November 11, 2019
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Penn program addresses ‘barriers and bias’ unique to women in oncology

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Charu Aggarwal, MD, MPH
Charu Aggarwal

PHILADELPHIA — More than 40% of U.S. medical students and physicians-in-training over the past 2 decades have been female.

However, women account for only 18% of hospital CEOs and 16% of all deans and department chairs across the country. Additionally, only 10% of senior authors of peer-reviewed journal articles and only 7% of medical journal editors-in-chief are female.

Although sex disparities have started to narrow, much work remains in the effort for women to have truly equal opportunities in the medical field, according to panelists from A Seat at the Table: Removing Barriers & Bias for Women in Oncology, an inaugural event hosted by University of Pennsylvania.

“Women in oncology bring so many characteristics to the table,” meeting co-chair Charu Aggarwal, MD, MPH, assistant professor for lung cancer excellence at University of Pennsylvania’s Perelman School of Medicine and a HemOnc Today Editorial Board Member, said during the presentation. “With their grit, compassion, kindness, empathy and attention to detail, it’s no surprise women are at the forefront of cancer discoveries and leading departments, divisions and cancer centers. At the same time, women face unique barriers and bias every day — especially in medicine.”

Program participants discussed critical issues for women in oncology, focusing on topics such as mentorship, maximizing opportunities and work-life balance.

Mentors and sponsors

It is extremely important for women to have effective mentors when they are training to become physicians, Carmen E. Guerra, MD, MSCE, FACP, associate professor of medicine in the division of general internal medicine, associate chief of staff of Abramson Cancer Center, and vice chair for diversity and inclusion in the department of medicine at Perelman Center for Advanced Medicine, told HemOnc Today.

“A mentor should be wise and should care about the whole person, not just who you are at work,” Guerra said. “They should help make important decisions about balancing career and family as you move up and develop skills to be independent.”

Because of workforce disparities in the oncology community, female trainees or early career clinicians do not always have the opportunity to have another woman as a mentor. However, when possible, it is advantageous, Guerra said.

“She may understand the challenges of being a woman at home and being a faculty member at work,” Guerra said. “There is a lot of tension between those two roles, and how she navigated that is often so liberating to understand and can be adopted as a strategy to help with success.”

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Female trainees also should look for sponsors, whose role differs from the more personal relationship one has with a mentor.

A sponsor typically is at the highest levels of the institution and has relationships with members of senior leadership. However, the relationship must be reciprocal.

“If he or she is willing to spend their political capital on elevating you for leadership positions, they are going to expect that you will do a phenomenal job,” Guerra said.

‘Jumping at o pportunities

Sex disparities in pay are particularly pronounced in the medical field.

A study published in 2017 in Annals of Internal Medicine showed that male primary care physicians made $229,000 annually, whereas women made $197,000. This gap is even wider for specialists, with men earning $345,000 annually and women earning $251,000.

In academic medicine — after adjusting for faculty rank, age, years since residency, specialty, funding from NIH, clinical trial participation, publication count and total Medicare payments — male physicians made an average of $247,661 annually, whereas female physicians made $227,783.

“One of the most effective things we have seen in other countries is that companies over a certain size have to publish their pay gap, so there is pressure to close that gap so they can recruit younger women to that company,” Erin Aakhus, MD, associate director of the hematology/oncology fellowship program and assistant professor of clinical medicine at Perelman School of Medicine, told HemOnc Today.

Salary negotiations also vary between men and women, Aakhus said.

“Eliminating salary negotiation and having policies that are not negotiable — including a payment scheme where individuals can’t adjust their salary based on certain arguments — could help with the pay gap,” she said.

It also is important for women to take advantage of opportunities when presented with them, panelists said.

“When you see an opportunity, do not be afraid to grasp it,” M. Celeste Simon, PhD, scientific director of Abramson Family Cancer Research Institute at Perelman School of Medicine, said during the presentation. “My life and career have been a discovery. I’ve been very fortunate to have many people throughout my career tell me I was thinking too small. I can’t overemphasize how important jumping at opportunities is for advancing your career.”

Work-life balance

Beyond the pay gap, balancing work and family life — particularly given societal expectations — can be one of the toughest challenges a woman committed to a career in oncology will face, panelists said.

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“We all have purpose and passion in what we do,” meeting co-chair Julia C. Tchou, MD, PhD, FACS, section chief of breast surgery and professor of clinical surgery at Perelman School of Medicine, said during the presentation. “But how do we sustain this purpose and passion while dealing with home life? That’s an internal conflict we all experience.”

Part of the key is remembering that work is a part of life, just as family members, friends and communities are.

“This idea that... we have to find this counterweight to work is an unrealistic ideal,” Maureen R. Hewitt, MD, clinical associate of medicine at Perelman School of Medicine, said during the presentation. “It can really make us dissatisfied with our work and can lead to burnout, which we are hearing more and more about. The trick is to find things in work that are restorative for us and remind us why we love doing what we do. It’s very meaningful and very gratifying, and sometimes we have to remind ourselves of that.”

As society continues to evolve, the medical field will, too, Aakhus said.

“The majority of students in medical school are actually women, and this has changed dramatically over the last 20 years,” Aakhus told HemOnc Today. “The challenges are going to be how we adapt our institutional expectations and policies to meet the values and changing expectations of younger doctors.” – by John DeRosier

For more information:

Erin Aakhus, MD, can be reached at erin.aakhus@uphs.upenn.edu.

Charu Aggarwal, MD, MPH, can be reached at charu.aggarwal@uphs.upenn.edu.

Carmen E. Guerra, MD, MSCE, FACP, can be reached at carmen.guerra@uphs.upenn.edu.

References :

Butkus R, et al. Ann Intern Med. 2018;doi:10.7326/M17-3438.

https://www.med.upenn.edu/oncologywomen/?utm_source=vanity%20URL&utm_medium=Referral&utm_campaign=penn-medicine&utm_content=redirect-pennmedicine-org-abramson%2Fwio2019