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This interview has been edited for clarity and length.
Sara E. Wobker, MD, MPH, and Francesca Khani, MD, were curious about the gender representation of physician award recipients in the pathology field. They analyzed publicly available online information about physician recipients during a seven-year period from three general pathology society websites. They compared their data to specialty data from the Association of American Medical Colleges (AAMC) from 2015 and 2019, which showed a minimum of 36.7% women pathologists in 2015 and up to 43.4% in 2019.
Their analysis included 26 awards and 230 physician recipients, of whom 159 (69.1%) were men physicians and 71 (30.9%) women physicians. Overall, women physicians were underrepresented in recognition awards when compared to AAMC benchmarks. Career achievement awards that recognize a person's body of work showed a similar disparity with 22 of 73 recipients (30.1%) being women. Men physicians were more likely to receive multiple awards.
Critical Values sat down with first author Dr. Wobker, of the University of North Carolina, Chapel Hill, NC, and senior author Dr. Khani, of Weill Cornell Medicine in New York City. We wanted to know why they performed the study, what the findings mean, and the possible implications for the future of pathology.
Critical Values (CV): How did this study come about?
Francesca Khani (FK): As an active member of the academic pathology community, it has seemed to me that a lot of the great work women accomplish often gets overlooked and is underrecognized. Last year, Dr. Julie Silver, a physical medicine and rehabilitation physician who's one of the leading voices on gender equity in medicine, gave a lecture at Weill Cornell, where she presented some eye-opening published data that highlighted gender disparities in other medical specialties. Her work hadn't yet covered the field of pathology specifically, so I was inspired to initiate the study, and I recruited Dr. Wobker to lead it. Dr. Silver was incredibly generous in collaborating with us and sharing her expertise.
CV: What can we infer about awards in pathology from these results?
Sara Wobker (SW): As one of the first studies to look at gender representation in the field, it was especially important that we not make assumptions, but I think we can infer that pathology has the same problem that many other medical specialties have, which is the systemic underrepresentation of women for awards and recognition.
CV: What surprised you about the study results?
FK: We were surprised to learn that over the contemporary time period covered in the study, prestigious lifetime achievement awards went to women less frequently, despite more women advancing in the field and public efforts to shed light on diversity, equity, and inclusion issues.
SW: Yes, this is the opposite of what we expected. Over the years, with more women rising to the ranks of associate and full professor, we would have expected to see more prestigious awards going to women over time, not fewer.
CV: Are these results the product of a “pipeline problem” in pathology, in which younger underrepresented physicians “fall out” of the advancement pipeline prematurely?
SW: We don’t think this is an issue since we studied only people who were already board-certified pathologists. Many of the recipients have been in the specialty long enough to be promoted and receive tenure, especially in the case of prestigious awards, which most often go to late-career recipients.
CV: Speaking of promotions, why is it important who receives awards in any given field? FK: Recognition of women for awards speaks to a general question of fairness, but there are also practical implications. Awards may come with a cash prize, an invited lectureship, or other tangible benefits, all elements that promote a national reputation and help advance one’s career. Success is iterative and helps open the next door and the door after that. Additionally, doing more work for lesser recognition than one's colleagues is a known contributing factor to burnout. The data show that burnout is more prevalent in women in medicine. I think it seems likely that increasing the recognition of women in the field should help to alleviate this problem.
CV: How can this situation change in the future?
SW: Part of the reason we kept the study as broad as possible was to avoid the impression of pointing fingers at anyone. We’re not calling anyone out. We are information gathering so that we can get a better understanding of the current status and then start developing ways to improve it.
FK: Although different organizations have different processes for selecting award recipients, we feel that increased awareness of gender disparities during the submission and selection process would be helpful for increasing diversity in the pool of candidates and minimizing implicit bias. Steps can be taken to ensure that nominating committees are representative of our field.
SW: Dr. Silver has worked with various associations, including the American Academy of Neurology, where they have a gender disparity task force that put out a report that includes direct recommendations for their own society on how to improve this situation. These suggestions are quite specific and concrete, and many are applicable to any field of medicine. There are good materials out there to use as a roadmap if we as an association decide that is something we want to do. Our hope is that this study will start the conversation.
Read the full findings from Dr. Wobker and Dr. Khani on AJCP.