Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association.

Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.

Patched but Still Leaky: An Update on the Pipeline for Women in Gastroenterology.

BACKGROUND: Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI. AIMS: To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties. METHODS: We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021. RESULTS: In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14 years (p < 0.01). CONCLUSIONS: GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI.

Working Vacations and Adventure: American Women Physician Volunteers to the Labrador Mission of Wilfred Grenfell Before 1914.

Many accounts, autobiographical and scholarly, emphasize how volunteers portrayed their work in the mission established for fishers by British physician Wilfred Grenfell in Newfoundland and Labrador: as escapist adventure. Scholars have not studied women physicians or their motivations to volunteer, however. This oversight derives from their small number combined with lack of knowledge about this mission's distinction from the foreign medical missions and domestic frontier missions that drew many women physicians to permanent positions. This study therefore discusses two American physicians, Alfreda B. Withington (1860-1951) and Emma E. Musson (1862-1913), who volunteered for summer service with this mission in 1907 and 1909, respectively. Through their publications, biographical sources, and clinical accounts, it reveals the appeal to them of such temporary, accessible volunteer service as a working vacation that rejuvenated. Importantly, it counters the skewed perspective of contemporary accounts in which the connection of Withington and Musson to an international celebrity, Wilfred Grenfell, overrode fuller considerations of their own lives, careers, and experiences. Finally, this examination suggests possible differences in their volunteerism between women physicians and their male counterparts: along with other women professionals, medical women often incorporated volunteer vacation experience into a continuum of similar endeavors in their careers.

"A Much Wider Field in Which to Operate": Early Black Women Physicians in Public Health.

In a profession shaped by Whiteness and masculinity, the few Black women physicians who earned medical degrees prior to the Second World War found some of their rare professional opportunities in public health. Though their choices were often constrained by racism and sexism, they embraced public health work as a means of carrying out their "mission" in marginalized communities and as a way of practicing medicine with a more expansive definition than treating individual patients or illnesses. Black women physicians shaped public health by creating unique programming to meet the needs of the communities they served, including mobile health clinics and community health weeks. The first Black women physicians who worked in public health in the nineteenth and early twentieth centuries applied the new tool of public health "vital" statistics to Black lives and questioned the limits of their utility when created by White practitioners with racial biases. In the 1930s, some Black women physicians began earning some of the first master's degrees in public health, just as the field was beginning to professionalize. Throughout the twentieth century, Black women physicians pioneered community health programming and, though born from exclusionary policies that limited where they could practice, experimented with alternative clinical spaces, even as the hospital and laboratory became the primary sites of medicine for White clinicians. By embracing public health, Black women physicians shaped the field and used it as a tool to address racial health disparities in the communities they served, acting on their belief that Black health could be improved, thereby contesting notions of biological inferiority.

Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care.

BACKGROUND: Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE: This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN: This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS: Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION: Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.

Empowering the Invisible: Accelerating Leadership Development for Midcareer Women in Medicine.

Midcareer women physicians face numerous obstacles to career advancement and leadership roles resulting in their contributions and achievements becoming "invisible." This paper addresses the paradox of increasing professional experience coupled with decreased visibility for women in medicine at this stage in their careers. To address this disparity, the Women in Medicine Leadership Accelerator has developed a leadership skill development program specifically tailored for midcareer women physicians. The program incorporates key principles derived from effective leadership training models and aims to combat systemic barriers while equipping women with the necessary tools to navigate and transform the medical leadership landscape.

System-Wide Change Is Essential to Value the Contributions of Women in Medicine and Science.

The persistent and pervasive gender gap in health care is a fact backed by data, science, and evidence. This editorial aims to describe some of the challenges that continue to persist. Many of the strategies outlined can be implemented both locally and nationally to effect meaningful change and work toward closing the existing gender gap in health care.

Gender and Racial Disparity Among Liver Transplantation Professionals: Report of a Global Survey.

Equality, diversity, and inclusion (EDI) are fundamental principles. Little is known about the pattern of practice and perceptions of EDI among liver transplant (LT) providers. International Liver Transplant Society (ILTS) EDI Committee survey around topics related to discrimination, mentorship, and gender. Answers were collected and analyzed anonymously. Worldwide female leadership was also queried via publicly available data. The survey was e-mailed to 1312 ILTS members, 199 responses (40.7% female) were collected from 38 countries (15.2% response rate). Almost half were surgeons (45.7%), 27.6% hepatologists and 26.6% anesthetists. Among 856 LT programs worldwide, 8.2% of leadership positions were held by females, and 22% of division chiefs were female across all specialties. Sixty-eight of respondents (34.7%) reported some form of discrimination during training or at their current position, presumably related to gender/sexual orientation (20.6%), race/country of origin (25.2%) and others (7.1%). Less than half (43.7%) received mentorship when discrimination occurred. An association between female responses and discrimination, differences in compensation, and job promotion was observed. This survey reveals alarmingly high rate of experience with racial and gender disparity, lack of mentorship, and very low rates of female leadership in the LT field and calls to action to equity and inclusion.

Gender-Specific Attitudes of Internal Medicine Residents Toward Gastroenterology.

BACKGROUND AND AIMS: Female representation among gastroenterology (GI) fellows has remained around 30%, yet women comprise over 50% of internal medicine (IM) residents. We aim to identify the gender-specific barriers of IM residents toward pursuing GI. METHODS: We surveyed IM residents in the Northeast by emailing 168 IM programs a survey link to be distributed to their residents. A 4-point Likert barrier scale and bivariate analysis were performed with "yes" and "no," where "yes" was analyzed as "somewhat of a barrier" and above. Females received a third table assessing female-specific barriers. Significance was set at < 0.05. RESULTS: Of 215 survey responses, 56.3% (n = 121) were female. Response rate could not be determined due to resident identity protection and inconsistent responses of survey dissemination from programs. Females had significantly greater concerns about fertility, maternity leave, radiation exposure, work-life balance, stress, and burnout compared to males (p < 0.05). For females, 48.7% felt a lack of gender diversity in GI, 54.6% felt a lack of female GI mentors, and 43.7% felt there is a lack of respect as a female in GI. No gender differences existed in motivation to pursue GI, exposure to GI, and access to GI mentors, or GI-related research. CONCLUSIONS: Our study reveals that female IM trainees had greater concerns surrounding fertility, radiation exposure, and maternity leave compared to male IM trainees. Lack of gender diversity and lack of female GI mentors were noted barriers for female IM trainees. Addressing these barriers may help increase female representation in GI.

Addressing Gender Disparity: Increase in Female Leadership Increases Gender Equality in Program Director and Fellow Ranks.

INTRODUCTION: Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI. MATERIALS AND METHODS: Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test. RESULTS: In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04-12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34-6.6). CONCLUSION: Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

Women family physicians' working conditions and career satisfaction: a multinational study.

BACKGROUND: As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns. OBJECTIVES: This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries. METHODS: A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05). RESULTS: A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied. CONCLUSION: Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales.

'So near and yet so far': the early women of the Royal Australasian College of Physicians - the first 20 female MRACP 1938-1947.

At the time of the inauguration of the Royal Australasian College of Physicians in 1938, there were 232 Foundation Fellows, but only five were women. Those who wished to gain a postgraduate qualification for internal medicine or related specialties then sat for Membership of the new College. In the first decade (1938-1947), 250 gained Membership, but only 20 were women. These women lived in an era of professional and societal restrictions. Still, they all showed great determination and contributed significantly to their chosen fields, while many combined a busy practice with family life. They improved the path for those women who followed. Their stories, however, are rarely reported.

WOMEN'S MODERNISM IN MEDICAL SCIENCE OF WESTERN UKRAINE - SOFIA OKUNEVSKA-MORACHEVSKA, SOFIA PARFANOVYCH AND VOLODYMYRA KRUSHELNYTSKA.

OBJECTIVE: The aim: The purpose of this article is to identify through the analysis of biographical and scientific Sofia Okunevska-Morachevska, Sofia Parfanovych and Volodymyra Krushelnytska common features of personal and professional development to understand the scientific, social and cultural parts of their activities in the context of the historyof national medical tradition. PATIENTS AND METHODS: Materials and methods: We will try to consider in general terms the life and professional path of Sofia Okunevska-Morachevska, Sofia Parfanovych, Volodymyra Krushelnytska, highlighting common features and analyzing them in contexts of social, political, and cultural features of the era. CONCLUSION: Conclusions: Analyzing the biographical milestones and scientific achievements of women physicians in Western Ukraine in the late XIX - early XX century, we concluded that these personalities of Ukrainian medicine can be combined with a number of characteristics, thus demonstrating the continuity and longevity of the national female medical elite in Ukraine.

Merit Ptah, "The First Woman Physician": Crafting of a Feminist History with an Ancient Egyptian Setting.

Merit Ptah is widely described as "the first woman physician and scientist" on the Internet and in popular history books. This essay explores the origins of this figure, showing that Merit Ptah came into being in the 1930s when Kate Campbell Hurd-Mead misinterpreted a report about an authentic ancient Egyptian healer. Merit Ptah gradually became a prominent figure in popular historical accounts during second-wave of feminism, and, in the twenty-first century she appeared in Wikipedia and subsequently spread throughout the Internet as a female (sometimes black African) founding figure. The history of Merit Ptah reveals powerful mechanisms of knowledge creation in the network of amateur historians, independently from the scholarly community. The case of Merit Ptah also pinpoints factors enabling the spread of erroneous historical accounts: the absence of professional audience, the development of echo chambers due to an obscured chain of knowledge transmission, the wide reach of the Internet, the coherence with existing preconceptions, the emotional charge of heritage, and even - in the case of ancient Egypt - the tendency to perceive certain pasts through a legendary lens. At the same time, the story of Merit Ptah reveals how important role models have been for women entering science and medicine.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

INTRODUCTION: The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. METHODS: Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. RESULTS: Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. CONCLUSIONS: Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

The woman physician as antidote to the ills of modern medicine.

This article, drawing on the work of Edith Stein, reflects on the feminine aspects of the medical profession, specifically attention to the whole person and personal accompaniment. It presents these feminine aspects, in light of the mechanistic, highly specialized, and often impersonal ethos of modern medicine, as a needed corrective to such an ethos. Finally, this thesis is illustrated with an example from physician Victoria Sweet.

Gender Trends in Radiology Authorship: A 35-Year Analysis.

OBJECTIVE: The purpose of this study was to describe trends over time in female authorship in the radiology literature and to investigate the tendency of female first authors to publish with female senior authors. MATERIALS AND METHODS: Data on the gender of academic physician authors based in the United States for all major articles published in three general radiology journals--Radiology, AJR, and Academic Radiology--were collected and analyzed for the years 1978, 1988, 1998, 2008, and 2013. Multivariate logistic regression was used to identify significant trends over time, and a chi-square test of independence was performed to determine significant relations between the genders of first and senior authors. RESULTS: The gender of 4182 of 4217 (99.17%) authors with MD degrees was determined. The proportion of original research articles published by women as first authors increased from 8.33% in 1978 to 32.35% in 2013 (p < 0.001). The proportion of original research articles with women as senior authors increased from 6.75% in 1978 to 21.90% in 2013 (p < 0.001). Female first and senior authorship increased significantly over time (first author, p < 0.001; senior author, p < 0.001). There was a statistically significant relation between the genders of first and senior authors of original research articles and guest editorials (p < 0.001). CONCLUSION: Over 35 years, there was a statistically significant upward linear trend of female physician participation in authorship of academic radiology literature. Female first authors were more likely to publish with female senior authors.

Association of burnout and harassment among cardiology trainees: Pakistan's perspective.

OBJECTIVE: This study explores the relationship between sexual harassment and burnout among cardiology trainees, shedding light on the prevalence and impact of these experiences in medical practice. METHODS: A cross-sectional online survey was conducted among 518 respondents, with 420 responding to the Sexual Experience Questionnaire (SEQ). The survey measured harassment experiences and their impact on burnout, especially among female physicians. Correlations were analyzed to understand the association between these variables. RESULTS: Out of 1,375 invitees, we received 671 (48.8 %) responses. The study population was divided into two main groups: males (359) and females (312). The study identified a high prevalence of sexual harassment experiences among female physicians, with incidents occurring primarily during training. Moderate to large correlations were observed between SEQ subscales related to colleagues and patients and their families. While sexual harassment was not significantly related to burnout, this study suggests the need for interventions to create a safer medical workplace. Approximately 22 % of male participants (n = 359) reported career-related inappropriate sexual incidents, with 28 % of male physicians experiencing weekly burnout. Among female participants (n = 312), around 37 % reported inappropriate incidents, while 42 % of female physicians felt weekly burnout. CONCLUSION: Sexual harassment in medicine is a pervasive issue with potential implications for physician well-being. Initiatives aimed at changing the organizational response and fostering a more equitable environment are warranted to address this critical concern.

Trends in female representation in cardiology and its subspecialties: The current state and the desired state.

INTRODUCTION: Women have been historically underrepresented in Cardiology and its subspecialties. However, limited research has been done to examine the trends of representation of women in cardiology and its subspecialties over time. Our study aims to examine these trends and compare them to other internal medicine subspecialties. METHODS: We used data from the Accreditation Council for Graduate Medical Education (ACGME) to conduct a retrospective analysis of the gender trends of cardiology and its subspecialties over a decade from 2013 to 2023. Chi-square statistical testing was used to compare representation percentages across groups. A p-value <0.05 was considered statistically significant. RESULTS: Compared to all internal medicine subspecialties, cardiology and its subspecialties continues to remain the least represented by women. We found a statistically significant increase in women's representation in cardiovascular disease and interventional cardiology. However, there was no statistically significant changes in the representation of women in electrophysiology and advanced heart failure. We have found over the last decade that there was a positive trend in overall women fellows choosing cardiology and its subspecialties, especially since 2018. CONCLUSION: While strides have been made in increasing the number of female fellows in cardiology, it still lags compared to other internal medicine subspecialties. As we celebrate this minor milestone, it is crucial to emphasize the importance of persistently overcoming obstacles and fostering a supportive environment throughout all training phases to attract, retain, and mentor female trainees.