Indian Journal of Rheumatology

: 2021  |  Volume : 16  |  Issue : 3  |  Page : 245--247

Gender disparity in indian rheumatology – The problem and the solution

Tanmayee Bichile1, Grace C Wright2,  
1 Division of Rheumatology, Drexel University School of Medicine, Rheumatologist, Allegheny Health Network, Autoimmunity Institute, West Penn Hospital, Pittsburgh, PA, USA
2 Association of Women in Rheumatology, New York, NY, USA

Correspondence Address:
Dr. Tanmayee Bichile
Drexel University School of Medicine, Rheumatologist, Allegheny Health Network, Autoimmunity Institute, West Penn Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224

How to cite this article:
Bichile T, Wright GC. Gender disparity in indian rheumatology – The problem and the solution.Indian J Rheumatol 2021;16:245-247

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Bichile T, Wright GC. Gender disparity in indian rheumatology – The problem and the solution. Indian J Rheumatol [serial online] 2021 [cited 2021 Dec 5 ];16:245-247
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It is well established that women are underrepresented in medicine, with emerging evidence to indicate that this is a global problem. Women comprise up to 50% of medical students in the USA, but there exists significant gender disparity in leadership and academia. Women are less likely to be appointed to leadership positions in medical schools and professional organizations, to be lead authors in publishing papers in medical journals, to be invited speakers at medical grand rounds and annual conferences, to participate in clinical practice guidelines committees and attain full professorship. Women are paid less, promoted less often and in academia, receive less research funding as compared to men. This disparity has been shown to permeate across specialties in medicine and surgery and affect premier institutes like the National Institutes of Health in the USA.[1],[2],[3]

From an Indian perspective, this underrepresentation of women in medicine is similar to the overall global experience. Indian women now make up to 50% of medical students but only 33% pursue postgraduate training. In a recent study, Bajpai et al. report existing gender disparities for women oncologists in leadership positions (1 out of 4 major oncology societies has a female president, 2 out of 4 have female general secretaries). Similarly, there is a small proportion of women in executive committees ranging from 10.5% to 23.5%, as well as underrepresentation among memberships of oncology societies.[4] Authors Mohansundaram et al., in their important and timely paper “Does gender gap exist in Indian rheumatology? Analysis of faculty gender representation at its annual conferences” attempt to evaluate the extent of this problem in the Indian rheumatology sector.[5]

Mohansundaram et al., looked at the representation of women among speakers and chairpersons (India and International) as well as the first authorship among abstract presenters that attended IRACONs (Indian Rheumatology Association's [IRA] Annual Conferences) from 2010 to 2019. Their comparison of data from 2010 to 2014 and 2015–2019, revealed that over the past 10 years, only 18.5% ±2.34% of women were speakers and chairpersons in IRACONs. The proportion of male-to-female speakers was higher from 2015 to 2019 as compared to 2010–2014 (4.6:1 vs. 3.3:1 for male: female speakers). Only 4 women compared to 25 men, gave orations in the past 10 years. Among abstract presentations, women comprised 27% of presenters in the past 10 years with a male-to-female ratio of 2.7:1. An analysis of gender representation among life members of IRA found that female members have doubled from 30 to 61 from 2015 to 2019 as compared to 2010–2014, whereas male members only increased from 162 to 165. Despite this improvement in gender representation in life members, there was no significant change in the proportion of women as speakers and chairpersons at IRACONs. There was however, a positive trend noted in abstract presenters.

One of the limitations of the study includes the lack of comparison of gender-based membership trends at IRACONs over time to the total rheumatology training workforce in India. Do the IRACON/IRA memberships reflect national and local/regional trends? Another limitation is the lack of comparison among female representation at organizational and committee levels to invited speakers/chairpersons and abstract presenters.

In Rheumatology, gender disparity has been reported by Adami et al. in the first authorship of guidelines and recommendations and by Monga et al. in speaker representation at annual conferences. Adami et al. found that from January 1, 2004 to January 1, 2019, females comprised only 32.0% as first authors with an increase in first female authors noted in the past 15 years. The majority of published Rheumatology guidelines for rheumatoid arthritis, psoriatic arthritis/spondyloarthropathy, and osteoarthritis also revealed under-representation of female authorships.[6] Monga et al. found that among speakers and moderators of the American College of Rheumatology (ACR) and Association of Rheumatology Health Professionals meetings from 2017 to 2018, females represented 42.8% in 2017 and 47.0% in 2018. ACR had female representation above the mean compared to other North American medical conferences in 2017. A comparison before 2017 was not performed, so it is not known if this reflects an increase or decrease compared to prior years.[7]

The root cause of the gender gap in medicine and academia is complicated and poorly understood and is likely influenced by multiple factors. Societal and family expectations for roles defined by gender continue to exist globally. Female physicians and surgeons are not exempt from these gender roles. There are insufficient support systems at work (childcare) and home to help women manage responsibilities at home and work to progress in their careers. There are also few female mentors who can provide the needed support and guidance. Bias, both conscious and unconscious, may affect behaviors and attitudes that have negative outcomes for the advancement and promotion of women.

A “leaky pipeline” effect has been described in academia, with a sharp decline seen in positions with equal or higher women representation at undergraduate and postgraduate levels to those at senior and leadership roles. The reasons behind this are poorly understood.[8] “The reputation model” describes two components that can influence someone's status in the scientific community. First is their “Scientific reputation” which is identified by scientific contribution to the field, specifically activities that add value to their CV. Second being “Social reputation” which primarily includes their behavior and appearance which includes attributes of confidence, sociability, race, gender, professional network, etc., This model indicates that scientific contributions, personable behaviors and a strong professional network can improve someone's reputation. On the other hand, lack of scientific contribution, impersonal behavior, and bias can lead to discrimination and stereotyping and affect reputation negatively. One study found that after adjusting for the gender ratio of attendance and seniority, men ask 1.8 questions compared to women attendees in a conference. This lesser degree of participation was also apparent in classrooms in academic settings.[9],[10] It is apparent that women need to “speak up” in all types of professional and academic settings, engage in “self-promotion” and form a strong and wide professional network to enhance progress in academia and in leadership roles.

Does gender disparity matter and is it important to address it? Having representation and equity leads to a diverse and equitable work environment with positive effects not only on the quality of patient care, morbidity, mortality but can also create economic advantages. Evidence from the corporate sector shows that promoting gender diversity and equality at work has a positive impact on employee productivity, retention, satisfaction, and innovation.[11] With more health-care systems globally (including India) changing to a corporate model, it has become important to understand those things that can help employees thrive at work, with resultant improvements in productivity and profitability. Among Medicare patients, Tsugawa et al. found significantly lower 30-day mortality and readmission rates among elderly patients treated by females as compared to male physicians.[12] In a Canadian population-based cohort study, Wallis et al. found a small but significant decrease in 30 day mortality and surgical outcomes among patients treated with the female as compared to male surgeons.[13] These studies show that promoting gender equality and diversity has a positive impact on patient morbidity and mortality. Diversity and equality should be utilized by organizations to attract and retain talent.

Improving the gender gap in Rheumatology requires an acknowledgment of the problem, across the global rheumatology diaspora. It is encouraging to see the ACR providing a platform for women rheumatologists with increased representation in recent years. The European League Against Rheumatism (EULAR) has established a “EULAR Task Force on Gender Equity in Academic Rheumatology” taking a positive step to improve the representation of women rheumatologists in academia. The Association of Women in Rheumatology is also dedicated to increasing diversity, equity, and inclusion, as it provides mentorship and tools to advance women in Rheumatology.[14]

It is crucial for Indian rheumatologists at IRA and elsewhere, to join forces to address the problem articulated by the authors. Strategies should be developed to enhance the progress of Indian women rheumatologists in academic and leadership roles with resources dedicated to providing programs for early and effective mentorship, leadership training, and research funding.


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