06.10.2020 | COVID-19 | Perspective
Minding the Gap: Organizational Strategies to Promote Gender Equity in Academic Medicine During the COVID-19 Pandemic
Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2020
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The COVID-19 pandemic and its sequelae are likely to have disproportionate impact on women physicians, professionally and personally, and we must take steps to mitigate this undue burden. Women are more likely to be essential workers during the pandemic and comprise the majority of the healthcare workforce writ large.1 Compared with male colleagues, women in medicine also have increased responsibility for dependent care and domestic duties.2‐7 In light of these additional roles and responsibilities, we are particularly concerned about women’s sustained productivity, career advancement, and compensation as well as potentially deleterious effects on their well-being and retention.8 As we move into the next phase of the pandemic, whether it be recovery or planning for a resurgence, it is imperative that healthcare institutions pay attention to the inequitable impact policies and practices may have on a significant portion of our physician workforce. Furthermore, it is critical that decisions made during the current public health crisis do not erode previous progress our profession has made toward gender equity. In this statement, we highlight four crucial concerns and recommend organizational strategies to prevent or mitigate each.-
Standardize how professional effort is calculated among the three mission areas of education, research, and clinical care. Identify appropriate compensation benchmarks for this effort and apply these metrics consistently across departments and divisions. Conduct salary audits and, when doing so, consider base pay, incentive pay, and leadership stipends with an eye toward equity and eligibility. Women in medicine experience well-documented disparities in leadership opportunities,13, 14 potentially limiting their earning potential. Because women are also disproportionately assigned to uncompensated service-related tasks within organizations (e.g., committee work), salary studies should attempt to capture professional effort related to non-clinical activities.15‐17
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Robustly monitor gender metrics pertaining to full-time equivalent (FTE) reductions and/or reallocations and assess impact on total compensation (salary and benefits)—at many institutions, reduction in FTE leads to a disproportionate decrease in benefits like healthcare coverage. Commit to sharing these metrics throughout the institution in a transparent and accessible manner, and preferably provide forums for discussion and feedback prior to implementation.
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Identify and account for reduced year-end clinical productivity and reimbursement due to COVID-19 so as not to impact incentive compensation negatively.
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Ensure that women physicians participate in organizational decision-making around changes to salary, benefits, and professional effort due to the pandemic. Incorporating women’s voices, knowledge, and leadership in this arena is critical to developing equitable (and realistic) practices.
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In the setting of pay freezes or salary reductions in response to the pandemic, reimburse individuals for monies that would have been earned, when institutional finances allow, with a focus on achieving pay equity.
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Consider awarding stipends to physicians who are re-deployed to COVID-19-related work.
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Continue alternate (and flexible) work schedules as well as enhanced access for remote working during non-surge periods.
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Partner with local businesses to offer subsidized or bulk discounts to support self- and family-care needs such as dry cleaning, food delivery, and housecleaning, to minimize the financial and time burdens of these activities.
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Promote efforts within departments or divisions to pool and vet dependent care providers for all to share (if not already established by the institution).
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Collaborate with local organizations, including existing childcare providers, to create or reopen care centers for children of essential workers.
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Consider introducing or increasing subsidies for dependent care costs if school or daycare closures cause undue financial hardship.
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Develop social support hubs and practical seminars focused on resiliency, managing vicarious trauma, and building camaraderie and community. Be mindful that these opportunities do not place additional burden on women physicians to organize and execute.
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Implement a mechanism to capture “COVID-19 contributions” on curriculum vitae and specifically encourage women faculty to document their efforts. The pandemic has afforded unique opportunities for innovation in operations, clinical care, research, and teaching. Contributions may include developing evidence-based institutional guidelines, creating patient-centered communications, responding to media or other inquiries, building forums for peer education or community-building, attending to trainee education, and analyzing social determinants of health and inequities.
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Encourage the inclusion of women on COVID-19 research teams, and sponsor women for dedicated institutional and national COVID-19 research funding opportunities.
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Allow scholarly activities (e.g., invited talks, conference workshops) that were canceled or had to be declined because of the COVID-19 pandemic to be listed on curriculum vitae.
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Ensure that women and those with diverse research portfolios are included in decision-making around prioritizing activities within the research enterprise.
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Resist cuts to internal grant mechanisms that support early career investigators.
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Consider the long-term implications on career advancement before implementing cost-cutting measures that would diminish travel time and funding for scholarly endeavors (e.g., reducing annual allotments for conference attendance and prohibiting professional travel).
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Develop promotion structures and processes to recognize COVID-19 research, clinical care, administration, and teaching.
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Develop a mechanism for extending promotion deadlines for academic faculty to account for disruptions in productivity and opportunities related to the COVID-19 pandemic. Normalize this extension by creating a culture of acceptance around productivity challenges during the pandemic or by automating a standard extension for all faculty.
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Capitalize on affiliations with national organizations such as the Society of General Internal Medicine (SGIM) and the American Association of Medical Colleges (AAMC) that have professional development and sponsorship programs that specifically benefit women physicians and allow for remote participation (e.g., SGIM’s Career Advising Program).38
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When possible, maintain funding streams for institutional programs that support women’s career advancement and leadership development.
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Widely publicize organizational leadership opportunities and ensure that women have strong representation on search and promotion committees.