26, Debrecen, Hungary
| | - József Rinfel
- Institute of Primary Care, University of Pécs, 7623 Rákoczi St. 2, Pécs, Hungary
| | - Albert Varga
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Dalma Csatlós
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
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Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career. Health Aff (Millwood) 2021; 40:1856-1864. [PMID: 34871074 PMCID: PMC9910787 DOI: 10.1377/hlthaff.2021.00461] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Differences in income between male and female academic physicians are well known, but differences for community physicians and career differences in income have not been quantified. We used earnings data from 80,342 full-time US physicians to estimate career differences in income between men and women. The differences in annual income between male and female physicians that we observed in our simulations increased most rapidly during the initial years of practice. Over the course of a simulated forty-year career, male physicians earned an average adjusted gross income of $8,307,327 compared with an average of $6,263,446 for female physicians-an absolute adjusted difference of $2,043,881 and relative difference of 24.6 percent. Gender differences in career earnings were largest for surgical specialists ($2.5 million difference), followed by nonsurgical specialists ($1.6 million difference) and primary care physicians ($0.9 million difference). These findings imply that over the course of a career, female US physicians were estimated to earn, on average, more than $2 million less than male US physicians after adjustment for factors that may otherwise explain observed differences in income, such as hours worked, clinical revenue, practice type, and specialty.
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Affiliation(s)
| | - Tina Koo
- health policy at the RAND Corporation
| | | | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital and Harvard Medical School, both in Boston, Massachusetts
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Sepúlveda-Vildósola AC, González HM, López-Sepúlveda MF, Martínez-Escobar CB. Trends in Medical Specialization and Employability in Mexico According to Gender. Arch Med Res 2021; 53:205-214. [DOI: 10.1016/j.arcmed.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/02/2022]
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Alberto CK, Kemmick Pintor J, Martínez-Donate A, Tabb LP, Langellier B, Stimpson JP. Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care. JAMA Netw Open 2021; 4:e2133857. [PMID: 34757410 PMCID: PMC8581727 DOI: 10.1001/jamanetworkopen.2021.33857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Disparities in medical home provisions, including receipt of family-centered care (FCC), have persisted for Latinx youths in the US. OBJECTIVE To examine the association between maternal-clinician ethnic concordance and receipt of FCC among US-born Latinx youths. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional secondary analysis of data from the Medical Expenditure Panel Survey from January 1, 2010, to December 31, 2017, was conducted. Data analysis was performed from January 6 to February 3, 2020. Latinx youths (age, ≤17 years) born in the US who had a usual source of care and used care in the past year, their Latina mothers (age, 18-64 years), and youths' health care clinician characteristics (eg, race, ethnicity, and sex) were evaluated using χ2 tests and propensity-score matching methods. MAIN OUTCOMES AND MEASURES Maternal reports on whether their youths' clinician listened carefully to the parent, explained things in a way the parent could understand, showed respect, and spent enough time with the patient. RESULTS There were 2515 US-born Latinx youths with linked maternal characteristics during the study period; 51.67% (95% CI, 48.87%-54.45%) of the youths were male, mean (SD) age was 8.48 (0.17) years (30.86% [95% CI, 28.39%-33.44%] were between ages 5 and 9 years), 61.53% (95% CI, 57.15%-65.74%) had public insurance coverage, and 39.89% (95% CI, 32.33%-47.89%) had mothers who were ethnically concordant with the youths' medical care clinician. We found that for youths with maternal-clinician ethnic concordance, the probabilities of reporting FCC were significantly higher than they would have been in the absence of concordance: that the medical care clinician listened carefully to the parent (average treatment effect on the treated [ATET], 5.44%; 95% CI, 2.14%-8.74%), explained things in a way the parent could understand (ATET, 4.82%; 95% CI, 1.60%-8.03%), showed respect for what the parent had to say (ATET, 5.51%; 95% CI, 2.58%-8.45%), and spent enough time with the patient (ATET, 5.28%; 95% CI, 1.68%-8.88%). CONCLUSIONS AND RELEVANCE Given the increase of Latinx populations and the simultaneous shortage of underrepresented minority health care clinicians, the findings of this study suggest that increasing the number of clinicians from underrepresented minority backgrounds and ethnic-concordant parental-clinician relationships may help reduce disparities in receipt of medical home provision among US-born Latinx youths.
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Affiliation(s)
- Cinthya K. Alberto
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Ana Martínez-Donate
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Loni Philip Tabb
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Brent Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P. Stimpson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Frank E, Zhao Z, Fang Y, Rotenstein LS, Sen S, Guille C. Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2134315. [PMID: 34767022 PMCID: PMC8590168 DOI: 10.1001/jamanetworkopen.2021.34315] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has placed increased strain on health care workers and disrupted childcare and schooling arrangements in unprecedented ways. As substantial gender inequalities existed in medicine before the pandemic, physician mothers may be at particular risk for adverse professional and psychological consequences. OBJECTIVE To assess gender differences in work-family factors and mental health among physician parents during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 276 US physicians enrolled in the Intern Health Study since their first year of residency training. Physicians who had participated in the primary study as interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a secondary longitudinal follow-up study were invited to complete an online survey in August 2018 and August 2020. EXPOSURES Work-family experience included 3 single-item questions and the Work and Family Conflict Scale, and mental health symptoms included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scale. MAIN OUTCOMES AND MEASURES The primary outcomes were work-to-family and family-to-work conflict and depressive symptoms and anxiety symptoms during August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic) were compared by gender. RESULTS Among 215 physician parents who completed the August 2020 survey, 114 (53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among physician parents, women were more likely to be responsible for childcare or schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; P < .001) during the pandemic compared with men. Women were also more likely than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater work-to-family conflict (β = 2.79; 95% CI, 1.00 to 4.59; P = .03), family-to-work conflict (β = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive (β = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (β = 2.87; 95% CI, 1.49-4.26; P < .001) symptoms compared with men. We observed a difference between women and men in depressive symptoms during the COVID-19 pandemic (mean [SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; P = .86). CONCLUSIONS AND RELEVANCE This study found significant gender disparities in work and family experiences and mental health symptoms among physician parents during the COVID-19 pandemic, which may translate to increased risk for suicide, medical errors, and lower quality of patient care for physician mothers. Institutional and public policy solutions are needed to mitigate the potential adverse consequences for women's careers and well-being.
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Affiliation(s)
- Elena Frank
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Zhuo Zhao
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Lisa S. Rotenstein
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Srijan Sen
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Thomas KL, Mehta LS, Rzeszut AK, Lewis SJ, Duvernoy CS, Douglas PS. Perspectives of Racially and Ethnically Diverse U.S. Cardiologists: Insights From the ACC Professional Life Survey. J Am Coll Cardiol 2021; 78:1746-1750. [PMID: 34674820 DOI: 10.1016/j.jacc.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Sandra J Lewis
- Northwest Cardiovascular Institute, Portland, Oregon, USA
| | - Claire S Duvernoy
- VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan, USA
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Merali Z, Malhotra AK, Balas M, Lorello GR, Flexman A, Kiran T, Witiw CD. Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study. CMAJ 2021; 193:E1584-E1591. [PMID: 34663601 PMCID: PMC8547248 DOI: 10.1503/cmaj.210437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice. Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.
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Affiliation(s)
- Zamir Merali
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Armaan K Malhotra
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Michael Balas
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Gianni R Lorello
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Alana Flexman
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Tara Kiran
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont.
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Affiliation(s)
- Randl B. Dent
- Department of Health Policy and Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Anushree Vichare
- Department of Health Policy and Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Abstract
BACKGROUND Prior studies demonstrated that wage disparities exist across race and ethnicity within selected health care occupations. Wage disparities may negatively affect the industry's ability to recruit and retain a diverse workforce throughout the career ladder. OBJECTIVE To determine whether wage disparities by race and ethnicity persist across health care occupations and whether disparities vary across the skill spectrum. RESEARCH DESIGN Retrospective analysis of 2011-2018 data from the Current Population Survey using Blinder-Oaxaca decomposition regression methods to identify sources of variation in wage disparities. Separate models were run for 9 health care occupations. SUBJECTS Employed individuals 18 and older working in health care occupations, categorized by race/ethnicity. MEASURES Annual wages were predicted as a function of race/ethnicity, age, sex, marital status, having a child under 5 in the household, living in a metro area, highest education attained, and usual hours worked. RESULTS Non-Hispanics consistently made more than Hispanic licensed practical/vocational nurses (LPNs/LVNs), aides/assistants, technicians, and community-based workers. Asian/Pacific Islanders consistently made more than Black, American Indian/Alaska Native, and Multiracial individuals across occupations except physicians, advanced practitioners, or therapists. Asian/Pacific Islanders only made significantly less when compared with White physicians, but more than White advanced practitioners, registered nurses, LPNs/LVNs, and aides/assistants. Based on observed attributes, Black registered nurses, LPNs/LVNs, and aides/assistants were predicted to make more than their White peers, but unexplained variation negated these gains. CONCLUSIONS Many wage gaps remained unexplained based on measured factors warranting further study. Addressing wage disparities is critical to advance in careers and reduce job turnover.
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Fleming MA, Scott EJ, Bradford PS, Lattimore CM, Omesiete WI, Williams CA, Williams MD, Martin AN. The Risk and Reward of Speaking Out for Racial Equity in Surgical Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:1387-1392. [PMID: 33531275 DOI: 10.1016/j.jsurg.2021.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/22/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
In order to maintain productivity and career advancement, Black and Brown individuals often find themselves downplaying persistent elements of bias and racism experienced in predominantly white fields. These elements are commonly reinforced by institutional and departmental policies that hinder the creation of an equitable and inclusive environment for all. In this manuscript, we outline specific challenges faced by Black and Brown trainees and faculty that are perpetuated by such policies. The challenges are followed by specific recommendations for change as they may apply to faculty, staff and trainees. The outlined recommendations or "action items" may be enacted by any residency program or department based on perceived timeliness and should serve as a foundation for change-one that is intently created through a lens of anti-racism. The risk of speaking up for racial equity is outweighed by the potential rewards of building an environment that is diverse, inclusive and better for everyone.
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Affiliation(s)
- Mark A Fleming
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Erik J Scott
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Perry S Bradford
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Wilson I Omesiete
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Carlin A Williams
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Michael D Williams
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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Barry J. Real wage growth in the U.S. health workforce and the narrowing of the gender pay gap. HUMAN RESOURCES FOR HEALTH 2021; 19:105. [PMID: 34454538 PMCID: PMC8403397 DOI: 10.1186/s12960-021-00647-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Healthcare has been identified as a job engine during recent recessions in the U.S. Whether the healthcare sector provides better than average pay remains a question. This study investigates if wages grew with the expanding demand for healthcare workers between 2001 and 2017. Wage growth in the (1) physicians and surgeons, (2) nurse, (3) healthcare practitioner and technical, (4) healthcare support, and (5) direct patient care jobs are examined. The gender pay gap in each occupation is investigated. METHODS The American Community Survey (ACS) public use microdata sample (PUMS) for 2001, 2004, 2008, 2013, and 2017 were used to derive hourly wages for full-time, full-year workers aged 18-75. The cumulative percent change in unadjusted, median hourly wages between 2001 and 2017 was calculated for each occupation. Quantile regression estimates predicted a median hourly wage for men and women by year and job after adjusting for differences in demographics, industry, and hours worked. RESULTS Unadjusted median wage growth was 9.92% for nurses, 5.68% for healthcare practitioners, and 37.6% for physicians between 2001 and 2017. These rates are roughly above the estimated national rate of wage growth at the 50th wage percentile. In healthcare support and direct patient care occupations, workers experienced either stagnant or negative wage growth. Women had lower occupational wages than men. CONCLUSION The slow or negative median wage growth in all but the physician occupation between 2004-2008 and 2008-2013 confirms that healthcare wages in the U.S. are not recession-proof, unlike healthcare employment. Generally, women's earnings grew at rates that were higher or less negative than rates for men. This trend contributed to narrowing the gender pay gap in every occupation except for nurse.
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Affiliation(s)
- Janis Barry
- Department of Economics, Fordham University, 113 West 60th Street, New York, NY, 10023, USA.
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Hertzberg LB, Miller TR, Byerly S, Rebello E, Flood P, Malinzak EB, Doyle CA, Pease S, Rock-Klotz JA, Kraus MB, Pai SL. Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists. Anesth Analg 2021; 133:1009-1018. [PMID: 34375316 DOI: 10.1213/ane.0000000000005676] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A gender-based compensation gap among physicians is well documented. Even after adjusting for age, experience, work hours, productivity, and academic rank, the gender gap remained and widened over the course of a physician's career. This study aimed to examine if a significant gender pay gap still existed for anesthesiologists in the United States. METHODS In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the primary variable examined in the model, and compensation by gender was the primary outcome. Compensation was defined as the amount reported as direct compensation on a W-2, 1099, or K-1, plus all voluntary salary reductions (eg, 401[k], health insurance). The survey directed respondents to include salary, bonuses, incentive payments, research stipends, honoraria, and distribution of profits to employees. Respondents had the option of providing a point estimate of their compensation or selecting a range in $50,000 increments. Potential confounding variables that could affect compensation were identified based on a scoping literature review and the consensus expertise of the authors. We fitted a generalized ordinal logistic regression with 7 ranges of compensation. For the sensitivity analyses, we used linear regressions of log-transformed compensation based on respondent point estimates and imputed values. RESULTS The final analytic sample consisted of 2081 observations (response rate, 7.2%). This sample represented a higher percentage of women and younger physicians compared to the demographic makeup of anesthesiologists in the United States. The adjusted odds ratio associated with gender equal to woman was an estimated 0.44 (95% confidence interval, 0.37-0.53), indicating that for a given compensation range, women had a 56% lower odds than men of being in a higher compensation range. Sensitivity analyses found the relative percentage difference in compensation for women compared to men ranged from -8.3 to -8.9. In the sensitivity analysis based on the subset of respondents (n = 1036) who provided a point estimate of compensation, the relative percentage difference (-8.3%; 95% confidence interval, -4.7 to -11.7) reflected a $32,617 lower compensation for women than men, holding other covariates at their means. CONCLUSIONS Compensation for anesthesiologists showed a significant pay gap that was associated with gender even after adjusting for potential confounding factors, including age, hours worked, geographic practice region, practice type, position, and job selection criteria.
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Affiliation(s)
- Linda B Hertzberg
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Thomas R Miller
- Department of Analytics and Research Services, American Society of Anesthesiologists, Schaumburg, Illinois
| | - Stephanie Byerly
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Rebello
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela Flood
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Elizabeth B Malinzak
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | | | - Sonya Pease
- Department of Anesthesiology, Cleveland Clinic Martin Health, Palm Beach Gardens, Florida
| | - Jennifer A Rock-Klotz
- Department of Analytics and Research Services, American Society of Anesthesiologists, Schaumburg, Illinois
| | - Molly B Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
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Racial disparities in vascular surgery: An analysis of race and ethnicity among U.S. medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce. J Vasc Surg 2021; 74:33S-46S. [PMID: 34303458 DOI: 10.1016/j.jvs.2021.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.
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Are female authors under-represented in primary healthcare and general internal medicine journals? Br J Gen Pract 2021; 71:302. [PMID: 34319882 DOI: 10.3399/bjgp21x716249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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