Marking achievements in gender equity

The role of women in medicine has reached some significant milestones, according to Susan Thompson Hingle, MD, MACP.

“Students matriculating into medical school now are 50/50 men and women, or even slightly more women are entering medical school than men, and that has been sustained over the past 20 years,” Dr. Hingle said. “That is progress.”

While leadership in medicine is still predominantly male, there's been progress there as well, she said, especially given the time it takes for physicians to complete their training and move into senior roles.

“For women compared to men, for a long time, for positions like department chairs and deans of medical school, we were kind of hovering in the teens, like 13%, 14%,” said Dr. Hingle, who is an internal medicine specialist, professor of medicine, associate dean for human and organizational potential, and director of faculty development at Southern Illinois University School of Medicine in Springfield. “The last data that I saw were at 20%, which was a pretty big jump. … That is something positive that hopefully will be sustainable, and something that we can build on.”

Dr. Hingle, a past Chair of ACP's Board of Governors and Board of Regents, became President-elect of the American Medical Women's Association (AMWA) in March. To mark Women in Medicine Month this September, she spoke to ACP Internist about gender equity and the importance of advocacy and mentorship, among other topics.

Q: Where are the biggest challenges to increasing gender equity in medicine?

A: One area that I think is still one of the greatest challenges or opportunities, depending on your perspective, is the gender pay gap. That hasn't changed at all. It's a hard thing, because people don't like talking about money. It makes them uncomfortable. … It's related to negotiation skills, and whenever you have that as the foundation of how you pay people, there's going to be that gender pay gap because of gendered expectations, societal norms.

Women are not going to push as hard. Even if you teach us how to do it, we're still not going to do it, and so until we get to a point where we say, “An internal medicine physician gets paid this much, a pediatrician gets paid this much, work as a department chair is worth this much, work as a dean is worth this much,” really paying for what the work is, we probably will continue to have those huge gender pay gaps.

If you look at it over a lifespan, in internal medicine, the most recent data show that female physicians are making, on average, $50,000 less per year than male physicians. When you're talking about $250,000, $200,000, to calculate that over a lifetime, you're talking about a couple of million dollars. It's huge.

Q: What effects have you seen on gender equity from the COVID-19 pandemic?

A: The pandemic set a lot of things back a few years, or lots of years, because we got into gendered roles again, gendered expectations, and it's hard to dig your way out of that. I am a feminist, I am someone who believes in equity and inclusion and trying to get rid of stereotypes and gendered norms, but I fell into those roles. At home, I was the one who felt like I needed to be making sure that the kids were on their Zoom classes and made sure that we had meals on the table.

I think there was huge potential to use some lessons learned from the pandemic to really advance lots of things, because we did learn that people could work remotely, and that we could communicate with technology differently than we had, and that you didn't have to work eight hours straight, that you could sort of break it up and come back to it. We learned that we needed the ability to decompress and that the way we were working before didn't allow it.

Lots of these things could have translated into progress, but people were so exhausted by the pandemic, they just wanted to get back to the way that it was, and that has been the goal. …There was this window of opportunity that we had to reimagine what life after the pandemic was going to look like, and I think we might have lost that. I think that window might have closed.

Q: How important is mentorship to women, and physicians in general?

A: Mentorship is really important, and I think it is undervalued by organizations and by society. If you talk to people who have been successful in their careers, I don't have statistics, but the vast majority of people will say that mentors played a key role in that. But if you look at promotion guidelines, very few of those have explicitly said, “Mentorship is a key component of getting promoted.”

If you're trying to get promoted from assistant to associate professor, associate to a full professor, you need to have publications, you need to have clinical productivity metrics in there, you need to have good national impact, you need to get invited to give lectures. All this stuff is spelled out, but very rarely is mentorship listed.

It's interesting, because, again, when you talk to people and ask them, “Why do you think you've been successful in your career?,” mentorship is one of the key components. They need mentors to help them get research grants, to get publications, to get invited to be a speaker at other institutions or at meetings. But it's not explicit criteria.

One of the things people can do is try to work to change that, to get it integrated into a career advancement guideline, so that it is recognized and valued. They can also work to get it integrated into position descriptions, so that it's not something people do on a volunteer basis, but it's something that is actually valued by the organizations that people work in.

It's sort of expected that we'll just do that for each other, and women tend to do it a lot more than men do. You hear about the minority tax; there's also the gender tax. Women are expected to be good citizens and to help anyone who reaches out to us. And to do it right, to do it well, it takes a lot of time and effort, and so it should be valued. It probably should be valued with protected time or with financial reimbursement, rather than simply as a citizenship expectation.

Q: What opportunities are there for women in medicine to get involved in advocacy?

A: Advocacy is one of the big pillars of AMWA. There's so many similarities with ACP—I think one of the great things about both of the organizations is they have such a broad lens, they are so vision-oriented and mission-oriented. … Similar to ACP, we are encouraging members to reach out to their congresspeople to say, “We want you to support this bill.” People can sign up to be part of that advocacy network and get notified when there are critical bills.

Regarding getting involved, a lot of people will say, “If not me, then who?” That's a really, really important mindset to have. When we talk about physician wellness, clinician wellness, people talk about how it's a system-level issue, and it is, for the most part. But if I'm not going to engage in trying to make it better, why should I expect that the decision makers are going to want to make it better?

They need to hear from us. They need to know that we're committed to making it better. You can say that, really, about just about anything that you find important: gender equity, gun violence, reproductive health access. If we're not committed to being part of making it what we want, we sort of have to just accept what happens, right?

Q: What else should our readers be thinking about during Women in Medicine Month?

A: I would really encourage everyone to really view equity and inclusion with a broad lens. Right now we're talking about gender equity and gender inclusion, but the principles relate to so many different things, to racial differences and to differences in practice setting, for example, private practice versus academic. We look at all these things that make us different, but the unifying theme, the unifying goal, is to really create a society where people can be their authentic selves and feel valued and included and a sense of belonging.

There's a lot of work going on now looking at belonging, and loneliness is on the rise. There are studies that show that loneliness is a greater risk factor for heart attacks, strokes, and congestive heart failure than smoking, than diabetes, than hypertension. When you think about what internal medicine physicians do, we treat hypertension, we treat diabetes, we try to get people to stop smoking, but we don't address this issue of loneliness and belonging. That's something that probably deserves more attention than it's been getting.