Q&A with Dr. Jagsi: Opportunities to improve gender equity in medicine

As the coronavirus pandemic disrupted our workplaces, schools and families, studies have shown that women bore a disproportionate burden. The pandemic has been especially challenging for women in medicine, a field that’s already had slow progress in gender equity.

The National Academies of Sciences, Engineering and Medicine published a report in 2021 detailing some of the challenges women face in the medical field: increased workload, reduced academic productivity, changes in interpersonal interactions, difficulties with remote work. Women have had to cut back on work hours – and compensation – to care for children or older parents.

“As we focused on beating COVID-19 and keeping our patients safe, work aimed at promoting gender equity, diversity and inclusion has in some ways taken a step back. We must seize the disruptive moment this presents to make real, lasting change in our field toward gender equity,” says Reshma Jagsi, M.D., D.Phil., director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.

The pandemic has changed work places. It’s provided more opportunities, but at the same time it’s magnified many gender inequity issues that women physicians and researchers face. In a New England Journal of Medicine perspective, Jagsi and colleagues outline some of the issues and opportunities. She discusses them here with Michigan Health Lab.

How can we take advantage of some of the changes that came from the pandemic to improve gender equity in medicine? What barriers stand in the way of that change?

Jagsi: Many things we always thought were impossible have suddenly become routine. We have discovered that we can deliver clinical care, teach and attend professional conferences virtually. Of course, there is still value to in-person interaction, and when we are able to gather again in person, we must be careful to leverage the possibilities for virtual interaction in ways that promote equitable participation and the pursuit of our shared mission.

As an example, we led a study a couple of years ago that showed women were less likely to attend oncology professional society meetings than men, and their biggest challenge was childcare. Virtual meetings definitely offer some promise in making these opportunities more accessible.

That said, we also heard in the survey commissioned for the NASEM report that many women struggled to find the space and time needed to fully participate in such virtual meetings. So we have to be careful to evaluate how these changes in the ways we work are affecting equity.

Your example of virtual meetings really highlights both opportunity and challenge: It gives women more access to meetings because they don’t have to travel, but then women struggle to find space and privacy at home – and they’re being trolled in the comments. Can you take that apart a little more to explain the many layers at play impacting women’s success? It feels like even when you have opportunity, you still don’t.

Jagsi: The factors that have kept us from achieving truly fair equality of opportunity in our society are incredibly complex. Gendered expectations of who should be responsible for home and family don't just affect whether someone has the flexibility to travel for a conference or work late hours.

It also affects who gets priority when there is only one home office, whose meeting takes precedence when there is limited bandwidth, or who is interrupted when a dependent needs attention. This means that ensuring truly equal access isn't as simple as making it possible to work from home. What we need are greater social supports and a transformation of attitudes regarding gender roles.

It’s discouraging to hear that women giving important scientific talks are being trolled in the comments. How do we begin to hold people responsible for inappropriate remarks?

Jagsi: Inappropriate workplace behavior is unfortunately not new. The new virtual world we inhabit has, however, provided new ways for it to manifest. Fortunately, the decades of organizational psychology research on how to promote civility and respect within organizations can help to inform how we approach these situations. Allies can stand up rather than stand by when they see these situations unfolding, and when they do so, the culture begins to transform. Of course, we need research to evaluate how all of this plays out with virtual interactions.

You mention mixed responses from institutions and leaders. Can you give some examples of both positive changes as well as missed opportunities?

Jagsi:  As one participant in a webinar I recently joined noted, leaders have been remarkably nimble about addressing challenges they have experienced in their own lives or were intuitively obvious to them. For example, many institutions have focused on ways to address the concerns of tenure-track faculty about promotions processes and the impact of pandemic-related disruptions to productivity.

However, some of these interventions will have unclear impact on equity. In the field of economics, for example, stopping the tenure clock has been shown to benefit men but not women. Moreover, far less has been done to address the issues faced by faculty who are not on the tenure track, a group that disproportionately includes women and people of color.

There are so many examples and so many pandemic-related issues that are disproportionately impacting women. As COVID-19 and pandemic restrictions continue, how can women begin to emerge from this and keep their career on track?

Jagsi:  We have to take responsibility for ensuring equity at the institutional level. Right now, many individuals are doing their best with work-life boundary management, but individual coping strategies may not suffice in the face of overwhelming structural challenges. Reaching out to understand the unique lived experiences of all of the members of our profession is essential to guide policy and practice to support its ongoing vitality and ability to serve society.

Paper cited: “Promoting Equity for Women in Medicine – Seizing a Disruptive Opportunity,” New England Journal of Medicine. DOI: 10.1056/NEJMp2104228