Volume 7 no 1
Gender disparity in academic radiology: leaky pipeline by design or default
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Gender disparity in academic radiology: leaky pipeline by design or default
https://doi.org/10.37964/cr24726
Although the success rates of both female and male applicants are comparable for matching in radiology, there have been fewer practising female radiologists than men in the past decade. We discuss the gender gap in leadership positions and research productivity in subspecialties of academic radiology, radiology professional societies, and editorial boards of radiology journals. We also highlight reasons for ongoing disparity and remedial actions for achieving parity.
KEY WORDS: gender disparity, academic radiology, leadership
CITATION: Wilson RD. Fourteen health care systems versus COVID-19: are these the best systems for future health care decisions and needs? Can J Physician Leadersh 2020;7(1):27-30.
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In 2018, women made up 54.1% of applicants for the R-1 residency match in Canada, but only 1.3% of women — compared with 4.5% of men — considered diagnostic radiology as their first-choice discipline.4 Even though the success rates for matching in radiology are comparable for both genders, there have been fewer women practising in the discipline for over a decade.4,5
Pursuing gender parity specifically in academic radiology will result in a more creative and productive learning environment, promoting the specialty for prospective female radiologists. These assertions are strongly supported by other studies showing better communication and participatory decision-making with providers and patients of the same race, ethnicity, or gender.6
Our article summarizes recently published literature as we sought to discuss trends in gender disparity among multiple subspecialties of radiology related to such factors as research and faculty promotion. Our goal was to recommend effective interventions to promote parity. Top
Neuroradiology
In academic neuroradiology, of 465 faculty members for whom data were available, men made up 76.9%, while women constituted only 23.0%. Furthermore, women held 24.9% of assistant professor, 23.4% of associate professor, and 21.4% of professor positions in academic institutions across Canada and the United States.7 Only 8.2% of the 72 faculty members who held higher leadership ranks were women.7 Based on median H-index, women faculty members also published less and had fewer citations than men.7
Nuclear medicine
In academic nuclear medicine, we identified 249 faculty members, for whom academic ranks were available for only 237.8 Of these practising faculty members, 24.4% were women while 75.6% were men.8 Despite similar median H-indices at each academic rank, nuclear medicine faculty also exhibited a decreasing proportion of women at higher academic ranks, indicating that research productivity was not an influential factor in explaining the gender disparity at those levels.8 It is not entirely clear whether the time lag in career progression or the fact that women may not be promoted at the same rate as their male counterparts contributed to the lower ratio of women faculty members.
Musculoskeletal radiology
Among the 183 musculoskeletal radiology programs analyzed in this study, with 255 faculty with available academic ranks, 30.7% were women.9 Most significantly, male dominance and leadership increased with each progressive rank.9 In terms of academic productivity, men and women had very similar H-indices, indicating similar levels of academic achievement. However, women had to be 2.5 times more academically productive at the same rank to get promoted.9
Emergency radiology
Emergency radiology is a fast-paced subspecialty of radiology with opportunities for career development. Thus, it is not surprising that this specialty is considered attractive and exciting to new radiologists. Of the 99 faculty members who met the inclusion criteria for the study,10 women constituted only 22.2%. Out of the 25 faculty members serving in leadership roles, only 12.0% were women.10 There was no significant difference between the H-indices of men and women.10 Top
Interventional radiology
Interventional radiology had the least female representation of any of the subspecialties studied, with women making up only 9.8% of faculty members.11 Although about a tenth of assistant and associate professors were women, women held only 5.3% of full professorships.11 Furthermore, the percentage of women in leadership positions was comparable to overall female representation in interventional radiology: 9.9% of the 71 faculty members serving in leadership positions in this subspecialty were women.11 Nevertheless, women and men had similar levels of academic achievement, with women having more citations than their male counterparts except at the professor rank.
Breast imaging radiology
Unlike other subspecialties, the pattern of male predominance was reversed in breast imaging radiology. Of 370 faculty members, 69.7% were women. There were more female assistant professors and associate professors than men; however, this pattern changed at the professor level, where slightly over half were men.12 Women in breast imaging radiology had lower H-index values and fewer citations than men.12 It has been noted that research productivity might be constrained by a discrepancy in the domestic and parenting roles between genders.13 Top
Of the radiology subspecialties studied, pediatric radiology exhibited the greatest gender parity, with a faculty composed of 46.6% women.13 Although 54.8% of assistant professorships were held by women, there were fewer women than men at the associate professor and full professor ranks. Among professors, only 28.6% were women. Metrics of academic performance were significantly higher for men than women across all academic ranks.13 Among faculty members serving in leadership roles, women served in 56.8% of primary leadership roles (director, chair, division head) and 66.7% of secondary leadership roles (vice-chair, assistant/associate director).
North American radiology societies
Radiology societies followed a similar trend in terms of underrepresentation of women, with only 32.6% of committee members women.14 Further, women held 28.0% of leadership positions.14 Although research productivity metrics were comparable at the assistant and associate professor levels, with increasing academic rank the representation of women on society committees decreased.14 Top
Journal editorial boards of the largest international radiologic societies
A study of the editorial boards of the journals of the six largest international radiology societies found significant gender disparity, as only 19.1% of board members were women.15 Women editorial board members were underrepresented in all institutional academic ranks and were less likely to hold a departmental leadership position.15 Compared with women, male members had more publications overall (110 vs 65) and a higher H-index (25 vs 19).15
Canadian academic radiology departments
Among 932 faculty members in Canadian radiology departments, only 36% were women.16 The gender gap increased with ascending academic rank: 41.1% of assistant professors, 31.4% of associate professors, and only 19.8% of professors were women.16
Steps to achieving parity
In the USA, men account for about three-quarters of the resident workforce in radiology,17 and similar disparities have also been documented recently in academic medicine, cardiology, psychiatry, hematology-oncology, and dermatology.18-23 Top
Academic institutions
To advance parity in academic disciplines, it is essential to ensure that leadership and policymakers understand the importance of recruiting, promoting, and sponsoring underrepresented physicians. Institutions should record data on academic rank, promotion to a leadership role, and type of leadership role by gender so as to recognize and quantify disparities in advancement.24 As in radiology, there is a considerable gender imbalance in the discipline of interventional cardiology, where only 9% of fellows were women in 2017 in the USA.25 Barriers identified by female cardiology fellows included “old boys club” culture, sex discrimination or harassment, and lack of female role models.25
Surveys using a validated assessment tool should be conducted to explore reasons affecting radiologists’ career advancement. Further, methods, such as focus-group sessions with female radiologists from all academic ranks, could be employed to mitigate the factors responsible for the ongoing disparity in academic rank and leadership positions. Women may also benefit from building networks and finding guidance and mentorship.26
Although mentorship is often described as the most influential factor in selecting a specialty, surprisingly, a large percentage of women express dissatisfaction with mentoring practices in place.27 In part, this can be attributed to a lack of female mentors. It is also important to gain input from mentees about their mentorship preferences to serve them better. Top
Academic organizations should set goals to improve gender balance in the workforce, acknowledge leadership achievements as a performance metric, ensure gender representation on leadership selection committees, and recognize and support female leaders.26 Moreover, interventions, such as structured behavioural interviews and camouflaging of names of applicants during early screening, can help decrease bias when appointing and promoting physicians.28 Increasing the number of women on editorial boards is associated with better gender representation of published authors in journals and the use of blinded reviews to preclude bias.29 Top
A commonly cited justification for male dominance in leadership positions remains the familial obligations women often face early in their careers. These obligations, including child-rearing, make it harder for women to travel widely and attend the academic conferences that foster research and academic collaboration. Young women physicians continue to tackle the work–family conflict by reducing their work hours at considerably greater rates than men.30 A break from work during the early years of a physician’s career can lead to disparity in compensation and promotion later.2 Flexible and equitable family-friendly policies should be adopted, including paid childbearing leave for new parents and emergency back-up care to allow physicians to meet the needs of children and maintain balance at work.31
A multifaceted approach is essential to tackle the several unique challenges presented to women who pursue academic radiology. For instance, endorsement of same-sex mentorship and sponsorship programs, use of teleconferencing and teleradiology to allow women to participate in conferences remotely, as well as improved policies for family, maternity, and medical leave can help support those with familial obligations.20,27 Top
Medical schools
Lack of exposure to radiology rotations in medical school discourages interest and becomes a barrier to entry into this specialty; similarly, less funding for research also adversely affects women’s success in academic radiology and research.27 Adequate exposure, mentoring, and sponsorship programs can help female medical students enter and excel in radiology, which remains a male-dominated discipline.
A drop in the percentage of women with increasing academic rank each year was observed from 2006 to 2017, indicating a lack of promotion of women radiology faculty.32 Increased efforts should be made to achieve equitable female representation and ensure enhanced health care delivery.33
Furthermore, during selection for leadership positions, importance is given to academic profile, including research, grants, citations, etc., with little consideration of a track record or advocacy for equity, diversity, and inclusion.34 Once appointed to leadership positions, those with such a record are expected to implement affirmative action and equal opportunity, but they may have little experience in this area and negligible practical knowledge. The barriers to entry are therefore increasingly being replaced with barriers to promotion. Future programs should examine whether policies are being enforced for an accommodating work plan to endorse enrollment, promotion, and retention of female faculty members and mentors.35 Top
References
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Acknowledgements
Dr. Khosa is the recipient of the Association of Faculties of Medicine of Canada’s May Cohen Equity, Diversity and Gender Award (2020). Top
Authors
Emaan Amin, MBBS, is a student at Dow University of Health Sciences, Karachi, Pakistan.
Tiara Safaei is a recent graduate of Crofton House School, Vancouver, Canada.
Muhammad Mustafa Memon, MBBS, is a student at Dow University of Health Sciences, Karachi, Pakistan.
Emily Bretsen is a recent graduate of Crofton House School, Vancouver, Canada.
Faisal Khosa, MD, MBA, is an associate professor in the Department of Radiology at Vancouver General Hospital, University of British Columbia, Canada. He is also head of Grants and International Collaboration in UBC’s Emergency & Trauma Radiology program.
Author attestation: The authors received no funding or sponsorship for this work and declare no conflicts of interest. All authors contributed substantially to the study design, manuscript writing, reviewing, and editing, and approved the final version of this article. They agree to be accountable for all aspects of the work.
Correspondence to:
This article has been peer reviewed.