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Features Leveling the Playing Field Can We Achieve Gender Equality in Medicine? When Stephanie Abbuhl, MD, professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine, was growing up in the early 1960s, the women around her – her grandmother, mother, aunts, and friends’ mothers – were either homemakers, teachers, secretaries, or nurses. Then came Title IX in 1972, a civil rights law that amended the Higher Educa- tion Act of 1965 and prohibited discrimination on the basis of sex in any federally funded education program or activity. “I had just started college at the time, and I saw the change happen. It was very exciting, and suddenly, more women were going to medical school,” said Dr. Abbuhl, who also serves as the executive director of the FOCUS on Health & Leadership for Women program at Penn. FOCUS is dedicated to supporting the advancement of female faculty into leadership positions and promoting research into women’s health. Dr. Abbuhl entered medical school in 1976, when women comprised approximately a quarter of incom- ing medical school classes. In the first 20 years of her career, she saw that number grow to 50 percent. “It was remarkable – and a complete sea change,” she told ASH Clinical News. Yet, when she became a faculty member at the Uni- versity of Pennsylvania, she saw fewer women advancing in academic medicine. Witnessing the difficulties women were having climbing the ranks and attaining leadership roles gave her pause – and ignited her interest in devel- oping initiatives that support and help advance women faculty. “Women were bringing unbelievable talent to the medical workforce – talent that, frankly, medicine des- perately needed,” said Dr. Abbuhl. “But I also saw these women’s struggles, particularly as our society is still structured such that one parent often needs to put more time in at home. That responsibility was falling mainly on women.” Gender inequality has become a frequent topic of discussion, with movements like Time’s Up and #MeToo shining a light on discrimination and harassment against women in the workplace. The movements origi- nated in Hollywood, but no profession was immune, including medicine. ASH Clinical News spoke with Dr. Abbuhl and others who study the factors that influence gender inequality in medicine and design interventions to correct these imbal- ances and help women reach the same levels of success as their male counterparts. Rising Through the Ranks Molly Carnes, MD, MS, a professor in the Department of Medicine at the University of Wisconsin’s School of Medi- cine and Public Health and director of the Center for Women’s Health Research, had an experience similar to Dr. Abbuhl’s. When she became a tenured professor, she looked around and saw that, unlike her medical school class, 40 percent of whom had been women, she was the only female tenured faculty member in her department. “That observation intrigued me, much more so than the benchtop research I was doing,” she said. “So, I redirected my focus to dig into the interventions that could foster better —LINDA BURNS, MD opportunities for women and other “Leaders in academic medicine have to create a sense of urgency. And we can change the culture!” 60 ASH Clinical News underrepresented groups in STEMM [science, technol- ogy, engineering, mathematics, and medicine] fields. Particularly, I wanted to help these individuals become leaders in their field,” Dr. Carnes told ASH Clinical News. Even though one in three physicians are women, a study conducted in 2017 found that female physicians continue to be passed over for recognition awards, which represent access to key resources and participa- tion in leadership activities. 1 The disparity was stagger- ing, particularly in the case of the American Academy of Physical Medicine and Rehabilitation, which hadn’t recognized a woman with an achievement award in 40 years. 1,2 A recent study that tracked women’s career advance- ment in academic medicine in Germany found that, even as more women have joined the ranks of clinicians and investigators over the last 20 years, the proportion of female chairs and full professors in academic medi- cine is staggeringly low. 3 The ratio of women to men in medical school was 1.54 in 2013; in the same year, the ratio in specialty chair positions was only about 0.1. This pattern was observed even in subspecialties in which women represent the majority of physicians, such as obstetrics/gynecology. “It’s concerning to me that, despite more women entering academic medicine, there remains a large gender gap in promotion from junior faculty to senior leadership positions,” said Linda Burns, MD, the vice president and medical director of Health Services Re- search at the National Marrow Donor Program/Be The Match and former president of the American Society of Hematology (ASH). “I suspect that the reasons are varied, including the need for role models, faculty men- torship programs, and a self-awareness that we must be advocates for our own career advancement.” Dr. Burns added that, in her experience, “ASH staff and leadership have done a fantastic job of raising awareness about gender imbalances and ensuring diver- sity throughout the organization – award committees, July 2018