Article: Allan JM, Kim JL, Ralston SL, Black NMP, Blankenburg R, Shaughnessy EE, Fromme HB. Gender Distribution in Pediatric Hospital Medicine Leadership. J Hosp Med. 2021 Jan;16(1):31-33. doi: 10.12788/jhm.3555. PMID: 33357327.
Fellow: Angie Buttigieg, MD PGY-5, Mount Sinai Kravis Children’s Hospital
Summary: Gender disparities exist in virtually every speciality in medicine, including pediatrics. Newer evidence suggests some improvement in gender disparities among younger professionals. This study aimed to explore the gender distribution in leadership of one of the youngest pediatric subspecialities, pediatric hospital medicine (PHM). Given there is no single database of PHM programs in the US, the authors used the AAMC list of Liaison Committee on Medical Education (LCME)- accredited US medical schools to find pediatric hospital medicine programs associated with these medical schools. Leadership of these PHM programs was found via internet search and confirmed through direct communication with program leadership. The percentage of women in PHM was estimated in three ways- the gender breakdown of the 2019 American Board of Pediatrics (ABP) PHM Board Certification Exam applicants, the 2019 American Academy of Pediatrics Section on Hospital Medicine membership, and a random sample of all PHM faculty in 25% of the programs included in this study. The most conservative of these estimates of women in the field at large was 70%, thus this value was used for comparison. The results demonstrated that the proportion of women PHM division directors was 55% compared to 70% in the field overall (p <0.001). There was no disparity between the proportion of women in the role of PHM fellowship director (66%) and the field as a whole. Women were well represented in associate and/or assistant director roles, both at the division and fellowship levels (82%).
Key Strengths: This study had clear definitions of what is meant by a leadership role and only included roles that were formally designated. Medical schools with multiple sites were considered separately if each had its own primary inpatient pediatric site, thus increasing the power of the study. All leadership positions were verified by two authors. Estimates for the overall proportion of women in the field of PHM were calculated in three ways, making the result more reliable.
Limitations/Flaws: The lack of a centralized list of PHM programs meant that the authors used a list of AAMC LCME-accredited medical schools as a means to find PHM programs. Therefore, this study only describes university-based PHM programs, and cannot be generalized to non-university programs. Furthermore, lack of data on the gender distribution of the PHM workforce meant the authors had to estimate this value. Finally, this study described gender in binary terms.
Takeaway Message: This study demonstrated a significant difference in the proportion of women in division leadership to the field as a whole, but no significant difference was demonstrated in the proportion of women in associate/assistant positions and in fellowship leadership positions when compared to the proportion of women in PHM as a whole. Similar studies have also demonstrated a higher number of women in educational leadership roles and a smaller number of women in roles with more influence. The higher number of women in associate and assistant director roles may represent a robust pipeline of women, or, may reflect the “sticky floor” phenomenon where women get stuck in supportive roles as these represent “women’s work.”
Practice Impact: Further qualitative studies need to be done to understand why there is lower representation of women in leadership roles. Studies should also track women currently in associate/assistant roles to determine if they stay in supportive roles or escalate to primary leadership positions. Most importantly, in order to address the gender gap, women in assistant and associate roles should be provided adequate mentorship and/or sponsorship in order to encourage their promotion.
Fellow: Angie Buttigieg, MD PGY-5, Mount Sinai Kravis Children’s Hospital
Summary: Gender disparities exist in virtually every speciality in medicine, including pediatrics. Newer evidence suggests some improvement in gender disparities among younger professionals. This study aimed to explore the gender distribution in leadership of one of the youngest pediatric subspecialities, pediatric hospital medicine (PHM). Given there is no single database of PHM programs in the US, the authors used the AAMC list of Liaison Committee on Medical Education (LCME)- accredited US medical schools to find pediatric hospital medicine programs associated with these medical schools. Leadership of these PHM programs was found via internet search and confirmed through direct communication with program leadership. The percentage of women in PHM was estimated in three ways- the gender breakdown of the 2019 American Board of Pediatrics (ABP) PHM Board Certification Exam applicants, the 2019 American Academy of Pediatrics Section on Hospital Medicine membership, and a random sample of all PHM faculty in 25% of the programs included in this study. The most conservative of these estimates of women in the field at large was 70%, thus this value was used for comparison. The results demonstrated that the proportion of women PHM division directors was 55% compared to 70% in the field overall (p <0.001). There was no disparity between the proportion of women in the role of PHM fellowship director (66%) and the field as a whole. Women were well represented in associate and/or assistant director roles, both at the division and fellowship levels (82%).
Key Strengths: This study had clear definitions of what is meant by a leadership role and only included roles that were formally designated. Medical schools with multiple sites were considered separately if each had its own primary inpatient pediatric site, thus increasing the power of the study. All leadership positions were verified by two authors. Estimates for the overall proportion of women in the field of PHM were calculated in three ways, making the result more reliable.
Limitations/Flaws: The lack of a centralized list of PHM programs meant that the authors used a list of AAMC LCME-accredited medical schools as a means to find PHM programs. Therefore, this study only describes university-based PHM programs, and cannot be generalized to non-university programs. Furthermore, lack of data on the gender distribution of the PHM workforce meant the authors had to estimate this value. Finally, this study described gender in binary terms.
Takeaway Message: This study demonstrated a significant difference in the proportion of women in division leadership to the field as a whole, but no significant difference was demonstrated in the proportion of women in associate/assistant positions and in fellowship leadership positions when compared to the proportion of women in PHM as a whole. Similar studies have also demonstrated a higher number of women in educational leadership roles and a smaller number of women in roles with more influence. The higher number of women in associate and assistant director roles may represent a robust pipeline of women, or, may reflect the “sticky floor” phenomenon where women get stuck in supportive roles as these represent “women’s work.”
Practice Impact: Further qualitative studies need to be done to understand why there is lower representation of women in leadership roles. Studies should also track women currently in associate/assistant roles to determine if they stay in supportive roles or escalate to primary leadership positions. Most importantly, in order to address the gender gap, women in assistant and associate roles should be provided adequate mentorship and/or sponsorship in order to encourage their promotion.