Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Sustainability of the Subspecialty of Anesthesiology Critical Care: An Expert Consensus and Review of the Literature

While considerable literature exists with respect to clinical aspects of critical care anesthesiology (CCA) practice, few publications have focused on how anesthesiology-based critical care practices are organized and the challenges associated with the administration and management of anesthesiology critical care units. Currently, numerous challenges are affecting the sustainability of CCA practice, including decreased applications to fellowship positions and decreased reimbursement for critical care work. This review describes what is known about the subspecialty of CCA and leverages the experience of administrative leaders in adult critical care anesthesiologists in the United States to describe potential solutions.

Women Surgeons: Barriers and Solutions

BACKGROUND

Underrepresentation and undertreatment of women in surgery continues to be highly prevalent, with major barriers to improvement. The aim of the study was to review the current state of women surgeons in Poland.

METHODS

Information from the various Polish databases on women surgeons in 9 medical universities in general, oncological, vascular, thoracic, and cardiac surgery was retrospectively evaluated. Demographics of residents and staff surgeons, academic ranks and leadership positions at universities, in surgical societies and on scientific journals editorial boards were analyzed. Descriptive statistics were used.

RESULTS

In 2020, 61% of 3,668 graduates of Polish medical universities were women. In 5 surgical specialties, 11.9% (1,243 of 10,411) of the surgeons were women, with the lowest numbers in cardiac (5.6%), and in vascular surgery (6.4%); 40.4% of general surgery residents were women, less in vascular (18.4%) and thoracic surgery (24%), more in oncological surgery (28.7%). In 35 surgical departments of 9 universities, all department chairs were men, all full professors were men; 7% of associate professors and 16% of assistant professors were women. Rectors of all universities were men; 27% of the vice-rectors were women. In the senates and university councils, 39% and 35%, respectively, were women. Presidents, vice presidents, and secretaries of surgical societies and Editor-in-Chief of 4 surgical journals were all men.

CONCLUSIONS

Polish women surgeons face major difficulties with representation in surgery, in departmental, institutional, and societal leadership, and on scientific journal editorial boards. A multifaceted approach to correct these serious inequalities is urgently needed.

Gender Differences in the Path to Medical School Deanship

Importance

Women account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy.

Objective

To identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship.

Design, Setting, and Participants

In this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis.

Main Outcome and Measures

Career and leadership development experiences were elicited using a semistructured interview guide.

Results

We interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms.

Conclusions and Relevance

This qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.

Gender Disparity in Full Professor Rank Among Academic Physicians: A Systematic Review and Meta-Analysis

PURPOSE

The gender gap in promotion in academic medicine is well established. However, few studies have reported gender differences in promotion adjusted for scholarly production and national or international reputation, namely, career duration, publications, grant funding, and leadership positions. The authors performed a systematic review and meta-analysis of the differences between men and women in achieving benchmarks for promotion and analyze where such differences lie geographically and within specialties.

METHOD

A systematic search of Academic Search Premier, Business Source Complete, Cochrane Library, ERIC, GenderWatch, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science was conducted from inception to August 17, 2022. All studies that reported the number of male and female full professors on medical school faculty were included. The primary outcome was the adjusted odds ratio (AOR) for promotion to full professor for women compared with men.

RESULTS

Two hundred forty-four studies met the inclusion criteria. The unadjusted OR for promotion to full professor for women was 0.38 (95% confidence interval [CI], 0.36-0.41). Sixteen studies reported an AOR. The pooled AOR of promotion for women to full professor was 0.60 (95% CI, 0.46-0.77). The AOR for promotion to full professor was 0.55 (95% CI, 0.34-0.88) in surgery and 0.80 (95% CI, 0.57-1.11) in internal medicine. Statistical heterogeneity was high ( Q = 66.6, I2 = 79.4%, P < .001). On meta-regression, 77% of the heterogeneity was from studies outside the United States, where more disparity was reported (AOR, 0.29; 95% CI, 0.22-0.38).

CONCLUSIONS

Most studies continued to find decreased promotion of women. Gender disparity was particularly notable in surgery and in studies from outside the United States. The results suggest that differences in promotion were due to differences in productivity and leadership and to gender bias.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents

BACKGROUND

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians.

OBJECTIVE

This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians.

DESIGN

This study evaluated 12 months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature.

SUBJECTS

Mayo Clinic internal medicine residents.

MAIN MEASURES

Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time.

KEY RESULTS

Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked (p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001). There was no difference in message turnaround time, total messages, or number of results received.

CONCLUSIONS

Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.

Trends Among Women in Academic Medicine Faculty Ranks

Introduction: Similar proportions of women and men have entered medical school since 2003. However, career advancement and promotion for women continues to be fraught with disparities and inequalities. Building on current literature, this study explores the rates of change of female faculty in faculty ranks over the last 10 years to gain a more comprehensive view of the faculty trends of women in academic medicine. Methods: Using the Faculty Administrative Management Online User System database, counts by gender and faculty rank at each Association of American Medical Colleges (AAMC) academic medical school were obtained. Statistical analysis was done using generalized estimating equations modeling to assess rates of change for each gender from 2012 to 2021. Results: Higher proportions of female faculty are concentrated at the Instructor and Assistant Professor level and lower proportions at the Associate Professor and Professor rank compared to male faculty. Over the study period, female faculty showed increased rate change compared to male faculty of 1.007 (95% confidence interval [CI]: 1.002-1.012) for Associate Professor rank and 1.012 (95% CI: 1.007-1.016) for Professor rank. At the Instructor and Assistant Professor levels, female faculty decreased at a relative rate of 0.980 (95% CI: 0.969-0.990) and 0.995 (95% CI: 0.992-0.997) each year, respectively. Conclusion: Female faculty continue to be concentrated at the junior faculty rank. Rate changes at the senior faculty rank for female faculty have slightly improved over the last 10 years compared to male faculty. However, this improvement is minimal, and work is still needed to achieve true gender equity in academic medicine.

Challenges in Medicine, Magnified by the Pandemic: A Dual Battle for Female Physicians

INTRODUCTION

 We aimed to understand how the pandemic impacted work hours and employment status of female physicians.  Methods: An anonymous survey of female physicians was distributed through social media and email lists from 12/2021 to 2/2022. Primary outcomes were changes in physicians' work schedules and employment status. Analyses included descriptive statistics of closed-ended items and qualitative content analysis of open-ended responses.

RESULTS

 We restricted our analysis to four specialties: obstetrics and gynecology, internal medicine, anesthesia, and pediatrics (n=626). The majority (92%) of respondents had caretaking responsibilities; 43% changed work schedules to accommodate those responsibilities. Around 17% of physicians changed jobs. The most common reasons for job changes included: negative work environment, lack of work-life balance, burden of work, and lack of efforts to mitigate COVID-19.  Conclusion: The pandemic highlighted the need for flexibility, improvements in workplace culture, and financial incentives to increase retention.

Gender and work-life balance: Results of a national survey of pediatric hospitalists

In medicine, difficulty integrating work and home can lead to decreased job satisfaction, diminished well-being, and increased turnover. Understanding the experience of pediatric hospitalists can provide insights into building a stable, long-term workforce. We aim to examine gender differences in work-life balance and parental leave for physicians practicing Pediatric Hospital Medicine.

METHODS

This was a cross-sectional survey study of 1096 pediatric hospitalists. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associated variables and work-life balance satisfaction. We analyzed free responses on parental leave to provide nuance to quantitative survey data.

RESULTS

Five hundred and sixty-five respondents (52% response rate) completed the survey with 71% women. 343 (62%) prioritize work-life balance in career decision-making. Women report taking on more household responsibilities than their partners (41.4% vs. 8.4%; p < .001) including a larger percentage of caregiving and domestic tasks. Female gender and performing <50% caregiving were associated with decreased work-life balance satisfaction; performing <50% domestic tasks increased satisfaction. Median parental leaves were 4 weeks, with men taking significantly shorter leaves (3.5 vs. 6 weeks; p < .001) and more "paid back" time off.

CONCLUSION

Work-life balance is an important factor in career decisions for men and women. Women perceive carrying a larger load at home. Qualitative results suggest that parental leave may be inadequate in length and salary support for men and women. This study adds insights into work-life integration in PHM.

Perceptions of gender equity in emergency medicine in Canada

INTRODUCTION

Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine.

METHODS

We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements.

RESULTS

A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians.

CONCLUSION

In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement

BACKGROUND

The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.

METHODS

A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.

RESULTS

Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare.

CONCLUSIONS

This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.

Workplace Belonging of Women Healthcare Professionals Relates to Likelihood of Leaving

Purpose

There is a high rate of attrition of professionals from healthcare institutions, which threatens the economic viability of these institutions and the quality of care they provide to patients. Women professionals face particular challenges that may lower their sense of belonging in the healthcare workplace. We sought to test the hypothesis that workplace belonging of women healthcare professionals relates to the likelihood that they expect to leave their institution.

Methods

Participants of a continuing education course on women's leadership skills in health care completed a survey about their experiences of belonging in workplace and their likelihood of leaving that institution within the next 2 years. An association between workplace belonging (measured by the cumulative number of belonging factors experienced, scale 0-10) and likelihood of leaving (measured on a 5-point Likert scale) was evaluated using ordinal logistic regression. The relative importance of workplace belonging factors in predicting the likelihood of leaving was assessed using dominance analysis.

Results

Ninety-nine percent of survey participants were women, and 63% were clinicians. Sixty-one percent of participants reported at least a slight likelihood of leaving their healthcare institution within the next 2 years. Greater workplace belonging was found to be associated with a significant reduction in the reported likelihood of leaving their institution after accounting for the number of years having worked in their current institution, underrepresented minority status, and the interaction between the latter two covariates. The workplace belonging factor found to be most important in predicting the likelihood of leaving was the belief that there was an opportunity to thrive professionally in the institution. Belonging factors involving feeling able to freely share thoughts and opinions were also found to be of relatively high importance in predicting the likelihood of leaving.

Conclusion

Greater workplace belonging was found to relate significantly to a reduced likelihood of leaving their institution within the next 2 years. Our findings suggest that leaders of healthcare organizations might reduce attrition of women by fostering workplace belonging with particular attention to empowering professional thriving and creating a culture that values open communication.

Supporting Our Physician Parents (SOPPort): A pilot program for parental wellness at the Massachusetts General Hospital

Physician parents encounter unique challenges in balancing new parenthood with work responsibilities, especially upon their return from parental leave. We designed a pilot program that incorporated 1:1 parental coaching to expectant and new physician parents and provided stipends for lactation support and help at home. Additional initiatives included launching a virtual new parent group during the COVID-19 pandemic and starting an emergency backup pump supplies program. There was positive feedback for our Parental Wellness Program (PWP), which was used to secure expanded funding. Pilot results showed that our program had a meaningful impact on parental wellness, morale, productivity, and lactation efforts.