By Laura Dean, Valerie Dobiesz, and Peter Chai
During the COVID-19 pandemic, women health care providers have not only put their health at risk, but also suffered disproportionate professional consequences.
Women comprise 70% of the global and 76% of the US health care workforce, and data from the U.S. Centers for Disease Control (CDC) suggest that nearly three-quarters of the COVID-19 cases among health care workers are women. Additionally, pregnant health care workers suffer greater morbidity and mortality from COVID-19, face uncertain risk from medications and vaccines due to exclusion from clinical trials, and experience significant psychological and medical risk managing pregnancy amidst an uncertain pandemic. Returning to work in an era where limited and ill-fitting personal protective equipment (PPE) is available and risk of infection is uncertain is especially challenging to new and lactating mothers seeking to advance their careers in academic medicine.
Women physicians are underrepresented in executive leadership roles in nearly all academic departments, hospitals, and health care systems. They are recipients of fewer federal and industry research grants, despite equivalent qualifications. Further, women physicians are often involved in the education of trainees, a critical task that ensures that competent physicians graduate from residency programs, but one that is rarely adequately compensated in protected time or salary. In the COVID-19 pandemic, additional stressors to the clinician educator include revising curricula into a virtual format and addressing stress among trainees, adding to an already increased workload. Taken together, these factors result in women physicians working heavier clinical workloads than their male counterparts, all while facing the increased physical and mental burdens of the COVID-19 pandemic.
At home, women shoulder a disproportionate share of domestic work, and that burden has only grown during the pandemic. Combined with clinical and academic requirements, this “second shift” has grown to include childcare, eldercare, and overseeing virtual school while holding meetings from home and balancing clinical work. Recent investigations demonstrate that women are less academically productive than men during the current pandemic. The number of women first-author publications, a metric of academic productivity, dropped by almost a quarter in 2020 compared to 2019. Women investigators already receive less funding in their early career grants, and in 2020, preliminary data suggest the number of women applying for first-time NIH grants also declined. The exacerbation of gender inequities in the pandemic not only stymies scientific progress, but also will result in delayed progression to promotion, leaving women years behind their male counterparts. Further, early data suggest women academics have left the workforce at an exponentially increasing rate over the last twelve months. This in turn will decrease the number of women mentors and role models for those who are considering medicine as a career. This failure to harness the full talents of the academic workforce will compromise what gains the field has seen in gender equity.
So how can we best address the secondary crisis in medicine among women physicians who are facing increased responsibilities at work and at home, and barriers in academic medicine exacerbated by the COVID-19 pandemic? While long term change depends on re-examination of our societal values, the COVID-19 pandemic may provide the necessary impetus to spur academic departments to prioritize family-centered personnel policies to retain a valuable subset of their workforce.
National working groups in medical specialties including emergency medicine, internal medicine, and anesthesia have identified several interventions to mitigate the disproportionately damaging effects of the pandemic on women academic physicians. In the short term, departments can consider implementing staffing models to minimize potential COVID-19 exposure for higher risk individuals, including those who are pregnant, immunocompromised, or care for immunocompromised family members. Teams can vary meeting schedules throughout the day to better accommodate parent-clinicians who are managing remote schooling and childcare at home. Moving forward, departments should consider bridge funding and enhanced research support, extend promotion timelines, institute tenure clock-stopping policies, provide temporarily modified promotion criteria, and ensure that all academic work accepted for publication or presentation at cancelled events is eligible to be included in promotion packages.
The COVID-19 pandemic has exacerbated long-standing gender inequities in academic medicine. At the same time, it offers an opportunity to revisit the parameters of tenure timelines and reconsider the possible benefits of virtual meetings and conferences. Attending and presenting at national conferences without the hassle of travel and burden of missed family obligations offers new platforms for parents, especially mothers, of young children to engage. With a more flexible, family-friendly approach, academic departments can use this moment to establish strong precedent for retaining and supporting the women in their ranks, rather than suffer the loss of their contributions to the field.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.