Gender equality remains elusive for women in academic oncology, a survey of nearly 700 female oncologists in the US shows.
More than half of respondents in academic medicine said they believe their gender negatively affects their likelihood of advancement, and 1 in 5 said they are considering leaving university in the next 5 years.
Given the percentage of female oncologists planning to leave the science, “there is a high risk that gender inequality will persist unless culture is addressed,” the authors write in their study, published online December 30 JAMA network open.
Although women currently outnumber men in medical schools in the US — a shift that first occurred in 2019 — female representation in higher-level academic oncology is dwindling. Women make up 45% of resident physicians in hematology and oncology, only about 36% of academic faculty, and an even smaller percentage of leadership positions in academic medicine. For example, women hold about 31% of professorial positions in medical oncology, 17.4% in radiation oncology, and 11% in surgical oncology.
A team of researchers led by Emily C. Merfeld, MD, of the University of Wisconsin, Madison Hospitals and Clinics, set out to understand the factors that influence oncologists’ decisions to pursue academic or non-academic career paths.
Merfeld and colleagues analyzed the survey responses of 667 oncologists between August 1 and October 31, 2020 – 422 (63.2%) in academic medicine and 245 (36.8%) in non-academic practice.
Overall, 1 in 4 oncologists said their spouse or partner and family “extremely or moderately” influenced their decision to pursue an academic practice.
Almost 43% of academic oncologists considered time spent with loved ones to be the greatest sacrifice associated with a career in academic medicine. Approximately the same percentage (41.6%) of non-academic oncologists considered the pressure to advance academically as the most significant sacrifice related to academic oncology, while only 22.4% saw less time with loved ones as the biggest sacrifice felt.
“Although work-life balance has been a concern for academic oncologists and may be a factor in female oncologists leaving the academy, survey data suggest that women in non-academic practice face similar challenges,” the authors write.
More specifically, women in oncology academics reported working 2 hours more on weekends than women not in medical academics; However, both groups worked similar hours during the week.
On the recruitment front, nearly 24% of academic oncologists said their gender had a “negative or somewhat negative” impact on their ability to get a job, compared to 21% of non-academic oncologists. Conversely, nearly 28% of academic oncologists reported that their gender had a “positive or somewhat positive” impact on whether they were hired, compared to 41.2% of non-academic oncologists.
However, respondents perceived that gender strongly influenced promotion opportunities. More than half of the respondents – 54.6% of academic oncologists and 50.6% of non-academic oncologists – believed they were less likely to be promoted than their male colleagues.
This perception is consistent with the findings of previous studies, which found that “women were less likely than men to be promoted to associate professor, full professor, or department head,” the authors write.
Overall, most respondents in each group – 71.3% in academic medicine and 68.6% in non-academic practice – said they would choose the same career path again. But nearly 22% of academics said they would be “likely or very likely” to leave academic oncology in the next 5 years. Of these women, 28.2% said they would move into industry and 25% into group practice.
“Contrary to popular belief,” the researchers note, “a spouse or partner and/or family was not a significant factor in female oncologists’ preference for non-academic careers, as this factor was equally important for academic and non-academic oncologists.”
However, they note that “increased financial rewards in non-academic oncology may play a large role in some women’s career decisions.”
Progress on gender equality?
In 2013, oncologist Katherine Reeder-Hayes, MD, MBA, now an associate at the University of North Carolina, Chapel Hill, published a study on gender equality in oncology, in which she concluded that despite “an increasing significant presence in the oncology physician workforce “Women remained underrepresented in leadership positions and at higher levels of academic medicine”.
Since then, Reeder-Hayes says she’s seen progress but recognizes the need for more.
“To some extent I think representation is improving over time due to factors outside of the workplace – women are entering medical school in large numbers and may have more supportive partners and more social support for pursuing a professional career in general [compared to] a decade or two ago,” Reeder-Hayes said Medscape Medical News.
On a personal level, she noted, “I see a lot of mid-career women taking important leadership roles in my own institution.” However, she added, “I think the translation of these good candidates into greater representation in leadership is likely varies greatly from institution to institution.”
In a 2019 editorial, researchers highlighted this variation while also drawing attention to the “remarkable advances” made by the American Association for Cancer Research (AACR). In particular, the columnists reported that women represent 40% of AACR membership, 45% of the AACR Board of Directors and half of the last 10 association presidents.
Editorial co-author Elizabeth Jaffee, MD, Associate Director of the Sidney Kimmel Comprehensive Cancer Center in Johns Hopkins, Baltimore, Maryland, and former AACR President, said Medscape Medical News that she attributes this progress to “tangible measures to ensure equality throughout the organization,” which include gender balance on nominating and program committees, as well as research meetings and the provision of opportunities for mentoring, leadership training and networking.
Despite this positive change, the COVID-19 pandemic threatens to widen the gender imbalance. In a recent article, Julie Silver, MD, an expert on gender equality in medicine, said Medscape Medical News that she expects difficulties.
“There is a lot of evidence that women are leaving medicine in disproportionate numbers,” said Silver, associate chair and director of cancer rehabilitation in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. “A lack of fair pay and promotions that existed before COVID-19 is now being combined with a variety of pandemic-related challenges.”
In addition to salary and promotion disparities, the US continues to suffer from “a chronic lack of available, affordable, and quality childcare and a lack of federal policy or employer initiatives to expand paid family leave and develop childcare infrastructure and the workforce,” Reeder-Hayes said Providing extended leave for new parents and on-site childcare could go a long way in improving this problem, she said.
However, Reeder-Hayes noted that the “leaky pipeline” problem in oncology may underscore the fact that women “make good choices that reflect balanced life priorities,” she said. “If we don’t structure job responsibilities, childcare, and the pace of promotion and tenure so that people can nurture other parts of their lives, employees will feel like they are being asked to sacrifice important things.”
In other words, she said, “It’s the workplace that needs to change if we’re going to be convincing [women], and many men of similar values to stay.”
Open JAMA network. Published online December 30, 2021. Full text
Sharon Worcester is an award-winning medical writer at MDedge News, part of the Medscape Professional Network.
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