Gender Equity in Healthcare
A Woman’s Place Is Wherever She Wants to Be
The data is clear. When women are involved, patients get better care, teams function more effectively, and organizations perform better.
Gender Equality in Healthcare
A Woman’s Place Is Wherever She Wants to Be
![](https://assets.foleon.com/eu-central-1/de-uploads-7e3kk3/42187/gender-equity.a9d0b6f9974c.jpg?)
The data is clear. When women are involved, patients get better care, teams function more effectively, and organizations perform better.
If you want to find examples of trailblazing women in healthcare, you don’t have to look very far. At Cincinnati Children’s, Bea Lampkin, MD, was the first woman in the nation to hold a division director position in Hematology/Oncology (1973-1991). Marilyn Gaston, MD, established the sickle cell disease program here in 1972. Uma Kotagal, MBBS, MSc, became an international pioneer in the field of quality improvement, and Peggy Hostetter, MD, was the first woman to chair the Department of Pediatrics and direct the Cincinnati Children’s Research Foundation—a position now held by Tina Cheng, MD. Jane Portman served as our first female board chair, Liza Smitherman succeeded her in that role, and of course, Patty Manning, MD, just retired as our first woman chief of staff.
So, all is well on the gender equity front, right? Ummm, not exactly.
In 2023, gender bias is still a force to be reckoned with on the national front, particularly among physicians. That includes pediatricians, even though 70% of pediatricians in the U.S. are women.
Inspire talked with Jennifer O’Toole, MD, MEd, director of the Internal Medicine and Pediatric Residency Program, and Jennifer Reed, MD, MS, an attending physician in Emergency Medicine. O’Toole serves as co-president of Women in Science and Medicine (WIMS), an affinity group at Cincinnati Children’s, and Reed is on the WIMS Executive Council.
“I’ve been participating in advocacy work around gender equity in medicine for about five years now,” says O’Toole, who co-edited the book Women in Pediatrics: The Past, Present and Future. “Although women make up two-thirds of the pediatric field, we still struggle to reach the highest levels of rank and leadership. Nationally amongst all specialties, only 25% of us are full professors, 20% are department chairs, and 18% are deans at medical schools. In pediatrics, we are ahead of that benchmark with 40% who are full professors and 25% who are department chairs. It’s improved a lot in the past 20 years, but we still have work to do.”
Gender equity gets even more nuanced for women of color, women with disabilities, women who identify as LGBTQ+, and women of different nationalities or religious backgrounds.
“This intersectionality adds a whole other layer of complexity and challenges,” says O’Toole.
Assumed Identity
Gender bias manifests in both blatant and subtle ways.
Says Reed, “On a daily basis, I meet families who mistake me for a nurse, although I clearly introduce myself as Dr. Reed, the attending in charge. And, if I’m with a male resident, the family will look to him as the expert, even though he is a trainee, and I have 25 years’ experience.”
Although patients and families often make assumptions based on old stereotypes, sometimes there is a cultural preference about the gender of a physician, particularly when sensitive examinations need to be performed.
“I try to be respectful of that,” says O’Toole. “It’s important to listen to families’ concerns and accommodate them, if possible. In cases where it’s not, I reassure them that I am fully qualified to provide care for their child.”
Female physicians deal with other microaggressions, as well, including:
- Being tasked with office “housework,” such as sending flowers when a colleague has a baby or organizing a meal train if a coworker is ill. “While it does help to promote a supportive culture, this work is not funded, and it doesn’t contribute to advancement. Women more often do these types of tasks as compared to men,” says O’Toole.
- Instances in meetings or on discussion panels where male physicians are introduced using the title “doctor,” while a female physician is called by her first name. Says O’Toole, “It may not seem like a big deal, but the word ‘doctor’ is so powerful. I always use it when I introduce myself to patients and when I introduce my trainees, especially if the resident is a woman.”
The Parent Tax
Gender equity greatly influences career trajectory, compensation and even family planning.
“There are a lot of practices that can hold a woman back,” says O’Toole. “Parental leave is one of them. Fortunately, at Cincinnati Children’s, we’ve made great strides with our leave policy. Years ago, only women could take time off after having a baby. Now, both parents are eligible for time away, which normalizes taking leave.”
Normalizing leave is an important step in diminishing the negative perception that often surrounds taking time away from work to care for children. That negativity has contributed to higher rates of infertility among women physicians.
Says Reed, “A lot of women wait to have children until they are through with their training, although this is changing, thanks to better leave policies. But there are TED talks online about women in my specialty who have had miscarriages during their shifts because they hesitated to leave work and seek care when they began experiencing symptoms. When you choose a specialty, that’s one of the things people don’t realize. The stress of the job and working all these shifts is very challenging, especially if you’re having fertility issues.”
Scheduling is another potential barrier for women physicians, who are more likely to shoulder the bulk of caregiving responsibilities for children and/or elderly parents, although this, too, is changing a bit.
“We have to create work schedules that are compatible with family life,” says O’Toole. “Yes, women physicians work nights, weekends and holidays, as do men. But we can be more mindful about holding 7 am and 6 pm meetings and design schedules that promote well-being and a thriving personal life for everyone, regardless of gender.”
A Level Pay Field
The most obvious measure of gender equity is compensation. Studies show that, nationwide, women in general pediatrics and subspecialties are paid $51,319 less annually than their male counterparts. When adjusted for job-related factors and specific work-family characteristics, that disparity falls to just under $8,000. However, over the course of a 25-year career, it adds up to an estimated difference of $2 million.
Also noteworthy is a phenomenon called gender segregation. When a field or specialty becomes dominated by women, as with pediatrics, it tends to lose prestige, and pay is lower. To illustrate this, the median salary for pediatricians in 1975 was 93% of the national physician salary. At that point, only 23% of the field were women. Fast-forward to 2017, when the field was 63% women. The median salary for pediatricians fell to 71% of the national physician salary.
Says O’Toole, “Cincinnati Children’s has done a great job of ensuring women physicians are paid equitably. Dr. Cheng and all the division directors look at salaries every year and adjust as needed. But clearly, this issue is industry-wide and not unique to us.”
Calling All Allies
So, how do we change a cultural mindset that is so pervasive, many don’t even see that it’s there? O’Toole and Reed have some recommendations:
- Women need to advocate for themselves. Call people out on microaggressions whenever they happen. Take the opportunity to educate those who may not be aware of the effects of their behavior. Join an affinity group, like WIMS.
- Women need to support each other. As women advance in their careers, it’s imperative that they lift other women, mentor and sponsor them, and help them break through that glass ceiling.
- Men can be powerful allies. Men often want to help, but don’t know what to do. Brad Johnson has written a book called "Good Guys: How Men Can Be Allies for Women." It’s a great resource. And there are national training programs to teach men how to elevate women to leadership positions, how to speak up in a room when a woman is faced with a disparaging comment, and more.
- Be intentional about recruiting. It’s critical to have diverse search committees and applicant pools, especially when recruiting for high-level leadership positions. A Harvard Business Review article states that if one of four job candidates is a woman, the odds of her being chosen for the role is very low. But if two of four candidates are female, the chances of a woman being selected are much higher.
“Cincinnati Children’s is on a journey to improve gender equity in healthcare,” says O’Toole. “We’re not going to be 100% perfect, but as a world-renowned pediatric healthcare system, we can and must lead the way. I am excited about the work we’ve done so far, and I have confidence that we can get to where we need to be.”
![](https://assets.foleon.com/eu-central-1/de-uploads-7e3kk3/42187/reed_otoole.e5fc032f9702.jpg?)
Jennifer Reed, MD, MS (left), and Jennifer O’Toole, MD, MEd (right), say gender bias is sometimes subtle, but it can cost women millions of dollars over a lifetime.