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Schulz EV, Wyatt TR, Ma T, Maggio LA. When Taking Pay off the Table: A Qualitative Study of Gender Equity for Academic Leaders in the US Military. Mil Med 2024; 189:e1719-e1727. [PMID: 38241782 DOI: 10.1093/milmed/usad489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Although gender inequity persists globally in academic leadership positions, the United States Military has equitable pay and, in academic pediatrics, has equitable gender representation in leadership positions. To better understand how the US Military framework affects physician leaders, pediatricians were interviewed to illuminate the factors that facilitated their success and what barriers they faced in their career. MATERIALS AND METHODS In 2022, following institutional review board approval, semi-structured interviews were conducted with 13 total participants (69% female, 31% male) serving as general pediatricians or pediatric subspecialists in the US Military. These pediatricians were in leadership positions of military academic medicine across seven graduate medical education (GME) sites. The interviews examined the leaders' perceptions of facilitators and barriers to their success. The authors analyzed the interviews using Acker's theory of gendered organizations as a theoretical framework, which explains embedded gender roles within work environments. RESULTS Drawing on the theory of gendered organizations, the authors identified that participants described several facilitators to their success, including the availability of mentorship/sponsorship, inclusive leadership, and early and persistent exposure to women leaders in GME training and beyond. Because medicine's ideal worker was normed around the traditional roles of men, men observed and women experienced barriers to leadership success around issues related to childbearing, maternity leave, and microaggressions. CONCLUSIONS This study revealed that equitability for pediatric GME leadership in the military heavily relied on structures and support created by former leaders and mentors. Isolating these structures within a unique context of military academic medicine can illuminate physicians' experiences to address barriers and better support equitable leadership roles in both military and civilian academic medicine.
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Affiliation(s)
- Elizabeth V Schulz
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Tasha R Wyatt
- Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - TingLan Ma
- Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Lauren A Maggio
- Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Forster CS, Polak CA, Chen C, Kim JL, Allan JM, Gold JM, Ruch-Ross HS, Fromme HB, Huang B, Schondelmeyer AC. Association Between Gender and Salary Among Pediatric Hospital Medicine Physicians. Hosp Pediatr 2024; 14:507-513. [PMID: 38832448 DOI: 10.1542/hpeds.2023-007567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.
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Affiliation(s)
- Catherine S Forster
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catherine A Polak
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chen Chen
- Department of Biostatistics & Epidemiology
| | - Juliann L Kim
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Jessica M Allan
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Jessica M Gold
- Department of Pediatrics, Stanford University, Palo Alto, California
| | | | - H Barrett Fromme
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Bin Huang
- Department of Biostatistics & Epidemiology
| | - Amanda C Schondelmeyer
- Division of Pediatric Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Lewis KO, Kilbride HW, Bose C, Burchfield DJ. Fundamentals of designing high-quality surveys: revisiting neonatal perinatal medicine survey applications. J Perinatol 2024; 44:777-784. [PMID: 37863984 DOI: 10.1038/s41372-023-01801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
Surveys in neonatal perinatal medicine are practical instruments for gathering information about medical practices, and outcomes related to the care of newborns and infants. This includes research for identifying needs, assessing requirements, analyzing the effects of change, creating policies, and developing curriculum initiatives. Surveys also provide useful data for enhancing the provision of healthcare services, assessing medical specialties, and evaluating training programs. However, creating a high-quality survey can be difficult for many practitioners, particularly when deciding how to formulate the right questions, whether to utilize various types of questions and how best to arrange or format the survey tool for effective responses. Problems with design principles have been evident in many surveys submitted for dissemination to the members of the Section of Neonatal Perinatal Medicine (SoNPM). To prevent potential measurement errors and increase the quality of surveys, it is crucial to follow a systematic approach in developing surveys by adhering to the principles of effective survey design. This review article provides a brief summary of survey use within the SoNPM, and offers guidance for creating high-quality surveys, including identifying important factors to consider in survey development and characteristics of well-written and effective questions. We briefly note techniques that optimize survey design for distribution through digital media.
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Affiliation(s)
- Kadriye O Lewis
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Howard W Kilbride
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Carl Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bhatia A, Nestander M, Lucke A, Bernstein SM, Gautam S, Horowitz E, Day C. Factors Influencing Compensation of Early Career Neonatologists. Am J Perinatol 2024; 41:e1908-e1916. [PMID: 37308087 DOI: 10.1055/s-0043-1769792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Workforce characteristics and compensation specific to early career neonatologists remain poorly defined. Lack of transparency surrounding compensation limits benchmarking for neonatologists entering the workforce and may negatively influence individual lifetime earnings. Our objective was to provide granular data for this unique subpopulation by defining employment characteristics and factors influential to compensation of early career neonatologists. STUDY DESIGN An anonymous 59-question cross-sectional electronic survey was distributed to eligible members of American Academy of Pediatrics Trainees and Early Career Neonatologists. A focused analysis was conducted on salary and bonus compensation data collected from the survey instrument. Respondents were classified based on primary site of employment: nonuniversity located (e.g., private practice, hospital employed, government/military, and hybrid employment groups) versus university located practice settings (e.g., work is primarily conducted in a neonatal intensive care unit (NICU) setting located within a university organization). Median quantile regression was used to conduct univariate and multivariate analyses using SAS Software version 9.4. RESULTS We received 348 responses (26.7% response rate). Median salary was $220,000 (interquartile range: $200,000-250,000). Factors associated with salary include academic rank (instructor: $196,000; assistant professor: $220,000 [12% increase; p < 0.001]; associate professor: $260,000 [18% increase]; p = 0.027) and years of experience (p = 0.017), after adjusting for relevant factors. Employment location, practice type, group size, clinical schedule, location of medical school training, and gender identity did not significantly influence salary in multivariate quantile regression. Median annual bonus was $7,000 higher for nonuniversity located positions ($20,000 vs. 13,000; p = 0.021), with assumption of additional administrative roles and practice group seniority as most commonly cited bonus criteria (p = 0.002 and <0.001, respectively). CONCLUSION Academic rank and years of experience may influence salary. Bonus earnings are higher for nonuniversity located positions. Employment models are evolving to incorporate academic teaching appointments while practicing in nonuniversity located NICUs. This is the first detailed compensation analysis of early career neonatologists. KEY POINTS · Transparent compensation data specific to early career neonatologists is lacking.. · Associated factors influential to compensation of early career neonatologists remain unclear.. · This study identifies years of experience and academic rank as possible factors influencing salary earnings of early career neonatologists.. · Practicing in nonuniversity located positions was associated with greater bonus earning potential..
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Affiliation(s)
- Anisha Bhatia
- Division of Neonatology, Rush University Medical Center, Aurora, Illinois
| | - Matt Nestander
- Division of Newborn Medicine, Carl R. Darnall Hospital, Fort Hood, Texas
| | - Ashley Lucke
- Department of Pediatrics, Dell Children's Hospital, Austin, Texas
| | | | - Shiva Gautam
- Department of Biostatistics, University of Florida, Jacksonville, Florida
| | - Eric Horowitz
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Colby Day
- Department of Pediatrics, University of Rochester Medical Center, Golisano Children's Hospital at Strong, Rochester, New York
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Horowitz E, Hudak ML, Peña MM, Vinci RJ, Savich R. Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678O. [PMID: 38300002 DOI: 10.1542/peds.2023-063678o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
In 2022, 3.7 million children were born in the United States, of whom ∼600 000 received care from a neonatologist. The dramatic growth of the neonatal-perinatal medicine (NPM) workforce from 375 in 1975 to 5250 in 2022 has paralleled exploding clinical demand. As newborn medicine continues to push the limits of gestational viability and medical complexity, the NPM workforce must advance in numbers, clinical capability, scientific discovery, and leadership. This article, as part of an American Board of Pediatrics Foundation-sponsored supplement that is designed to project the future of the pediatric subspecialty workforce, features a discussion of the NPM workforce's history and current status, factors that have shaped its current profile, and some plausible scenarios of the workforce's needs and configuration in the future. In the article, we use an analytical model that forecasts the growth trajectory of the neonatologist workforce from 2020 through 2040. The model uses recent data on the number of neonatologists and clinical work equivalents per 100 000 children and projects future workforce supply under several theoretical scenarios created by modifying key baseline parameters. The predictions of this model confirm the need for a greater sustainable clinical capacity of the NPM workforce. Several future trends indicate that there may be geographic shortages of neonatologists, similar to expected shortages in other pediatric subspecialties. We do not address what an appropriate target for workforce size should be with the model or this article because the current and projected geographic variability in the NPM workforce and risk-appropriate care suggest that a uniform answer is unlikely.
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Affiliation(s)
| | - Mark L Hudak
- University of Florida College of Medicine, Jacksonville, Florida
| | - Michelle-Marie Peña
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Robert J Vinci
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Renate Savich
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Machut KZ, Lingappan K, Savich R, Dammann CEL. Toolkit for gender equity in pediatrics. Pediatr Res 2024; 95:594-597. [PMID: 37833527 DOI: 10.1038/s41390-023-02846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Krithika Lingappan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Renate Savich
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Call to action: gender equity in neonatology. J Perinatol 2022; 42:982-983. [PMID: 35411019 DOI: 10.1038/s41372-022-01390-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022]
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Machut KZ, Kushnir A, Oji-Mmuo CN, Kataria-Hale J, Lingappan K, Kwon S, Dammann CE. Effect of Coronavirus Disease-2019 on the Workload of Neonatologists. J Pediatr 2022; 242:145-151.e1. [PMID: 34748740 PMCID: PMC8572527 DOI: 10.1016/j.jpeds.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the impact of coronavirus disease-2019 (COVID-19) on the neonatology workforce, focusing on professional and domestic workloads. STUDY DESIGN We surveyed US neonatologists in December 2020 regarding the impact of COVID-19 on professional and domestic work during the pandemic. We estimated associations between changes in time spent on types of professional and domestic work and demographic variables with multivariable logistic regression analyses. RESULTS Two-thirds (67.6%) of the 758 participants were women. Higher proportions of women than men were in the younger age group (63.3% vs 29.3%), held no leadership position (61.4% vs 46.3%), had dependents at home (68.8% vs 56.3%), did not have a partner or other adult at home (10.6% vs 3.2%), and had an employed partner (88.1% vs 64.6%) (P < .01 for all). A higher proportion of women than men reported a decrease in time spent on scholarly work (35.0% vs 29.0%; P = .02) and career development (44.2% vs 34.9%; P < .01). A higher proportion of women than men reported spending more time caring for children (74.2% vs 55.8%; P < .01). Reduced time spent on career development was associated with younger age (aOR, 2.21; 95% CI, 1.20-4.08) and number of dependents (aOR, 1.21; 95% CI, 1.01-1.45). Women were more likely to report an increase in time spent time doing domestic work (aOR, 1.53; 95% CI, 1.07-2.19) and a reduction in time on self-care (aOR, 0.49; 95% CI, 0.29-0.81). CONCLUSIONS COVID-19 significantly impacts the neonatology workforce, disproportionately affecting younger, parent, and women physicians. Targeted interventions are needed to support postpandemic career recovery and advance physician contributions to the field.
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Affiliation(s)
- Kerri Z. Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL,Reprint requests: Kerri Z. Machut, MD, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, #45, Chicago, IL 60611
| | - Alla Kushnir
- Department of Pediatrics, Cooper Children's Regional Hospital, Camden, NJ
| | | | | | - Krithika Lingappan
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Soyang Kwon
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
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Uduwana SR, Nemerofsky SL. A Questionnaire Assessing Utilization of Delayed Cord Clamping. Am J Perinatol 2021; 40:773-779. [PMID: 34144627 DOI: 10.1055/s-0041-1731047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to assess the practice of delayed cord clamping (DCC) and the awareness of its benefits for newborns between Obstetric (OB) and neonatal physicians. We examined if provider characteristics including years of experience, level of training, familiarity of the American College of Obstetricians and Gynecologists (ACOG)/American Academy of Pediatrics (AAP) recommendations, institutional policy, and the racial and ethnic background of patient population were associated with implementation of DCC. STUDY DESIGN This research is a cross-sectional online questionnaire study. RESULTS 975 questionnaires were returned. Overall, the awareness of ACOG versus AAP recommendations was 94 versus 86% (p < 0.01). 86 versus 78% of OB and neonatal physicians practiced or witnessed DCC >50% of the time, respectively (p < 0.01). An equal number of OB and neonatal physicians believed in the benefits to newborns of DCC. Physicians with >10 years of practice were less likely to acknowledge DCC benefits. Physicians with a majority of non-White patients were less likely to practice/witness DCC (p < 0.05). CONCLUSION There continues to be room for improvement in the practice of DCC. Institutional policies and awareness of ACOG/AAP recommendations impact the understanding of the benefits of DCC and the likelihood of the practice. There is a significant difference in the practice of DCC among patients with different racial backgrounds. Hospital leadership may consider investing in the education and implementation of updated guidelines to ensure DCC is routinely practiced. KEY POINTS · Knowledge of AAP/ACOG and institutional policies improved the practice of DCC.. · There is racial disparity in the practice of DCC.. · Physicians in practice for >10 years were less likely to know the benefits of DCC to full-term neonates..
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Affiliation(s)
- Shanika R Uduwana
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Long Island Jewish Medical Center, Northwell Health, Queens, New York
| | - Sheri L Nemerofsky
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, Bronx, New York
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Disparities in perinatal health: what can we do? J Perinatol 2021; 41:363-364. [PMID: 33510417 DOI: 10.1038/s41372-021-00920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/08/2022]
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