The United Nations says this about gender equality, “besides being a fundamental human right, (it) is essential to achieve peaceful societies, with full human potential and sustainable development.”1 Yet this globally recognized determinant of a society's evolution remains deficient in vital sectors such as science, research, and medical fields. Knocking down barriers to gender equality requires a deeper understanding of a fundamental factor – unconscious bias.
What is gender equality?
Global Health 5050 is an independent initiative committed to the advancement of universal gender equality in health. This organization defines gender as "the socially constructed norms that impose and determine roles, relationships, and positional power for all people across their lifetime. Gender interacts with sex, the biological and physical characteristics that define women, men and those with intersex identities."2
Global Health 5050 emphasizes that this definition encompasses all people. It is a social construct that determines a person's role in society and is influenced by individuals, families, communities, politics, and laws.2
As such, gender equality is achieved when all individuals have similar rights across all aspects of society – including career opportunities and healthcare treatment.
Does gender inequality exist in healthcare roles?
Culturally, we tend to think of surgeons as men, nurses as women — dentists as male, hygienists as female. Radiographers are guys, sonographers as ladies. Do those gender stereotypes prove out statistically, though?
According to the American Medical Association,3 men dominate the specialties of:
- Orthopedic surgery – 84.6%
- Neurological surgery – 82.5%
- Interventional radiology (integrated) – 80.8%
- Thoracic surgery – 78.2%
- Pain medicine – 75.3%
- Radiology – 73.2%3
However, 83.4% of obstetrics and gynecology specialists are women. Females also prevail in:
- Allergy and immunology – 73.5%
- Pediatrics – 72.1%
- Medical genetics and genomics – 66.7%
- Hospice and palliative medicine – 66.3%
- Dermatology – 60.8%3
The gender bias in healthcare is more pronounced than those figures for medical specialties indicate, though. A 2019 article in The Lancet4 reported that female participation in the health workforce is increasing, but on an inequitable basis. Though women hold approximately 75% of healthcare jobs globally, a disproportionate number are in lower-paying roles.4
In a field related to medicine, women represent less than 30% of researchers worldwide, with that number slightly higher (32%) for North America and western Europe. Though the number of female researchers is on the rise, they publish fewer papers and are less likely to collaborate internationally.4
In a 2018 report, Diagnostic Imaging said women are underrepresented in radiology. The commentary chronicles a study indicating that 23.1% (7,501 of 32,429) of all radiologists are women. By comparison, 46.6% of non-radiologist physicians are female.5
Yet the distribution by gender is virtually reversed in the role of a radiologic technologist. Radiologic Technology reports that in 2015, women comprised 72% of the field, with men holding 28% of the jobs.6
Combating unconscious bias
Unconscious bias is a prevailing factor in gender inequality, as well as an impediment for URMs (underrepresented minorities). Unconscious bias is a deeply rooted instinct that helps humans make decisions efficiently by drawing upon previous sensory exposure and experiences.
This primal trait can be helpful in many modern situations. It may cause a driver to automatically slow down on a rainy night when the temperature is near freezing, or allow a potential buyer to detect insincerity in the face of a used car salesman. Unconscious bias, however, is a serious roadblock to hiring and employment practices and delivery of healthcare.
The process causes a person to make a quick assessment or judgment, basically stereotyping another individual based on societal input and personal experience. Reflexively connecting attributes (negative or positive) to a person contributes to inequalities. It may contradict organizational values and practices and inhibit good personal intentions.
The problem stems from the involuntary nature of unconscious bias and the fact that the perpetrator is usually unaware of it. In addition to the impact on recruitment, selection, and advancement within the healthcare environment, unconscious bias can lead to prejudicial clinical decision making that affects patient care and outcomes.7
At an official level, an organization’s policies, procedures, and employment processes should clearly illustrate non-prejudicial commitment. At the level of human resources and leadership, it is important to recognize that unconscious bias is normal and unintentional. The goal is to disrupt stereotypes with awareness programs and evidence-based information, rather than creating resistance or feelings of guilt. This may involve self-monitoring, assessment of propensity toward bias, and role-playing (from the perspective of patient or co-worker). Dialogue programs that highlight how mainstream media typecasts various personas can also be advantageous.
Benefits of finding gender balance
In addition to the ethical viewpoint, there is a need for gender equality in medical fields, in terms of economic benefit, social balance, and health outcomes.
The Lancet quoted The High-Level Commission on Health Employment and Economic Growth with regard to the detrimental effect of gender bias in the health sector, saying such biases “undermine inclusive economic growth, full employment, decent work and the achievement of gender equality. They also create inefficiencies in health systems by limiting the productivity, distribution, motivation, and retention of female workers, who constitute the majority of the health workforce."4
Conversely, gender-diverse workplaces promote economic growth in the community through job opportunities, employee satisfaction, retention, innovation, and increased productivity.4
Diversity in the healthcare facility better meets the needs of the consumer population, too. The workforce is more apt to identify with and tailor services to the needs of patients, and patients may respond more favorably. A recent healthcare article illustrated both sides of that perspective.
"When they can connect with their medical provider, they often get the best care and walk away satisfied. However, if the environment does not make them feel like they belong, patients may get uncomfortable, fail to discuss all of their medical concerns, and not follow up with treatment.”8
Spirit of inclusivity
Recent gender reckoning social crusades such as Me Too and the transgender rights movement are compelling society to deal with inherited standards and roles. The resulting transformative changes are finding their way into virtually every aspect of life, including workplaces in the field of medicine. The shift to greater transparency and fairness leverages the best available talent for improved patient care.
- Gender Equality. United Nations. https://www.un.org/en/sections/issues-depth/gender-equality/ October 18, 2019.
- Gender and global health. Global Health 5050. https://globalhealth5050.org/gender-and-global-health/ October 18, 2019.
- These medical specialties have the biggest gender imbalances. American Medical Association. https://www.ama-assn.org/residents-students/specialty-profiles/these-medical-specialties-have-biggest-gender-imbalances October 18, 2019.
- Gender equality in science, medicine, and global health: where are we at and why does it matter? The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33135-0/fulltext October 18, 2019.
- Fewer Women in Radiology, Particularly in Certain Parts of the US. Diagnostic Imaging. https://www.diagnosticimaging.com/gender-issues/fewer-women-radiology-particularly-certain-parts-us October 18, 2019.
- Demographics of the Profession. Radiologic Technology. http://www.radiologictechnology.org/content/86/4/449.extract October 18, 2019.
- Diversity Matters in Academic Radiology: Acknowledging and Addressing Unconscious Bias. Journal of the American College of Radiology. http://www.differencematters.info/uploads/pdf/Diversity%20Matters%20in%20Radiology.pdf November 17, 2019.
- Why Diversity Matters in Radiology. GE Healthcare. https://www.gehealthcare.com/long-article/why-diversity-matters-in-radiology October 18, 2019.