Gender Bias, Discrimination Common in Academic Psychiatry

Women in the United States have made much progress in medicine since 1849, when the first woman obtained a medical degree. But 170 years later, a wide gender gap persists in compensation, advancement, and research funding, according to presenters at an APA Annual Meeting session on gender bias in academic medicine. Admissions of women to medical schools have more than doubled since the passage of Title IX of the Education Amendments of 1972, which prevents federally funded, higher-learning institutions from discriminating on the basis of gender. In fact, women made up 53% of medical school admissions in 2017 and have accounted for roughly half of residents in psychiatry for the past 20 years.

Despite the strong representation of women psychiatrists in residency training and early career positions, women faculty in tenured or executive leadership positions have not experienced similar gains, said speaker Latoya Frolov, M.D., M.P.H., a fourth-year psychiatry resident at the University of California, San Francisco (UCSF).

“Based on generational changes, seniority, and the number of women in psychiatry, we would expect about one-third of psychiatry department chairs to be women,” Kristen Berendzen, M.D., Ph.D., a fourth-year psychiatry resident at UCSF, told attendees. However, just 10% of psychiatry department chairs are women, and only about 30% of full professors in psychiatry are women (see chart).

Unequal pay is another inequity that women physician faculty including psychiatrists encounter. A 2016 JAMA Internal Medicine study of more than 10,000 physician faculty salaries found that women physicians were on average paid $20,000 less a year, even after researchers adjusted for a variety of other factors, including years since residency completion, faculty rank, specialty, and indicators of productivity such as clinical hours worked. A salary survey of 65,000 full-time physicians by Doximity found that in 2017 women earned $105,000 less on average, even after adjusting for hours worked, geographic location, provider specialty, and years in practice.

Berendzen also cited various studies revealing a gender gap in research funding. For example, a 2012 study found that fewer than one-third of research grants go to women, and the average size of grants awarded to men surpasses those awarded to women.

Among medical students, women face gender bias in their performance evaluations. Berendzen pointed to a study of nearly 90,000 clerkship evaluations from core clinical rotations at two medical schools. Published in May in the Journal of General Internal Medicine, the findings revealed gender-based differences in the language used to evaluate the students, even among students who received the same grade. Evaluations of women students were more likely to include descriptors of personality traits such as “lovely,” while evaluations of male students tended to focus on competency-related attributes such as “scientific” and “knowledgeable.”

Women also continue to experience sexual harassment and discrimination, said Berendzen. A 2018 study in the Journal of General Internal Medicine found that as many as two-thirds of academic women researchers surveyed said they had experienced gender bias or sexual harassment with negative effects on their confidence and career advancement.

“More women than ever are entering medicine, but at all levels of training and practice, they continue to experience harassment and discrimination,” Berendzen said. “The #MeToo and #TimesUP movements have created a platform to challenge inappropriate gender-related treatment in the workplace.”

Another significant issue that women in medicine continue to face is a lack of family-friendly policies in training programs and at work, Berendzen said. “Family-leave policies are not standardized across institutions, and they are discretionary, meaning they are allowed only at the discretion of management or the institution.” Women in psychiatry also cited the absence of mentorships and role models—obstacles reported by women in other areas of medicine as well.

In the spirit of problem-solving, audience members broke into small groups to brainstorm solutions to these issues. They came up with the following ideas:

“Sex Differences in Physician Salary in U.S. Public Medical Schools” is posted here. “Differences in Narrative Language in Evaluations of Medical Students by Gender and Under-represented Minority Status” is posted here. “Eliminating Gender-Based Bias in Academic Medicine: More Than Naming the ‘Elephant in the Room’ ” is posted here.