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Beyond Emergency Medicine's Glass Ceiling

Katz, Alissa

doi: 10.1097/

    Gender disparities persist within emergency medicine despite recent surges in women entering the specialty, and the percentage of women representing it is low compared with the percentage of women in other medical specialties.

    Adit Ginde, MD, who has studied the demographics of emergency medicine, said his latest findings put emergency medicine board certified and eligible female physicians at 25 percent, though he said he would guess that has probably increased to about 30 percent since he gathered data from 2009. The specialty as a whole has seen a bigger increase than that — 44.6 percent — in its number of active physicians from 2000 to 2010. (“2012 Physician Specialty Data Book,” Association of American Medical Colleges, November 2012;

    Without the full participation of women, the nation's ability to provide emergency care will be stretched even further, said Kathleen Clem, MD, a professor and the chair of emergency medicine at Loma Linda University School of Medicine and the chair of the American Association of Women Emergency Physicians.

    “The consequences of neglecting to address the unique needs of women in emergency medicine will negatively impact our ability to train emergency physicians and will ultimately affect the ability to provide medical care for the millions of patients who annually visit the nation's emergency rooms,” she said.

    Other specialties are composed of higher percentages of women — 58.1 in pediatrics, 47.4 in obstetrics & gynecology, and 39.7 in endocrinology as of 2010, according to the AAMC — but women still hold lower academic positions than men, said Juliet Lee, MD, the director of undergraduate surgical education, the division director of surgical education in the department of surgery, and the associate program director of the general surgery residency program at the George Washington University School of Medicine and Health Sciences. Dr. Lee and a team of researchers surveyed female chief residents in surgery, emergency medicine, and internal medicine for the past decade, and found that challenges continue to exist, including backlash, unclear policies, and a lack of role models. Women said they needed more mentorship, from men and women, and felt institutions' cultures mattered considerably in how women are viewed.

    The salary gap between men and women is also significant. Female emergency medicine directors at the 50th percentile reported earning $333,000 in 2013, and female EPs at the 50th percentile reported earning $293,000. Male directors in the same positions reported earning $351,911 and $315,000, respectively, according to the 2014 National Emergency Medicine Salary Survey conducted by Daniel Stern & Associates for the American College of Emergency Physicians.

    Finding a role model is what Angela F. Gardner, MD, said she thinks is the biggest challenge for women in emergency medicine. “Most young people these days enter the specialty around the age of 30, about the time when they're having young families. So, finding a role model and finding a plan to advance in a specialty is not a simple thing. All of the career moves that typically would be made by any professional to advance are very difficult for young women emergency physicians because that's when their families are very young,” said Dr. Gardner, the chief of quality and patient safety and an associate professor at the University of Texas, Southwestern, who was also the president of ACEP in 2010.

    The reasons are unclear why the proportion of female emergency medicine residents is low, but a 2010 report ventured possible explanations. “The growing number of women in EM programs is mainly due to the feminization of medical schools, and EM remains traditionally a male specialty,” the report said. (Acad Emerg Med 2010;17[7]:775.) Unexplained salary differences between men and women and work environments that are tarnished by conscious and unconscious biases are likely a big part of the underlying problem, said Stacey Poznanski, DO, the president-elect of the Academy for Women in Academic Emergency Medicine and an assistant professor of emergency medicine at the Wright State University Boonshoft School of Medicine.

    Despite setbacks, women in emergency medicine are making great strides at the national level, with recommendations from the Society for Academic Emergency Medicine task force on women in academic emergency medicine and through ACEP's Board of Directors' approval of a 2014 policy statement, which calls for the implementation of “policies and practices aimed at ensuring unbiased recruitment and hiring along with parity in advancement and compensation among employees,” and the “support of networking and mentorship opportunities for their women physicians.”

    Perhaps one of the greatest recent strides is that young women don't see any gender biases, according to Dr. Gardner. “That's actually what I run into. And this is a great thing. Many of them think there are no gender biases existing, so they don't take any steps to deal with it because it doesn't exist. And in many ways, that's a great thing. The problem is there are a lot people who are older, especially in our profession, who still recognize gender bias and see it happen at a level that the residents or medical students may not see.”

    For those not as blind to the biases, however, Dr. Clem has a list of tips to help women succeed in emergency medicine:

    n Understand the organization's mission and goals, and be sure you are a good fit.

    • Seize opportunities at hand if they interest you.
    • Don't be afraid of the scut work, like being the note-taker.
    • Stay focused on the targets and not on personal aggrandizement.

    Dr. Gardner said women need to stand up and make their voices heard, not apologize for the opinions they have or the comments they want to make. And, they have to work hard at their job to get ahead. Or as she said, quoting from a plaque her mother gave her when she went to medical school, “Act like a lady, speak like a man, and work like a dog.”

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