Inclusivity that compels: He for she

At a recent meeting of the medical executive committee of my institution (which includes chairs of departments, elected representatives of the medical staff, and hospital administrators), our then-president of the medical staff and chair of the committee, a male surgeon, was nominating members to an ad hoc committee. He proceeded to rattle off about five names of faculty, all illustrious, but all men. I had to interject that there was a notable absence of women faculty on that list of names, and after an uncomfortable silence, names of some stellar women faculty were proposed to replace some of the male nominees.

This is, unfortunately, a not uncommon occurrence in many institutions, much more so in academic medical institutions. Elizabeth Blackwell, MD (1821-1910), was an obstetrician-gynecologist who graduated in 1849 from Geneva Medical College in New York. It is said that she experienced significant challenges finding a job and practicing medicine. The College has intentionally chosen to recognize outstanding women in medicine by naming the Elizabeth and Emily Blackwell Award for Outstanding Contributions to Advancing the Careers of Women in Medicine after her and her sister (1826-1910), who earned her medical degree from what is now Cleveland's Case Western Reserve University in 1874.

Sadly, almost 200 years later, while we have grown in many aspects in science, technology, culture, and the arts, our progress on gender equity in medicine still lags behind. We may not hear about women not finding jobs in medicine, but we do hear that men are more likely to rise to top academic positions in academic medicine, such as chairs of departments, or that women experience delays in promotion to full professorship or to leadership of organizations.

Gender inequity in our society is not exclusive to medicine, and we have a long history of it in the U.S. History tells us that in 1848, the first convention for women's rights began as an idea over tea and ended up as a two-day meeting. It subsequently turned into a convention attended by hundreds in Seneca Falls, N.Y. Of the 300 people who attended, 68 women and 32 men signed a “Declaration of Sentiments,” which was modeled after the Declaration of Independence and laid out the rights denied to women, including the right to vote. (The 32 men who signed this declaration were, probably, the first “he for she” and need to be applauded and commended.)

Later, in 1850, more than 1,000 people—including abolitionists Lucy Stone, Lucretia Mott, and Abby Kelley—attended the first National Women's Rights Convention in Worcester, Mass. (the city where I work). The annual conferences would continue almost every year through 1860. Finally, in August 1920, just over a hundred years ago, the 19th Amendment to the U.S. Constitution was ratified, protecting citizens' right to vote that could not be abridged on account of gender. White women achieved the right to vote in 1920, followed by Native American women in 1924, Chinese immigrant women in 1943, Asian American women in 1952, and finally African American women only in 1965.

A few years ago, ACP's Council of Resident/Fellow Members brought forth a resolution to the Board of Governors calling for gender equity in career advancement and pay parity, leading to the College position paper “Achieving Gender Equity in Physician Compensation and Career Advancement,” published in the May 15, 2018, Annals of Internal Medicine. According to data from the Association of American Medical Colleges, in 2017 women made up more than 50% of medical school enrollment. In an article in 2018 article in Harvard Business Review, Lisa S. Rotenstein described gender inequity in the administrative side of medicine, with women making up only 3% of health care CEOs, 6% of department chairs, 9% of division chiefs, and 3% of chief medical officers. Yet 80% of the health care workforce is female. The statistics for the gender pay gap are equally disappointing.

Male physicians in leadership and positions of influence in our institutions are uniquely positioned to make a change in the status quo. This would require us to intentionally seek to promote our female colleagues, especially women of color; set a goal that the number of women in senior management positions be the same proportion as women in the workplace in the institution; set up clear evaluation criteria and steps that remove barriers such as publications per year or research grants; recognize well that women do need to take time off to have children and need to be able to spend time on family while balancing work demands; invest in training; and model these attributes institution-wide.

We need to push for change, not wait for a whole generation to pass before such change occurs. Like the 32 men who signed the “Declaration of Sentiments,” we need to be pioneers in the “he for she” movement, influencing change.

The United Nations is actively promoting gender equity at the website heforshe.org, and when making the commitment to promote the same, I noted that India is the number-one country in the world (the highest total number of commitments to the “he for she” cause), while the U.S. is only in fourth place.

Will you join me by going to heforshe.org and committing to gender equity in our respective workplaces and in our spheres of influence? If we all can commit to doing that, we will make the U.S. the number-one country in the list of commitment leaders. More important, we will echo President Joe Biden's words on April 28, 2021, after he began his first public address before a joint session of the U.S. Congress by saying, “Madam Speaker. Madam Vice President,” and then continued, to thunderous applause: “No president has ever said those words from this podium … and it's about time.”