Shining the Light on an Age-Old Problem

Canadian female physicians are earning less than their male counterparts, and still occupying far fewer top jobs in hospitals and medical schools given their population. They continue to face sexual harassment at work and in academia. Medicine is just one more field where the gender gap is killing dreams and hurting people.

On International Women’s Day, we spoke with St. Michael’s Hospital’s top medicine doc about the pervasive problem of gender inequity in medicine and what needs to be done to fix it.

Dr. Sharon Straus is nothing short of a trailblazer. The first woman to hold the prestigious position of Physician-in-Chief (Interim) at St. Michael’s Hospital, Dr. Straus is a leading Canadian physician and researcher, and a passionate advocate for diversity. 

You recently co-authored a study that revealed female scientists are at a disadvantage when it comes to securing research funding. Your team showed that when a proposed project was evaluated solely on its merits, female scientists weren’t too far behind their male counterparts. But, when the projects were assessed based on the Principal Investigator, the decision was far more likely to favour the male-led proposals. This is just one study but how does it fit in our understanding of the gender gap in Canada?

For the past few decades, women have made up more than 50 per cent of undergraduate students in Canada and more than half of graduate students. And at medical school, women have comprised more than 50 per cent of classes over the past 20 years. But when you look at female leadership in academic medicine, our numbers are not reflective of these demographics.

In the Department of Medicine at the University of Toronto, where I am a professor, we’ve got 800 full-time members and about 30 per cent of our department are women. When we first started tackling the diversity issue in 2015, 80 percent of the leadership positions were held by men. As of July 2018, over half of our division director leaders are women, which is the first time that has ever happened.

Here at St. Michael’s Hospital, we looked at the gender gap at the Li Ka Shing Knowledge Institute, made up of the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre. We have about five times as many scientists who are men compared to women. We also looked at things like the gender distribution of those who present at grand rounds and other types of educational rounds — a system where residents and medical students learn from senior physicians. In some types of rounds, men led them 90 percent of the time. If women aren’t given the opportunity to present, people don’t see them. And that can affect the trajectory of their careers and provides fewer opportunities for role modeling for trainees.

What are the consequences when women have limited opportunities? Does it affect patient care? 

We know that when physicians don’t reflect the diversity of our patients, there can be practice variations. In other words, things get done differently, which affects how patients are treated. For example, a recent study showed that hospitalized older adults treated by women physicians had better outcomes (specifically few readmissions and lower mortality) than those treated by men. 

We also know that the more diverse the healthcare providers, the more innovation there is. And we know that those coming into the health-care field need role models. If you can’t see us, you can’t be us. 

We have to look at individual factors as well. Our recent study published in the Lancet showed that women are assessed differently than men and it can impact their careers. Women are less likely to get grant funding, they are slower to get promotions, and there are salary differentials that are massive when you add it up over the span of a career. One of the biggest consequences is that we’re losing a significant portion of our population who can contribute in a big way.

No large-scale societal problem has a magic bullet, but what strategies do you think can be used to fix this problem?

There used to be no formal recruitment process at the University of Toronto’s Department of Medicine.  Jobs were created for people with no standardized processes for hiring. We’ve changed that under the leadership of our Chair, Dr. Gillian Hawker. Now every job has to go through a proper search committee, and we value diversity. That’s one of the reasons we have so many women working in leadership now. We have also committed to this process here at the Li Ka Shing Knowledge Institute and in our hospital’s Department of Medicine. 

Women also report in studies that they lack access to informal networking and mentorship, which are big parts of career growth. For example, a male mentor may take their male mentee out for a beer or to a ballgame but they won’t do that with a female mentee. It’s during those informal occasions that career opportunities get discussed. So, one of the things we’ve tried to do both at the university and in our Department of Medicine here at St. Mike’s is create informal networking opportunities for our trainees and junior faculty. We’ve also helped the Li Ka Shing Knowledge Institute develop a mentorship program. 

Women are more likely to experience incivility and unprofessionalism. At the university, we’ve tied professional advancement to professional behavior. If there is documentation of inappropriate behavior, our Chair, Dr. Hawker, will not support that individual for promotion until this is addressed.  

These are programmatic strategies to remove barriers, but we can also use some common-sense. We can decide not to hold meetings at 7:30 in the morning or during school pick-up hours. We identified some of these obstacles to people participating in various meetings in our St. Mike’s project. 

How much of the problem is because women are still the dominant caregivers at home?

It is a contributing factor. Women are the ones who have children, that’s the biological reality. 

We don’t have a good method yet for taking into account maternity leave, or any leave for that matter. We have to create a model of a person’s trajectory before their leave as a way of determining advancement. We also have to see if we can institute funding opportunities to support a leave. Another option might be to hire a research coordinator to cover off a leave or to ramp up when someone is coming back from leave. 

It’s not all bad news. Historically, less than 17 per cent of Canadian Research Chair Tier 1’s, which are the senior chairs, were held by women. Less than 30 per cent of women held Tier 2’s. But because the government has mandated that the universities address diversity, this year 50 per cent of applicants for the CRC are women. It’s pretty remarkable.

I’m incredibly privileged to do what I get to do every single day. I think the reason many women take on leadership positions is to effect change and to make things different for future generations.

Dr. Sharon Straus holds a coveted Tier 1 Canada Research Chair in Knowledge Translation and Quality of Care, and has secured more than $57 million in peer-reviewed research grants as a Principal Investigator(PI). An author of three books (one published in nine languages) and more than 400 publications, Dr. Straus is professor and Division Director of Geriatric Medicine at the University of Toronto where she has supervised more than 25 graduate students.