gender equity

Each year, the second Sunday of May is observed as Mother’s Day. This day provides an opportunity to celebrate and honor the mothers in our lives. Mothers make many sacrifices to ensure that their kids lead healthy and successful lives. They continually strive to balance their family and professional responsibilities. Women often put their careers on hold in order to raise their families. Even though there has been some improvement in recognition of gender bias issues inside workplaces, women are more likely to face family related interruptions in their careers¹. This social construct along with the culture of bias and discrimination in the workplace has led to women being grossly underrepresented in positions of leadership and influence, healthcare being no exception to this phenomenon. Lower salaries, a work culture that favors men, and sexual harassment are some grave challenges that women encounter in their professional lives. There has been a growing awareness of this problem in the last few years, thanks to efforts lead by organizations such as TIME’S UP.

Within the field of academic Neurology, there has been a growing call to recognize these issues related to gender disparity². Women are underrepresented both as recruited subjects in neurological clinical trials and also as project leaders for those clinical trials. A recent observational study found that only about 31% of all academic Neurology positions are held by women; this disparity widens as the academic rank increases with only 13.8% of Neurology professors being women³. Men also appear to have a higher rate of academic publications than women, with larger gaps seen at junior faculty positions. Similar gender inequities have been noted in other specialties including neurosurgery, orthopedic surgery and radiology⁴. However, this disparity cannot be explained by a lack of female representation in medical schools. American Association of Medical Colleges data from 2017 revealed that female students accounted for 50.7% of all enrollees in medical schools, which is a 9.6% increase since 2015⁵.

Similar to the business world, social media has played an important role in increasing recognition and reporting of gender disparities within the field of Neurology. Women Neurologists Group (WNG) was formed in 2015 as a closed Facebook group, which now has more than 2,000 members and also has more than 1,000 followers on Twitter (@WNGtweets). This group of “Women neurologists networking and supporting each other” provides a platform for women neurologists to discuss, among other topics, issues related to maintaining the family-work balance. According to Dr. Kathrin Lafaver (@LaFaverMD, Assistant Professor of Neurology at University of Louisville) who is one of the founding members of the group, this forum has provided a safe space for women to share their experiences and opinions about a variety of subjects including the problem of gender disparity and it’s potential solutions⁶. The American Academy of Neurology set up a task force to study the underlying causes of gender disparity in the field and put forth recommendations to tackle this problem. As part of this initiative, the academy established a “Women leading in Neurology” program in 2017 which aims to help women neurologists gain the appropriate leadership skills to advance their careers and attain top tier positions within their field.

Gender disparity in healthcare is obviously not an issue unique to the United States and is becoming recognized around the world. Last year, the European Stroke Organization (ESO) established WISE (Women Initiative for Stroke in Europe), with its main goal of improving stroke care for women across Europe. The group aims to increase awareness about stroke risk factors and symptoms in women and to ensure gender equity when it comes to stroke care in the continent. One of the objectives of the group is to support women clinicians and researchers in the field of stroke medicine and to help them attain leadership positions. The group organized their second annual WISE stroke leadership workshop earlier this week in conjunction with the ESO conference in Milan, Italy. During this workshop, Dr. Natalia Rost (@nsanar Professor of Neurology, Harvard University) represented the STROKE journal and provided a call for action to increase female leadership in the field of academic stroke neurology. She advocated for increased transparency within academic departments, recognizing achievements and contributions of women scientists and promoting diversity within scientific committees and editorial boards⁷. These are important steps toward establishing a culture of equality and fairness within the field of medicine.

While there is a clear commitment within neuroscience and the medical community at large to promote diversity inside academic and clinical arenas; a lot still needs to be done to help women maximize their potential as clinicians, educators and researchers. At this time of the year when we celebrate Mother’s day, let’s all pledge to support the women in our lives so that they can attain all the personal and professional success that they deserve.

References:

https://www.pewresearch.org/fact-tank/2015/03/10/women-still-bear-heavier-load-than-men-balancing-work-family/
Silver JK, Bank AM, Slocum CS, Blauwet CA, Bhatnagar S, Poorman JA, et al. Women physicians underrepresented in American Academy of Neurology recognition awards. Neurology. 2018;91:e603–e614
McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV, et al. Sex differences in academic rank and publication rate at top- ranked US neurology programs. JAMA Neurol. 2018;75:956–961
Jagsi, Reshma et al. Sex, Role Models, and Specialty Choices Among Graduates of US Medical Schools in 2006–2008. Journal of the American College of Surgeons , Volume 218 , Issue 3 , 345 – 352
https://aamc-black.global.ssl.fastly.net/production/media/filer_public/5c/26/5c262575-52f9-4608-96d6-a78cdaa4b203/2017_applicant_and_matriculant_data_tables.pdf
https://journals.lww.com/neurotodayonline/FullText/2018/07190/Neurologists_on_Social_Media__The_Women.13.aspx
Charlotte Cordonnier, Shelagh B. Coutts, Karen C. Johnston, Natalia S. Rost. Crucial Role of Women’s Leadership in Academic Stroke Medicine You Can’t Be What You Can’t See. https://doi.org/10.1161/STROKEAHA.118.024788

Last month, I wrote about gender representation in the scientific literature. This time, I’m taking a look at the popular press. Rather than look just at gender, I’m looking how nurses are represented (or not represented) as expert sources. I’m choosing to do this for several reasons; First, the public’s perception of nursing as a profession matters both to the future of nursing (who will pursue the profession?) and to the care we provide now (how do patients and other members of the health care team respond to us?). Second, there is an inherent gender bias in the under-representation of nurses as experts, since 90% of RNs are female¹. Finally, the practice and science of nursing are distinct from other fields and are valuable to health – including cardiovascular health. (If you aren’t familiar with nursing research, there’s a list of nursing journals at the end of this post – have a look at what’s getting published). Increased public visibility is a gateway to broader funding, adoption of nursing-generated evidence, and professional respect. This isn’t just good for nurses, it’s good for the health of the population.

Photo by Sam McGhee on Unsplash

Nursing has matured enormously as a profession and an academic field, but the public’s perception of nursing has not kept up. A seminal 1997 report, known as the Woodhull Study of Nursing in the Media², found that nurses were identified as sources in only 4% of health news stories in national and regional newspapers, and even fewer in industry publications. Over 20 years later, we see some increased awareness, but not enough. A team at George Washington University recently investigated the current state of women and nursing in the media. They found that many journalists don’t have a clear idea of the scope of nursing expertise, and that news organizations are infrequently reaching out to nurses. Additionally, the authors reported that journalists don’t know how to find nurses, healthcare organizations aren’t offering them as experts, and nursing professional organizations aren’t effectively engaging the media. Women remain underrepresented as expert sources in news stories at just 36%³. That’s a lot of barriers to effective representation. Yet the public trusts nurses more than any other profession, including physicians⁴. The valuable voices of nurses represent a huge opportunity for health and science communication, if we can learn how to effectively promote them. This will take dedicated work and attention from all sides.

Photo by Matt Botsford on Unsplash

Here are some ways to work on this problem:

Women, recognize that your contributions are needed. Women will never be treated with full fairness and equality unless our voices are audible– this is as true in science and academia as it is in politics. Cultivate expertise and believe in your own status as an expert. (Fellow early career blogger Alison Webel shared some strategies to combat self-doubt.)
Nurses, engage with the media. Write letters to the editor. Tweet. Promote your work, both clinical and research. Talk to journalists when the opportunity arises (see my tips here). Find out if your organization has a blog, and offer to write a post. Often, PR folks run these blogs and are delighted to have volunteer contributors.
Leaders in adjacent professions, seek out and recommend nurses as experts. If you’re asked to provide a quote, or background, consider whether the best person for the job might actually be a nurse– don’t assume the interviewer will know that.
Writers, aim for balance. Are you quoting and citing diverse sources? Think about profession, age, gender, race, rank, and nationality when you’re evaluating your sources.

Can you choose a strategy to focus on for your next project?

References:

National Council of State Boards of Nursing (2017). National Nursing Workforce Study. https://www.ncsbn.org/workforce.htm
University of Rochester (1997). The Woodhull Study of Nursing in the Media. Indianapolis, IN: Sigma Theta Tau.
Mason, D., Glickstein, B., Nixon, L., Westphaln, K., Han, S., & Acquaviva, K. (2018). Research Brief: The Woodhull Study Revisited: Nurses’ Representation in Health News Media. George Washington University. https://nursing.gwu.edu/woodhull-study-revisited
Brenan, M. (2018). Nurses again outpace other professions for honesty, ethics. Gallup News. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx?g_source=link_NEWSV9&g_medium=NEWSFEED&g_campaign=item_&g_content=Nurses%2520Again%2520Outpace%2520Other%2520Professions%2520for%2520Honesty,%2520Ethics

Resources for nursing research:

Journal of Cardiovascular Nursing: https://journals.lww.com/jcnjournal/pages/default.aspx

Nursing Research: https://journals.lww.com/nursingresearchonline/pages/currenttoc.aspx

Journal of Nursing Scholarship: https://sigmapubs.onlinelibrary.wiley.com/journal/15475069