Gender Reversal in the Field of Rheumatology

Alfred Kim, MD, instructor of medicine in the division of rheumatology at Washington University School of Medicine, St. Louis, agrees. After three years as a rheumatologist, Dr. Kim emphasized that everyone in his generation is interested in “protecting the work–life balance,” adding that, at his institution, clinicians negotiating their contracts may request both maternity and paternity leave with the department chairs on a case-by-case basis. Dr. Kim also finds that schedule flexibility has a positive effect on both clinical work and research: “Flexibility allows me to do the amount of research I want to do without compromising my ability to provide outstanding clinical care or receive training.”

“Protected time for the family” is the phrase used by Joshua F. Baker, MD, MSCE, instructor in the division of rheumatology at the University of Pennsylvania in Philadelphia. In his fifth year as a rheumatologist, Dr. Baker values the time flexibility of the field, which, as the son of a rheumatologist, he has always perceived to be an advantage. Like his female colleagues, Dr. Baker appreciates the opportunities that the field of rheumatology offers to fulfill both professional and personal obligations.

It appears then that the current workforce shifts are often due as much to generational changes as to gender. Both women and men in training and starting their careers are interested in establishing and maintaining a balance between their professional and personal lives. Younger rheumatologists focus less on gender and more on opportunities and professional growth for everyone. “Everyone’s voice can and should be heard if there is an even distribution of men and women in the field,” says Dr. Kim.

Gender Disparities

Despite the future trends, gender disparities do exist. What issues still need to be addressed?

• Compensation disparity is an ongoing issue. Dr. Abelson expresses concern about data from a study by Lo Sasso et al, indicating that in a controlled study of 8,000 physicians in New York, there was an ever-widening pay gap between men and women from 1999 to 2008.¹ Data available through the Medscape Rheumatology Compensation Report of 2012 show that men earn a mean of $191,000 per year while women earn a mean of $149,000 per year.²
• Women rheumatologists are underrepresented in academic leadership roles, and the representation has remained unchanged for the past five years.
• It often takes longer for women to complete tenure track due to personal and family obligations. Flavia Castelino, MD, instructor in medicine at Harvard Medical School in Boston, points out that while her institution “protects time for the parenting gap through institutional grants, it requires that a physician reach the level of assistant professor before entering the tenure track.”
• Research funding for women can be a challenge if the time needed to become an investigator or to achieve tenure is prolonged because of time taken for childbearing or family responsibilities.
• Funding to maintain ongoing research while attending to personal and family responsibilities is not always available for women. There is a need for resources (technicians and other staff) to carry out research functions while the researcher is starting a family or balancing other obligations.

Fortunately, remediation for some of these issues is already underway. The ACR is developing ways to support the practice preferences of women so that their collaborative approach receives equitable compensation.