Article In Brief
The AAN announcement of an all-women slate of officers resonated with other women neurologists, not only in terms inspiring other potential leaders in neurology but also for its impact on a societal level.
News of an all-female slate of officers nominated to lead the AAN for the 2019-2021 term lit up the social media stratosphere when the announcement was made in late 2018.
The Women Neurologists Group, which has more than 2,300 members, heralded the slate on its Facebook and Twitter feeds, prompting dozens of retweets and shout-outs to the AAN for its leadership. And Neurology Today editorial board member Jennifer Bickel, MD, FAAN, cited the announcement as one of the best advances of 2018 in the publication's annual round-up of critical news in the field.
Pointing out that the AAN's only female president—Sandra F. Olson, MD, FAAN, finished her term in 2005—Dr. Bickel said women who started their neurology careers after that time have never had a female president.
“The underrepresentation of women in leadership propagates downstream gender disparity,” she told Neurology Today. “The proposed slate of the AAN Board of Directors represents a welcome reversal of that trend.”
An all-female slate of officers also is newsworthy because the AAN appears to be the first medical society that has ever nominated an all-women leadership team. While other medical organizations have had women presidents or board chairs, Neurology Today was not able to confirm that any of them had an all-woman team of officers.
“I have several agenda items that I hope to bring forth, including trying to achieve gender equity across all of neurology, not just at the AAN level but also to help women in their own institutions and departments achieve equity with men.”
—DR. ORLY AVITZUR
In interviews, several neurologists told Neurology Today the news had special resonance at a time when multiple studies and reports (some in Neurology and this publication) had highlighted the underrepresentation of women neurologists on science committees, editorial boards, and for research awards.
Past Leadership Experience
The nominated slate are not newcomers to leadership positions. Orly Avitzur, MD, MBA, FAAN, who was nominated for president-elect, has served on the AAN Board of Directors and chaired the AAN Medical Economics and Management for the past six years (2013-2019). Ann H. Tilton, MD, FAAN, nominated for another term as AAN vice president, is the current president of the Child Neurology Foundation. Carlayne E. Jackson, MD, FAAN, nominated for secretary, and Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, nominated for treasurer, have both served in those roles for the 2017-2019 term.
Would gender have played a role in the nominations process? Not at all, according to AAN Chief Executive Officer Catherine M. Rydell, CAE. The AAN Nominations Committee does not intentionally consider gender when it considers nominees, but it does strive for a diverse balance of individuals, Rydell said in an email.
“The candidates put forward by the Nominations Committee are considered the most qualified to advance the mission and vision of the AAN at this time,” she said.
A Strategic Focus
Dr. Jackson said the growing number of women in AAN's board and committee leadership roles in recent years reflects its strategic focus on one of the organization's official values: “We commit to building and sustaining an inclusive organization that respects and values the diversity of our membership and the communities we serve, and promotes equality and professional advancement and compensation.”
“There has been a lot of intentional effort by the Academy to make sure that women are given opportunities and encouraged to participate and volunteer, and allow them to become chairs of committees and play other roles of importance at the AAN,” Dr. Avitzur said.
That commitment to promoting diversity and equity within its leadership and membership can be traced to Lewis P. Rowland, MD, FAAN, AAN president from 1989 to 1991, Dr. Miyasaki said. Dr. Rowland, who chaired Columbia University's Department of Neurology for 25 years, died in 2017. In an article published shortly thereafter, Timothy Pedley, MD, FAAN, said Dr. Rowland was influenced by his wife Esther, associate dean at Barnard College, whose special interest was to enlarge the pool of women and minorities preparing to enter the medical and legal professions.
“I think he appointed women where he could both in professional organizations as well as within the department,” Dr. Pedley was quoted in Columbia Medicine. “He had an enormous voice nationally about the need for advancing women in neurology and in medicine as a whole.”
“People look at this slate and they are amazed, but it took many years of behind-the-scenes work and dedication to realize this vision of equity that Dr. Rowland really started many decades ago,” Dr. Miyasaki said. “Now, in 2019, we're seeing the fruits of his vision.”
Influence on Career Trajectory
Medical societies are powerful because they influence the way physicians care for their patients as well as the budgetary and policy priorities that underpin the healthcare landscape. But they can also influence the career trajectories of their members.
“People are really beginning to understand how vital medical societies are to the careers of their members and how much we need to use data and longitudinal analysis to figure out gaps and to solve disparities,” said Julie Silver, MD, associate professor of physical medicine and rehabilitation at Harvard Medical School.
Dr. Silver has been examining the various ways that women in medicine are treated differently than their male peers. For example, women accounted for 35.2 percent of all active physicians in 2017, according to the Association of American Medical Colleges. Dr. Silver's review of 43 physician-focused medical societies found that, in the decade between 2008 and 2017, men dominated in presidential leadership, serving as presidents in 82.6 percent of the years.
The study, which was published earlier this year in the January 17 issue of JAMA Internal Medicine, found that 10 medical societies, including the AAN, had no female presidents during the decade under review.
Further, Dr. Silver's research suggests that, in some medical societies, female members have a different experience than their male colleagues.
“Diversity is simply being able to join a society, but inclusion is how they are able to progress within the society,” she said. “That includes being able to be on committees and be able to speak and have recognition awards and things like that.”
Indeed, women received only 21.9 percent of the recognition awards bestowed by the AAN between 2008 and 2017, even though women accounted for 31.5 percent of membership by 2016, according to research that Dr. Silver and her colleagues published in Neurology.
Underrepresentation by female AAN members was most notable for the most prestigious awards, the researchers found. That holds for many other medical societies as well, Dr. Silver said in an interview with Neurology Today.
“From the research that we've done to date, the gaps seem to be the most pronounced the higher one goes,” she said. “For example, the most prestigious awards, particularly lectureships where women might have the opportunity to offer a vision for the future of the specialty and their insights and opinions, tend to be the awards that they are most underrepresented in as recipients.”
Dr. Silver's findings prompted her last year to launch the #BeEthical campaign. Asserting that ending gender workforce disparities is an ethical imperative and it calls on leaders in four “gatekeeper” categories—medical schools/hospitals/healthcare organizations; medical societies; medical journals; and funding sources—to make system-wide action that quantify workforce equity rather than settling for incremental and anecdotal improvements.
Unlike some fields known for gender disparities—for example, engineering and information technology—the number of women physicians has been climbing rapidly for years. Currently, 36 percent of practicing physicians in the U.S. are female, according to Kaiser Family Foundation.
“With so many super-talented and highly educated women, why are there so many really profound disparities?” Dr. Silver asked. “We have to think that through and start asking about that.”
Dr. Avitzur said she will move to address these and other gender-based disparities when she begins her position as AAN president in 2020.
“There's definite value in having women in leadership positions because they may be more impassioned to promote other women. I think that the tide will turn, but it's going to take a lot of continued investment in women as leaders to make that happen.”
—DR. CARLAYNE E. JACKSON
“People look at this slate and they are amazed, but it took many years of behind-the-scenes work and dedication to realize this vision of equity that Dr. [Lewis P.] Rowland really started many decades ago. Now, in 2019, we're seeing the fruits of his vision.”
—DR. JANIS MIYASAKI
“I have several agenda items that I hope to bring forth, including trying to achieve gender equity across all of neurology, not just at the AAN level but also to help women in their own institutions and departments achieve equity with men,” she said.
Pay equity is a particular concern, and the AAN can help women understand the issue and learn to negotiate for fair pay. It can also call on its members who are in positions of influence in their own organizations to make pay equity a priority.
“We can certainly facilitate conversations with department chairs and raise awareness, which is really the first step to making change,” Dr. Avitzur said.
“There has been a lot of intentional effort by the Academy to make sure that women have opportunities to become chairs of committees and play other roles of importance at the AAN,” Dr. Avitzur said, noting that the AAN has created several leadership programs for women, including Women Leading in Neurology.
“The Academy has strived to seek out women who are young leaders or have leadership potential, and to help provide them with skills so they can lead, either on a national level like this, or in their own communities,” Dr. Avitzur said.
Women leaders at the practice or department level can be powerful change agents, Dr. Jackson said. Robin Brey, MD, FAAN, chair of neurology at UT Health, is one of only three female chairs at the institution.
“She has been very transparent about everyone's salary, and men are getting paid exactly the same as women at the same rank level,” Dr. Jackson said. “And she is very intentional about nominating women as well as men for various leadership awards.”
That shows a fair playing field is possible, but not yet inevitable.
“Diversity is simply being able to join a society, but inclusion is how they are able to progress within the society. That includes being able to be on committees and be able to speak and have recognition awards and things like that.”
—DR. JULIE SILVER
“There's definite value in having women in leadership positions because they may be more impassioned to promote other women,” she said. “I think that the tide will turn, but it's going to take a lot of continued investment in women as leaders to make that happen.”
Meanwhile, there's work to be done at the societal level as well, Dr. Miyasaki said, and an all-female slate of officers sends a message that has not yet been fully accepted.
She recently overheard a young girl correct her grandmother, saying “Grandma, that's not a doctor—she's a girl.” In another situation, Dr. Miyasaki introduced her team members—all physicians—to a patient, only to hear the patient say “So you're all nurses, right?”
“We have so far to go in terms of society,” she said. “The fact that our leadership is now so strongly reflecting diversity, at least gender-wise, is really important for our members, and potential members, to see. How powerful is that—to look up at the podium and see women?”