Article In Brief
An informal conversation at a conference led to a conversation and an in-depth study of the challenges facing women conducting headache research. Women researchers in other subspecialties discuss the reasons why the obstacles exist and what is needed to remedy them.
Despite a remarkable upswing in the number of women entering neurology, gender disparities persist on a national scale, particularly in the realm of research.
Seeking insight into factors that may dissuade women from applying for research grants, the National Institute of Neurological Disorders and Stroke (NINDS) turned to academic medical centers for feedback on the challenges facing women in neurology research. The idea originated from an informal conversation at a meeting of the American Neurological Association.
Mia T. Minen, MD, MPH, associate professor of neurology and a headache specialist at NYU Langone Health, sought answers through the prism of headache/migraine research. In December 2019, she contacted recipients of NIH training grants in headache medicine at other institutions, sparking a conversation to share observations.
While the findings were specific to migraine research, the overarching issues the study raises regarding research career advancement for women should resonate with physicians in other disciplines, several leading researchers agreed after reading the report published online July 9 in Neurology.
As a call to action, the article clearly outlines some of the deep-rooted systemic issues that may hinder women from reaching the pinnacle of a research career trajectory, said Allison Brashear, MD, MBA, FAAN, FANA, dean and professor of neurology at the University of California, Davis School of Medicine, who reviewed the report for Neurology Today.
Who Gets NIH Funding?
The data uncovered novel challenges, Dr. Minen and her collaborators across different academic medical centers found. Although the rate of women engaging in NIH-funded migraine research surged from 23 percent to 41 percent over the last 10 years, more women were presently supported by career development awards than higher-level research grants. In fiscal years 2017 to 2019, women held all of the six NIH training grants but only 12 of 36 NIH research grants, according to the report.
For mentored clinical science grants (K23 awards), men and women submitted applications in equal numbers. However, nearly half of the women qualified to embark on basic research (K08 awards) do not apply, the authors noted.
“Historically, though funding rates for K23 awards are about the same across gender, there was a gender disparity in the success rate of first-time R01 applicants,” they found—20 percent for women compared with 24 percent for men, (p = 0.006. ). In addition, there was gender disparity in the success rate of experienced applicants—32 percent for women, compared with 36 percent for men (p = 0.0004).
There also were disparities in the size of first-time grants: Women received a median of $126,615 in annual direct costs compared with $165,721 for men in across the Big Ten Universities, the eight Ivy League Universities, and the top 50 NIH most- funded institutions.
“The pipeline becomes leaky somewhere between K-awards and R01s,” said Nina F. Schor, MD, PhD, deputy director of the NINDS, who commended the study authors for exploring the issues that contribute to the under-representation of women in neurology research “from many vantage points.”
“The leak is of applicants,” Dr. Schor said, “not of the fraction of applicants who succeed in getting a grant.”
In addition, several researchers expressed concerns that young investigators sometimes do not receive appropriate recognition for their contributions. Too often, in neurology research endeavors, senior-level faculty are deemed the principal investigators and first authors, even when others perform the bulk of the work, said Robin L. Brey, MD, FAAN, professor and chair of neurology at the University of Texas Health Science Center at San Antonio.
This can be discouraging to young investigators, said Dr. Brey, whose research focuses on neurocognitive deficits in systemic lupus erythematous. “A more equitable system is needed to give people credit,” she said.
Available data suggest that disparities take root as early as the undergraduate level, the study authors noted, where women interact less often with their faculty mentors than men. Such biases, the authors contend, may limit female students' exposure to research training. Addressing these potential gender disparities should begin in high school science and math classrooms, undergraduate departments, and post-baccalaureate programs.
“Although more research in this area is needed, we argue that the ability for men to more easily engage in ‘micro’ social interactions with research mentors at the undergraduate level may give an early advantage to men as students make early decisions about whether or not to enter the research pipeline,” the authors wrote.
Underrepresented in Medicine
Responding to the report, several neurologists, who are underrepresented in medicine (UIM), noted that they face additional challenges in advancing through the echelons of research.
“It requires that extra 110 percent effort to get as far along as we need to,” said Temitayo Oyegbile-Chidi, MD, PhD, assistant research professor in pediatric neurology, sleep medicine, and epilepsy at Georgetown University School of Medicine, who is Nigerian-American.
“Racial bias tends to be unconscious as opposed to overt, but it can affect salary negotiations, start-up packages, pay raises, and academic promotions,” said Nicte I. Mejia, MD, MPH, FAAN, assistant professor of neurology at Harvard Medical School and director of neurology community health diversity and inclusion at Massachusetts General Hospital.
“Greater diversity and inclusion in leadership roles would enable UIM individuals to feel more at home in neurology research settings. Furthermore, increased diversity of investigators and focus on inclusive research leads to health equity by reducing disparities,” said Alyx B. Porter, MD, FAAN, associate professor of neurology and director of the cultural humility course at Mayo School of Medicine in Phoenix, AZ. “We want the research to be inclusive to complete our understanding of the disease spectrum.”
When Dr. Porter initially became interested in neuro-oncology as a subspecialty, she recalled that there were few African-American women to emulate. Even now, she said, to her knowledge, she is one of only a few Black women who are neuro-oncologists in the United States.
Transparency regarding salaries and performance reviews would foster a more supportive infrastructure for women, and therefore, help reduce attrition and enhance career satisfaction not only for junior faculty, but also mid-career and senior-level researchers, Dr. Porter noted.
The study authors noted that those who identify by sexual orientation—for example, lesbian, gay, bisexual, trans, or queer (LGBQT+)—may face additional barriers. “Future studies should consider including non-binary definitions of gender identify to examine how this may interact with career development in academic medicine,” they wrote, adding, “the development of strategies to recruit, retain and support these individuals requires further attention that is beyond the scope of this review,” they added.
The psychological and logistical challenges of having children add yet another layer of complexity to furthering a research career. Health systems that recognize physicians' needs in this realm can help ease the burden, said Dr. Mejia. The Office for Women's Careers, established in 1997 at Massachusetts General Hospital, implemented the Caring for Development Awards in 2013.
Although it's not specific to children, the award has covered expenses such as babysitting or plane tickets for Dr. Mejia's two young daughters to accompany her to conferences. “It's symbolic,” she said. “But I think psychologically, it's reminding me that someone is caring.”
In many households, there is still a more traditional framework, with women bearing the brunt of responsibility for raising children, several neurologists told Neurology Today. These demands have been amplified by school closures during the COVID-19 pandemic.
The unexpected work-from-home dynamic is “affecting all young academics across the board,” both men and women, said Eva L. Feldman, MD, PhD, FAAN, FANA, professor of neurology, director of the ALS Center for Excellence, and founder and director of the NeuroNetwork for Emerging Therapies at University of Michigan Medical School.
During a recent Zoom call with a male colleague, Dr. Feldman observed that “his 2-year-old came running and blowing bubbles into his face.” Another male faculty member—the father of a 3-year-old and a 1-year-old—was interacting with Dr. Feldman on Zoom when the children “came to sit on his lap and wave at me,” she recalled.
Despite the challenges, the study authors were sanguine about the prospects for change. “We believe there are ways to close the gender gap in neurology research—at the mentorship, institutional, and national level,” Dr. Minen told Neurology Today.
“Female trainees should be offered opportunities to take the lead on projects that align with their interests,” Dr. Minen said. “In the mentoring process, it's important not only to identify possible differences in nurturing or evaluating trainees' capabilities, but also to acknowledge women's contributions to research and to encourage collaborations.”
To promote successful leadership, institutions should boost the number of female mentors and career scientists. Awards should provide funding to women with and without child-rearing responsibilities. In fostering equal opportunity for participation and recognition in science, Grand Rounds and departmental presentations should include women as speakers. Tracking progress is essential with every intervention, Dr. Minen said.
On a national level, women's inclusion on panels and as plenary speakers would set a supportive tone. Resources should be allocated to examine mechanisms of gender bias and establish incentives for including female researchers on large collaborative science grant-funded projects, she said.
Leaders need “to shine a light” on any barriers to equal opportunity for both men and women, said Dr. Brashear, who assumed her current position in July 2019 after serving as professor and chair of neurology at Wake Forest University School of Medicine.
“Mentoring goes a long way toward providing much-needed encouragement, but sponsorship is also needed to advance women in academic medicine. I believe this is the most effective way to foster the next generation of researchers,” Dr. Brashear said, adding that “it takes a large village” to steer an aspiring young investigator toward a successful career in academic medicine.
However, the paucity of senior women in neurology research translates into a shortage of female mentors. As a result, some women in earlier stages of their careers may need to find male mentors to guide them.
“I have had some great male mentors,” said Dr. Oyegbile-Chidi. “Even though there are fewer senior female mentors in the neurology field, it's important that early- and mid-career females not view it as an obstacle, as male mentors can be great as long as they are truly supportive of you.”