Compared with men, women in medicine are less likely to be employed in academic posts, are less likely to be offered positions of equal seniority to those of equally qualified men, and receive lower salaries at each academic grade.1,2 The magnitude of this gender gap varies between specialties, institutions, and countries but remains both persistent and ubiquitous.1,2 Although overt discrimination is prohibited by law in most countries, a recent example from Japan3 suggests that intentional underrating of women may be ongoing. In general, however, the persistent underrepresentation of women is more likely to reflect unconscious bias, unequal family responsibilities, and gender stereotypes.4
A number of initiatives have been adopted to address the gender gap in medicine. In the United States, the longest-standing initiative is the Hedwig van Amerigen Executive Leadership in Academic Medicine for Women program.5 However, special commendation is due to the Athena SWAN program,6 a nationwide initiative in the United Kingdom that began in 2005. Initially, Athena SWAN focused on promoting women in science, technology, engineering, math, and medicine, but since 2015 it has expanded to encompass other disciplines. Moreover, it has been adopted in Ireland and in Australia7 and a consultation process for a Canadian version is currently under way. Additional European countries and New Zealand are actively considering national initiatives in line with Athena SWAN. The core concept of Athena SWAN is to rate institutions according to their internal procedures and achievements in promoting and documenting gender equity. In the United Kingdom, these ratings are linked to the level of governmental financial support of institutions and to their eligibility for grant funding; arguably, this link between gender equity and funding has been the most significant contributor to meaningful institutional changes. A formal and independent evaluation showed that Athena SWAN has led to improvements in women’s self-rated skills and capabilities as well as in women’s promotion, retention, and remuneration.8
Rao et al9 provide evidence that argues against complacency for even small gender differences in salaries, as they demonstrate how such disparity contributes to large inequities in cumulative wealth. The authors focus on the financial impact of the gender equity initiatives, a multicomponent program initiated in 2005 at the Johns Hopkins University School of Medicine in Baltimore, Maryland. By 2018, the initiative had successfully narrowed the gender gap, but a small difference in salaries (1.9%) persisted. This disparity was largely driven by persistently lower salaries for women at the rank of assistant professor, while the gender gap in salary was narrower for associate and full professors. Data on salaries of 1481 faculty (432 women) in 2005 and 1885 faculty (742 women) in 2016 were analyzed using simulations to model the association of gender differences with estimated annual salary and additional accumulated wealth over the course of a 30-year career for “otherwise identical representative” men and women employed as full-time faculty members. Their analyses indicated than a typical female faculty member, compared with her equivalent male counterpart, would be worse off by more than half a million dollars in accumulated wealth and would have to spend her retirement savings at a 40% slower rate.
Arguments for gender equity in the workplace traditionally emphasize general principles relating to the right of women as citizens to participate on equitable terms in all aspects of society and to the contribution of women to institutional and national financial and academic competitiveness. The authors highlight a very tangible disadvantage of salary discrepancies on women’s overall financial well-being during and beyond the active working years. They also demonstrate that, even for largely successful programs, rigorous assessment of their real-world outcomes can identify specific targets for further improvements.
Gender equity is widely accepted and enshrined in law. The key challenge is in the implementation of effective and sustainable programs to provide better work outcomes for women. Detailed evaluations of available schemes should be further encouraged, as they are an essential source of high-quality evidence to guide and refine the design of gender equity programs.
Published: December 21, 2018. doi:10.1001/jamanetworkopen.2018.6053
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Frangou S. JAMA Network Open.
Corresponding Author: Sophia Frangou, MD, PhD, FRCPsych, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029 (sophia.frangou@mssm.edu).
Conflict of Interest Disclosures: None reported.