Is there a light at the end of the gender inequality tunnel?

Abstract

Gender disparities in medicine and their detrimental impact on female physicians have been acknowledged and put on the agenda. Even in 2021, there are significant gaps to close, beginning with residency and continuing to senior career phases, where women remain underrepresented in leadership roles of departments and societies, as well as invited faculty at conferences. Financial inequities remain significant all along the career path. Over the past decades, there has been a steady increase in female ophthalmologists. According to a study conducted at Duke University, faculty members of both genders evaluating trainees gave female trainees the same score or even a slightly higher score than male trainees, regardless of their residency year. Additionally, researchers stated that 47% of faculty members were comprised of women. However, career advancement and salaries remain behind those of their male peers. Gender disparities start as early as in residency: female residents have about 20% less surgical volume than their male colleagues. They experience difficulties in advancement and in finding balance between various commitments due to familial responsibilities, lack of guidance and clinical workload. Even though women tend to pursue a higher academic degree than men, male residents choose to specialise more often in surgical subspecialties. A recent comparison of recommendation letters intended for residents found substantial qualitative differences, making use of stereotypical gendered phrases. Letters meant for male residents focused on describing their cognition and ability together with complex and positive experiences, as opposed to recommendations written about female residents, illustrating emotions and using words “touch” or “pain”. Decisions impacting the resident s further career and life, such as academic appointments, promotions, and salary might be based on these references, and unconscious or conscious, give male applicants an advantage. The phenomenon of bullying from either peers, patients, nursing or administrative staff, or acts of discrimination or sexual harassment are observed more frequently against women. Some examples can be observed in the surgical theatre, when lack of cooperation from surgical staff or hurtful remarks contribute to a hostile environment and reinforce cultural and societal norms. Harassment was reported by 66% of female ophthalmology residents compared to 43% among male trainees. It is alarming that almost half of all female fellows report discrimination from both genders and sexual harassment at one point or another. A significant pay gap between young male and female ophthalmologists has been reported as early as their first year of practice, with women earning on average 33 000 USD less than men. The financial disparity is even worse when looking at female ophthalmic surgeons who are paid 36% less and experience one of the largest pay gaps among all surgical specialties. Familial obligations rather than personal choices might explain the fact that most women work part time at some point in their career, and more women are employed by academic centres than private ones (42.8% vs. 30.2%). Compensation inequality could be explained by an unconscious bias of society. As shown in the previous report by Jia et al, there is implicit bias in the expectation that women are less capable than men, and subsequently women are paid less. Female authorship and productivity have long been an ongoing concern. The h-index of female editorial members and societies is lower than their male counterparts. However, when analysing the m-quotient, which aims at weighing the period of academic endeavour to reduce the bias in favour of scientists with longer careers, both genders perform equally. This data suggests that women tend to start their academic career later in life, and become more productive and influential at a later stage in their career compared to their male colleagues. Mimouni et al showed that between 2002 and 2014, more women served as middle authors than first or last ones, especially in subspecialty journals, such as “Retina” or “Journal of Glaucoma”, indicating again a lower percentage of specialisation amongst female ophthalmologists. The ongoing COVID-19 pandemic has put additional hurdles on female physicians and researchers. A recent study reported an overall of 6% decline in female led authorship. Even more concerning, a significant decrease in first and last female authorship roles was detected in comparison to the pre-pandemic era, declining from 27.6% to 22.1%, and 37.4% to 29.6%, respectively. DOI: 10.1111/ceo.13998