Barts-MS rose-tinted-odometer: zero ★s

As I gradually drift into health-related politics I realise that it is not enough just to measure something to trigger a change in behaviour. Information and data don’t change behaviour; carrots and sticks or incentives do. The US study below shows that women in academic medicine are no better off than they were 35 years ago. Women physicians are less likely than men to be promoted to the rank of associate or full professor or to be appointed to the department chair. I wouldn’t be surprised if the same situation exists in the UK and other high-income countries and it no doubt applies to academic neurology and the field of MS.

The discrimination against women and other segments of our population has a pernicious effect on outcomes. If there is no level playing field it affects motivation and performance in the workplace and ultimately the kind of research that gets done, MS services we provide and clinical outcomes of our patients with MS.

We have highlighted gender bias in relation to MS research activities many times before on this blog. In relation to the make-up of MS trial steering committees, speakers at conferences, authors on publications and the faculty of important MS conferences, etc. Unconscious bias is all around us and unless you have an active process in place to address gender imbalances they don’t go away. 

My wife who is a feminist is adamant that nothing is going to change regarding gender inequality unless men start to engage and actively promote women in their spheres of influence. I agree with her and more importantly as a father-of-daughters, I have a vested interest in making this happen. In the UK we have the so-called Athen Swan initiative, by which academic institutions have to show that they are addressing the gender gap and depending on how well they are doing they get a rating. This rating was used by the funding agencies to effect change; to apply for research funding from the MRC and NHIR you had to have a gold or silver Athena Swan award, which meant that women were getting a better deal from these Institutions.

This Athena Swan policy was the stick and carrot to make change happen. However, the Athena Swan requirement for funding applications has now been dropped in the UK. As a result, I predict there will be a gradual slide back down the hill and the next generation of women in academic medicine will be let down. I hope I am wrong.

The cynics reading this blog post will ask what thas this got to do with MS? I would suggest you think about the answer to this question and make a comment. Discussing how broader societal issues impact on MS research, MS management and the MS workforce underpins what happens in the field.  

Richter et al. Women Physicians and Promotion in Academic Medicine. N Engl J Med. 2020 Nov 26;383(22):2148-2157.

Background: In 2000, a landmark study showed that women who graduated from U.S. medical schools from 1979 through 1997 were less likely than their male counterparts to be promoted to upper faculty ranks in academic medical centers. It is unclear whether these differences persist.

Methods: We merged data from the Association of American Medical Colleges on all medical school graduates from 1979 through 2013 with faculty data through 2018, and we compared the percentages of women who would be expected to be promoted on the basis of the proportion of women in the graduating class with the actual percentages of women who were promoted. We calculated Kaplan-Meier curves and used adjusted Cox proportional-hazards models to examine the differences between the early cohorts (1979-1997) and the late cohorts (1998-2013).

Results: The sample included 559,098 graduates from 134 U.S. medical schools. In most of the cohorts, fewer women than expected were promoted to the rank of associate or full professor or appointed to the post of department chair. Findings were similar across basic science and clinical departments. In analyses that included all the cohorts, after adjustment for graduation year, race or ethnic group, and department type, women assistant professors were less likely than their male counterparts to be promoted to associate professor (hazard ratio, 0.76; 95% confidence interval [CI], 0.74 to 0.78). Similar sex disparities existed in promotions to full professor (hazard ratio, 0.77; 95% CI, 0.74 to 0.81) and appointments to department chair (hazard ratio, 0.46; 95% CI, 0.39 to 0.54). These sex differences in promotions and appointments did not diminish over time and were not smaller in the later cohorts than in the earlier cohorts. The sex differences were even larger in the later cohorts with respect to promotion to full professor.

Conclusions: Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chair, and there was no apparent narrowing in the gap over time. (Funded by the University of Kansas Medical Center Joy McCann Professorship for Women in Medicine and the American Association of University Women.).

Crowdfunding: Are you a supporter of Prof G’s ‘Bed-to-5km Challenge’ in support of MS research? The project being funded is being led by Dr Ruth Dobson; yes, a woman researching MS. So every pound raised will be addressing the gender issue indirectly.

CoI: multiple

Twitter: @gavinGiovannoni                                  Medium: @gavin_24211

15 thoughts on “Women”

  1. Very interesting Gavin,
    As a thought experiment, do you think training academic clinicians should advance through the training conveyor belt if and when they go off on maternity leave or should they return to work at the training level at which they left? Similarly, if they work part time, should their progression take longer? Presumably some of the inequality stems from women quite rightly choosing to have a work life balance to perhaps bring up children. I would be interested in seeing the analysis in this paper performed in women who have chosen not to have a family – I predict the inequality would be far less obvious.
    Perhaps men should start bringing up children!

    1. While only women can have children and arguably care for them in their earliest years, there is nothing stopping men from working part time to contribute to childcare and everyone’s work life balance. If more men did this then there would be less (hopefully one day no) difference between men and women in their career progression.

      1. I think some countries allow for extended paternity leave as well as maternity leave. It may be Scandinavian countries that allow this extended leave.

  2. I had a conversation with a fellow pwMS in 2019 at a support group, I had just been diagnosed and I was considering treatment options. The lady was unhappy on her current dmt copaxone, and informed me of her discussion with her treating neurologist re same, his suggestion to her was that she should keep having babies… I despaired. Thankfully, my male neurologist made no such suggestion, but he did skim over the having babies issue in regard to treatment options, and implications for same, I do wonder if a female would have handled such conversation in the same manner

  3. I like having a woman for a neurologist. Women really do have some unspoken commonalities.
    We’re used to men getting farther ahead. We run the family, have many responsibilities that pull at our ability to focus on our Own healthcare. I don’t see the solution as men creating opportunities for women. That Still is a Passive strategy. No, Women, Toot your Own horn. Create Women Physician Organizations and publish, educate, be Role models. Make the Guys want to join Your club!

  4. I have two male friends in their 40’s, that work in health care in the UK. One from Scotland, in a junior role and one from India, in a senior role. They both feel a woman’s role is to be the main parent to the children and to be the cook in the family, even if the mother /or woman works.

  5. I recommend that women who have MS are treated with as much regard as the men with MS. Having what we say ignored is not ok, even though as women we’ve got used to it. Especially as we age we are subject to becoming as invisible as we are in wider society.
    As for academia, who would want to join that stale brigade?! If I were a clinician I’d pick a more female friendly, and better resourced, specialty than neurology.

    Recommended reading: Science Book Prize Winner 2019 ‘Invisible Women. Exposing Data Bias in a World Designed for Men’ by Caroline Criado Perez; read especially the chapter ‘The Drugs Don’t Work’

  6. Pro G. Are you the new Michael Marmot?
    Three times as many women with MS as men. Fewer female neurologists as male. Probably fewer researchers, but I don’t have any data on either. It’s an issue for sure, but I don’t mind who diagnoses or treats me. I did have a falling out with a GP HoP because he had no female GPs on his panel. Got no reply to my first two letters. When I got heavy about it, he suggested I change to another surgery. I did not. Things have improved and he retired.

  7. Male PwMS here. I have come across good and bad male and female doctors (irrespective of gender, more bad ones, sadly, goes for neuros as well as GPs).
    I don’t care what gender my neuro is if (s)he listens and constructively works with me.
    Possibly the one point where it mildly matters: my inclination to discuss ED with a woman is somewhat limited (once did with a GP with rather odd results until a senior urologist stepped in) so my usual answer to that is ‘yes GP hands me a generous supply of PDE5 inhibitors’ and that is it.
    However, I would flat out refuse to see a female shrink – if I thought those were at all useful to begin with.

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