Aletha Maybank, MD, MPH, discusses gender equity issues in health care

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In recognition of Women in Medicine Month, three women physicians share their perspectives on gender equity and issues in health care, especially during the pandemic.

Learn more at the AMA COVID-19 resource center.

Speakers

• Aletha Maybank, MD, MPH, chief health equity officer, AMA
• Maya Hammoud, MD, senior advisor, medical education innovation, AMA
• Kate Kirley, MD, MS, director, chronic disease prevention, AMA

Unger: Hello, this is the American Medical Association's COVID-19 update. Today we're discussing gender equity issues in health care and COVID-19. This is part of a special series focused on women physicians and patients throughout September, in honor of the AMA's Women in Medicine Month. I'm joined today by Dr. Aletha Maybank, AMA's chief health equity officer in New York, Dr. Kate Kirley, AMA's director of chronic disease prevention in Chicago and Dr. Maya Hammoud, AMA's senior advisor in medical education innovation, and a professor at the University of Michigan Medical School in Ann Arbor, Michigan. I'm Todd Unger, AMA's chief experience officer in Chicago.

Dr. Maybank. Let's start with you. Can you tell us a little bit about what gender inequities do we see in health care right now and how have they affected women physicians during the pandemic?

Dr. Maybank: Yeah, thanks Todd. Gender inequities, as in most inequities that we're seeing were existing long before the pandemic. We were very clear pay gaps that existed for us as physicians. We know that female physicians are actually about a quarter less likely to get the same salary that their male peers do. And we know across race, ethnicity lines and gender, that those differences are even greater. We know that as women physicians also our leadership roles, we don't get them in the same way, in terms of executive positions or heads of divisions or health care systems at that. And so we're significantly less likely to have that.

And so the pandemic is really only served to amplify this reality and to kind of see that the woman's voice and our voice is not present in many spaces in terms of the response, but it also really speaks to and really has elevated kind of the amount of kind of pressure and burden that's on a woman in the context of not only her relationship of what, how she operates as a physician or exist as a physician, but also with her family and the context of her family, whether she has children or not. Your extended family, I have an 80 year old mother. And the reality is that I have to do a lot in order to care for her during his time. And how do you fit all of this in, especially as a physician, if you're a resident, a med student or physician, when you have to be in a particular space for that job. It's very rare that most physicians can work from home. And then if you're home and your children are home, what are you doing? It just all is amplified during COVID.

Unger: Dr. Hammoud, how we see these inequities play out in academic medicine?

Dr. Hammoud: Thank you, Todd, as you know, these gender inequities have existed for a very long time, and we have been very slow to make progress. Even though men and women have entered the profession equally since 2003, we still see a very, very small number of women who are full professors, deans, and chairs, and they are... women continue to be underrepresented among authors of medical research and tenured professors.

And right now with what Dr. Maybank just talked about is with the amplification from COVID-19 and what's happening. We are seeing more women taking pauses in their careers. I certainly see that in OB/GYN because we have a lot of women and what we need to be thinking about both short term and long term, it's going to... we already have a large gender gap, and this is just only going to amplify even further. And we need to be really a lot more proactive in thinking about it. And actually we already have data that shows that women—in June during the COVID-19 pandemic—even though research papers have gone up to journal submissions and publications, female authors have only accounted for about one third of all authors on published COVID-19 papers. And definitely there was a lower number of first authors, and it was very clearly seen in March and April. We are already seeing the effects and we know that this is going to affect women in their promotion and in their career progression.

Unger: What do you see as the dynamic behind that kind of decrease in the research?

Dr. Hammoud: It's what Dr. Maybank talked about is women have a bigger role in their personal lives. They are the ones who are taking care of the children. I know our own faculty here, their children who are having schools virtually from home. They are the ones who are responsible. They are the ones who are actually having to take time out or reduce their work. It's the disproportionate burden on women when it comes to personal lives and stressors.

Unger: Dr. Kirley, you've been in clinical practice, academia, and you've held leadership positions in medicine. What's your perspective on gender equity in medicine?

Dr. Kirley: Yeah, I really appreciate the comments from Dr. Maybank and Dr. Hammoud. They definitely ring true right now. As sort of an early career transitioning to mid-career physician, I am sitting here trying to sort of navigate and continue to advance my own career, despite all of the challenges of COVID, challenges of increased responsibility with home and personal life right now.

It's always so interesting to me that as women physicians we're told if we want to advance, we really need to behave a little bit more, perhaps, like a stereotypical man, sort of play within the system that really has been created by men. Meanwhile, as girls and as young women, society has really trained us to be more demure, be more deferential. And so then you enter this professional life and you're told, "Just kidding. You can't play like that. You really have to change the way you behave."

My strategy has really been to look for leaders, for mentors, for champions who are going to really work with me on my strengths rather than try to change me. And I think so far that's been a relatively successful strategy, but at the same time, that feels all up in the air right now, as the dynamics continue to change with all of the challenges of COVID. It's just a tough time right now.

Unger: I know one of the dynamics that you mentioned, that's somewhat ironic, is this a, I guess, a desire to protect women physicians given how much is on their plates. That must be magnified incredibly by this pandemic right now.

Dr. Kirley: Yeah. And I think it's a mixed bag there. It's so tough. Like I said, I've looked for leaders, champions who will recognize where I am in both my personal and professional life and will take that into consideration. But at the same time, we don't want our leaders making assumptions for us, assuming that we don't want to step into a leadership role or a more challenging role because of the limitations or the challenges outside of our professional lives right now.

And so I just encourage everyone who is in that leadership position to leave it open to us, to make that decision for ourselves. It's so great to hear the support and hear that people care and they ask about where you are right now, but at the same time, don't step into that decision making position for the person.

Dr. Maybank: And that asking about where you are, and it is a tricky question I feel oftentimes. We get asked all the time, 'How are you, Aletha. How's everything going?" And you feel this pressure to say, "Everything's great. Everything's fine. I'm okay." I see all the joy in so many people's spaces sometimes. And I really want to say, "I'm exhausted, I'm tired." And we don't have the space to do that as freely as women, and especially I feel as a Black woman, I really don't have that space, because then it's perceived that we can't handle it, that we're not strong enough. And that maybe we need to do something else, and even if we're doing well, it's just the narrative that starts to go around and around becomes defeating. And it doesn't help us and it's not supportive.

And so I think part of it is also challenging leadership to understand their own power and their own power in creating and changing these narratives. And these assumptions as was already mentioned that they have about women in society and what we can do and what we can't do. And when we express our emotion, that it's not a negative thing, it's actually a really positive thing. It really should help folks feel vulnerable and have space to relax, to be able to share their emotions.

Todd, you know me well, and I'm pretty direct. And I think it's really important to be that way, to have candor so that we can move forward and honest conversations about these power struggles between men and women in our society.

Dr. Hammoud: ... I'd to share with you, I am exhausted and tired.

Dr. Maybank: Yeah, exactly.

Unger: Dr. Hammoud, will you continue? Dr. Maybank is really speaking to what we can and should be doing to solve these challenges. What are your recommendations?

Dr. Hammoud: I think that it's hearing the voices. I've seen recently some decisions that were made that people have not really thought how does that impact women? I mean, I understand that there are a lot of changes that have to happen, but this goes to diversity in general, right? When you don't have all the perspectives on the table and then at a leadership level, you're not going to actually have that perspective. And we certainly have seen that happen, and we need to remind people, you must have all the voices on the table, because you need to understand how that actually affects every individual. We can tell women, "We want to help you, and we care about you," but if we're not listening to what they want or understand what they want, then we're not going to be able to actually help them.

And I would tell you, as a woman, myself, I feel very challenged. I lead a division of 35 faculty members, most of them are women. And I feel very challenged sometimes because my heart goes out to them. I want to help them. I'm managing down and I'm managing up about how do I actually help them get what they need.

Dr. Maybank: Yes, I echo that, that managing up, across, down and everywhere oftentimes is invisible to many people, right? Because we don't complain about it. We do it, because we know it has to get done. We do that in our workplace. We do that in our homes. That's kind of the nature, I think, in a sense of being a woman. And I think it's important for us, this is more kind of sister talk now, that we have to have our own spaces and our own trusted entities that we can go to in order to just unwind and to breathe and to say, "This is hard and this is not easy."

And in the context for me as well, and other people, not just me, but with George Floyd, the public murder, if I see another public murder or a video of an individual getting murdered in that way and killed and life loss, I almost can't take it; it's exhausting. And so all of that is compounding. We don't live singular lives and I feel we need to just appreciate that about all of us.

Dr. Kirley: Absolutely. If I can jump in Todd, I think 2020 has really highlighted the need for all of us to be supportive of each other, I think, within our own communities. But at the same time, what makes me feel a little bit more optimistic about 2020 is I think it's becoming a time of allies as well. And in the case of gender and equity, I'm seeing more and more men step up, and first of all, sort of notice the power structure, which I just appreciate the noticing, but more importantly, going beyond the noticing and taking steps, using their position of power to make changes. And I think I really want to encourage more people to be allies here.

Unger: You're all speaking to the idea of the exhaustion. We know burnout was one of those issues that was already an enormous problem in medicine before the pandemic. It's been exacerbated by that. I had the chance yesterday to speak with the family of Dr. Lorna Breen, the emergency medicine physician in New York who died by suicide back in April, really highlighting how burnout in this pandemic is deadly. Can you speak a little bit to how physicians should support each other in this time regarding burnout?

Dr. Maybank: I think it speaks to how the systems are not set up to work for us. Burnout is an output of a system and a structure that is not working well. I mean, COVID highlights how ineffective and fractured our health care system is, but it also highlights how ineffective our culture is as medicine and how it doesn't help support folks to thrive in the way that we think it does oftentimes. And it's a system and culture that forces people to feel like they can't share and to be quiet, but it also is a system that doesn't allow folks to have time to manage all aspects of their lives. And then you add COVID on top of that, and it's just like, oh my goodness. It's just a lot.

And so we really have to focus on the systems. And so for the leaders and for whomever, the leaders are, whether they're male, female, whatever, their race, gender identification, whatever it is, we have to focus on the systems and changing them so that that works better, which means we're going to have to focus more on the policies, right, that set up those systems.

I always push that. We can look at the downstream aspects of burnout: important. And how we support physicians and their own kind of direct downstream way. But that's not going to change or improve if we don't look more upstream.

Dr. Hammoud: What we're seeing is many times we actually make decisions that are counterproductive to what we're trying to accomplish. Right now, with a lot of the health systems and how they suffered financially, they're trying to really push their faculty and their physicians to work a lot harder. And what they're not realizing is we're all already extremely stressed. You add one more thing, actually, you're not going to do well if I'm out because I need the help. And people often forget that putting more stress and making people work harder is not necessarily going to mean more production. And I think we need to remember more of that in medicine.

Dr. Kirley: Absolutely. I mean, if one more person tells me to work smarter, not harder without also giving me the resources to do so, I'm probably going to lose it.

Dr. Maybank: I know.

Dr. Kirley: And advocacy really is a key tool that we need to employ here, for sure.

Unger: Well, thank you so much. This has been an excellent discussion. Really, really appreciate Dr. Maybank, Dr. Kirley, Dr. Hammoud for being here today, sharing your perspectives and being a part of AMA's Women in Medicine Month. That's it for today's COVID-19 update. We'll be back soon with another segment for resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.