When Will the “Manels” Go Away?

#NoMoreManels, a hashtag that continues to trend on social media in 2021, both within and outside nephrology, is used to draw attention to panels of all-men speakers and moderators, despite an active US physician workforce that is over one-third women (1).

As with its inception as a field more than 50 years ago, nephrology remains a man-dominated discipline, with 30% women nephrologists (2). There exist gender disparities, not only in representation of women nephrologists but also in significant imbalances in compensation and leadership positions. Women earn a mean of $31,000 per year less than their male colleagues. Only 15% and 16% of department chairs and deans, respectively, are women. A recent analysis of National Institutes of Health funding found that women receive smaller grants than men, despite adjustment for research potential (3). The impact of the coronavirus infectious disease 2019 (COVID-19) pandemic on academic productivity has been described as greater for women than for men, with a 19% decrease in COVID-19–related articles with a woman as first author compared with women as first authors in the same journals in 2019. Further, a pre-pandemic study found that up to 80% of peer reviewers are men, and only one-third of journal articles have women as primary authors (4). Between 2011 and 2019, only 12% of American Society of Nephrology (ASN) lifetime achievement awards were given to women (5). Moreover, each of these awards is named after its own “manel” of nephrologists (Belding H. Scribner, Donald W. Seldin, Homer W. Smith, John P. Peters, and Robert G. Narins).

Results from a large 2017 survey of nephrologists that asked about their race or ethnicity using US Census Bureau criteria found that 7% chose Hispanic/Latino and 5% chose Black/African American, with low percentages of women among these groups (6). An Association of American Medical Colleges analysis in 2016 found that women of color make up 11% of all full-time faculty in US medical schools. Despite Black women making up 54% of Black faculty, they made up only one-third of Black full professors (7).

Have we made any progress? Analysis of data from the ASN found that the proportion of women moderators and speakers had increased to 47% and 40%, respectively, in 2019 from approximately 20% in 2011 (5). Organizations like Women in Nephrology strive to support and provide mentorship for women developing careers within nephrology and to advocate within the nephrology community for education and research relevant to women, while also providing mentoring opportunities for all.

As a nephrology community, we must strive for gender equity and creative inclusive environments that foster and promote excellence for women and for transgender, nonbinary, and gender-nonconforming individuals who face barriers to employment and advancement. The solution to this problem lies beyond the inclusion of women as speakers and moderators. Institutional guidelines should aim to create a supportive and equitable environment for all faculty members with attention to hiring practices, effective mentorship of all faculty, and transparency of compensation policies and information about expectations and practices regarding tenure and promotion. Diversity and inclusion must be prioritized at all levels, from nephrology fellowship application review to the formation of committees and selection of department chairs. Representation is not enough. Mentorship and leadership programs are needed. Rampant sexual harassment, in which prevalence in academic medicine is almost double that in other science or engineering specialties (8), must be combatted with a climate of respect and inclusion. Institutions may seek guidance and consultation from organizations like Advancing Health Equity (9) that seek to “engage with healthcare and related organizations around bias and racism in healthcare with the goal of mobilizing for health equity and eradicating racialized health inequities.”

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We have work to do. And it is time for things to change.