Women have found an increasing presence throughout dermatology both at a general and subspecialty level, but gaps in representation remain.
Over the past decade, women have found a growing role in the specialty of dermatology. In 2008, just 38.2% of the total active physicians specializing in dermatology were women vs 61.8% men.1 Comparatively, in 2017, 48.9% of the 12,040 total active dermatologists were women.2 Recent literature has explored female representation throughout the specialty. While women continue to represent the majority of residents in training, leadership at organizational, symposium, and research levels is still skewed in favor of men.3-10
A recently published article in Pediatric Dermatology analyzed the trends of women in leadership and research within pediatric dermatology.11 In short, Baker and colleagues found that women represent the majority of leadership positions and research initiatives in pediatric dermatology, but a discrepancy still exists when it comes to lecturer positions at national meetings.
Dr Catherine Baker, lead author of the study, spoke with The Dermatologist regarding the results and its larger implications for women in medicine.
When your research group looked at women in pediatric dermatology, what did you find?
In this paper, we looked at pediatric dermatology in particular, a field that is known to have a preponderance of women practitioners. More than 70% of pediatric dermatologists were women as of 2015. This study showed that women have been prominently featured as leaders of the Society for Pediatric Dermatology (SPD) and the Pediatric Dermatology Research Alliance (PeDRA). In addition, women have served as leaders of major research projects in pediatric dermatology, earning a majority of grants in recent years. Women have also been well represented as authors in Pediatric Dermatology, the field’s primary research journal.
Despite this growing influence, when it comes to speaking as invited lecturers at the annual meetings for SPD, women were not as well represented. Interestingly, this has not really changed over time. Since 1996, women have gained influence in nearly all areas of pediatric dermatology but not as named lecturers at the SPD Annual Meeting. This is important because invited speakers at medical conferences are generally perceived as key opinion leaders in their field, delivering practice-changing lectures and serving as role models for upcoming leaders in the field.
What are the reasons for this discrepancy?
It may just be a matter of time. Women are still gaining increased representation in medicine and in pediatric dermatology; our data show that women are entering research and leadership positions in pediatric dermatology at increasing rates over time. Therefore, it may just take time for women to achieve higher levels of influence in the field as invited lecturers at national meetings. However, if it were just a matter of time, then we would expect at least a small increase in women lecturers at these meetings over the past 25 years. There remain other challenges for women as physicians and in dermatology. Work by other investigators has shown that though women are increasingly entering academic dermatology as instructors, junior professors, and assistant professors, the rate of rise of women as associate professors, full professors, and department chairs is not nearly as robust.8 The literature also shows that women physicians in academia are more likely to take on roles related to mentoring students or to committees,7,12 areas of their career that might not necessarily translate to a keynote or plenary lecture, so that is a potential contributor to this persistent discrepancy.
What else has the literature explored when it comes to women in dermatology?
I did another study (currently in press) about women in Mohs surgery that showed women were seeking leadership positions at the same rate as their male counterparts. Thus, while we did not study this directly in pediatric dermatology, one might infer that the lack of invited lectures by women at SPD meetings is not due to a lack of desire for those roles. This begins to touch on why representation matters. With more women in positions of influence, we can begin to address the issues causing this leaky pipeline.9,12
Similar to a recent study in general dermatology, our study on women’s experiences in Mohs surgery found evidence for perceived maternal bias among women surgeons.13 Many women perceive this bias in the setting of pregnancy during their career. Oftentimes, there are systemic issues with the way parental leave is granted, so we need more exploration of key issues like that to better address others areas of discrepancy in the careers of female dermatologists.
What would you say about the potential transmission of the traditional feminine role of nurturer from societal expectations to a professional setting?
I think that there needs to be more study into that and other granular issues that cause discrepancies in the workplace. We can start by having more conversations with women about their career goals, work-life balance, available resources, and perceived barriers to professional growth. Female dermatologists and doctors in general are more likely to have to spend a significant amount of their time at home taking care of their kids compared with their male counterparts.14 Women are much less likely to have a stay-at-home partner compared with men in medicine. We need to identify the gender roles that persist and pervade through dermatology and medicine in general.
What does the representation of women in dermatology mean for patients?
I do not know how much of this has been studied in dermatology, but a recent study in hospital medicine demonstrated that female physicians actually had lower readmission rates compared with their male counterparts.15 For the patient, receiving care from practices that have diverse input from men and women has the potential to increase the quality of care.
Similarly, inclusivity of other underrepresented groups in medical practice is extremely important. Studies have shown that more diverse medical groups, including doctors who are underrepresented minorities, are much more likely to provide care to patients who are underrepresented minorities and of limited-income groups.16 I think, in general, increasing the diversity and richness of practice is beneficial for the patient in all areas.
What would you like to stress about the outcome of your research into the representation of women in pediatric dermatology?
The biggest area of future research is going to explore the why behind all of this. We have several studies now that demonstrate the growing representation of women in dermatology, but there remain these kind of “sticky points”—where women are less likely to be invited as named lecturers at national meetings and are less likely to be named as full professors or department chairs. The key will be to figure out how best to address these issues and how to create policy that will enable more diverse representation, both for women and underrepresented minorities, at every level of academic dermatology and at national meetings.
References
1. Center for Workforce Studies. 2008 Physician Specialty Data. Association of American Medical Colleges; November 2008. Accessed November 30, 2020. https://www.aamc.org/media/33491/download
2. Active physicians by sex and specialty, 2017. Association of American Medical Colleges. December 2017. Accessed November 30, 2020. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017
3. Oska S, Touriel R, Partiali B, Delise A, Barbat A, Folbe A. Women’s representation at an academic dermatology conference: trending upwards, but not equal yet. Dermatol Online J. 2020;26(3):13030/qt1pp0073j.
4. Collins A, Strowd LC. Leading ladies: Why leadership programs are so valuable to female physicians. Int J Womens Dermatol. 2020;6(1):54-56. doi:10.1016/j.ijwd.2019.06.029
5. Lobl M, Grinnell M, Higgins S, Yost K, Grimes P, Wysong A. Representation of women as editors in dermatology journals: a comprehensive review. Int J Womens Dermatol. 2019;6(1):20-24. doi:10.1016/j.ijwd.2019.09.002
6. Shukla N, Wehner MR, Morrison L, Naik HB, Linos E. Gender equity improving among award winners and leaders at the society for investigative dermatology. J Invest Dermatol. 2019;139(10):2215-2217. doi:10.1016/j.jid.2019.06.123
7. Shi CR, Olbricht S, Vleugels RA, Nambudiri VE. Sex and leadership in academic dermatology: a nationwide survey. J Am Acad Dermatol. 2017;77(4):782-784. doi:10.1016/j.jaad.2017.05.010
8. Xierali IM, Nivet MA, Pandya AG. US dermatology department faculty diversity trends by sex and underrepresented-in-medicine status, 1970 to 2018. JAMA Dermatol. 2020;156(3):280-287. doi:10.1001/jamadermatol.2019.4297
9. Collins CE, Shipman AR, Murrell DF. A study of the number of female editors-in-chief of dermatology journals. Int J Womens Dermatol. 2017;3(4):184-188. doi:10.1016/j.ijwd.2017.03.001
10. Bendels MHK, Dietz MC, Brüggman D, Oremek GM, Schöffel N, Groneberg DA. Gender disparities in high-quality dermatology research: a descriptive bibliometric study on scientific authorships. BMJ Open. 2018;8(4):e020089. doi:10.1136/bmjopen-2017-020089
11. Baker C, Dwan D, Fields A, Mann JA, Pace NC, Hamann CR. Representation of women in pediatric dermatology leadership and research: trends over the past 45 years. Pediatr Dermatol. 2020;37(5):844-848. doi:10.1111/pde.14266
12. Sadeghpour M, Bernstein I, Ko C, Jacobe H. Role of sex in academic dermatology: results from a national survey. Arch Dermatol. 2012;148(7):809-814. doi:10.1001/archdermatol.2011.3617
13. Mattessich S, Shea K, Whitaker-Worth D. Parenting and female dermatologists’ perceptions of work-life balance. Int J Womens Dermatol. 2017;3(3):127-130. doi:10.1016/j.ijwd.2017.04.001
14. Jacobson CC, Nguyen JC, Kimball AB. Gender and parenting significantly affect work hours of recent dermatology program graduates. Arch Dermatol. 2004;140(2):191-196. doi:10.1001/archderm.140.2.191
15. Tsugama Y, Jena AB, Figueroa JF, Oray EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213. doi:10.1001/jamainternmed.2016.7875
16. Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity among physicians: an intervention to address health disparities? In: Smedley BD, Stith AY, Colburn L, Evans CH. The Right Thing to Do, The Smart Thing to Do. National Academies Press (US); 2001. Accessed November 30, 2020. https://www.ncbi.nlm.nih.gov/books/NBK223632/
