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    Lederer E. Women in nephrology today. Clin J Am Soc Nephrol 2018; 13:17551756. doi: 10.2215/CJN.07650618

  • 2.

    Martín-Gómez MA, et al. The role of women throughout the history of nephrology. Nefrologia (Engl Ed) 2019; 39:1517. doi: 10.1016/j.nefro.2018.08.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Eknoyan G. Women: Medicine, their kidneys, and nephrology. Adv Chronic Kidney Dis 2013; 20:382389. doi: 10.1053/j.ackd.2013.03.003

  • 4.

    Weinstock Brown W, Anderson S. Women in nephrology leadership. Adv Chronic Kidney Dis 2018; 25:519522. doi: 10.1053/j.ackd.2018.08.014

  • 5.

    Malieckal DA, et al. Trends in the proportions of women program chairs, moderators, and speakers at American Society of Nephrology Kidney Week 2011-2019. Clin J Am Soc Nephrol 2020; 15:265266. doi: 10.2215/CJN.08140719

    • Crossref
    • Search Google Scholar
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  • 6.

    Dave NN, et al. An introduction and guide to becoming a social media savvy nephrologist. Nephrol Dial Transplant 2020, 17. doi: 10.1093/ndt/gfaa067; https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa067/5834661

    • Search Google Scholar
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  • 7.

    Association of American Medical Colleges. Diversity and Inclusion. Diversity in Medicine: Facts and Figures 2019. Table 13. Practice Specialty, Males by Race/Ethnicity, 2018. https://www.aamc.org/data-reports/workforce/data/table-13-practice-specialty-males-race/ethnicity-2018

    • Search Google Scholar
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  • 8.

    Butkus R, et al. Achieving gender equity in physician compensation and career advancement: A position paper of the American College of Physicians. Ann Intern Med 2018; 168:721723. doi: 10.7326/M17-3438

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Martin KL. Medscape Nephrologist Compensation Report 2020. May 20, 2020. https://www.medscape.com/slideshow/2020-compensation-nephrolo-gist-6012736

    • Search Google Scholar
    • Export Citation
  • 10.

    Brotherton SE, Etzel SI. Graduate medical education, 2019-2020. JAMA 2020; 324:12301250. doi: 10.1001/jama.2020.14635

Women in Nephrology: Progress and Goals

  • 1 Anika Lucas is a Fellow in Nephrology at Duke University School of Medicine, Durham, NC. Mala Sachdeva is an Associate Professor of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY. Ellie Kelepouris is a Professor of Clinical Medicine with the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Lisa M. Curtis is an Associate Professor of Medicine with the University of Alabama at Birmingham, Birmingham, AL.
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Over 60 years ago, nephrology was established as a medical specialty. In 1966, the American Society of Nephrology (ASN) was founded by 17 men (1). Although there were many notable women researchers and physicians caring for women with kidney disease at that time, there was an apparent gender gap in leadership. Interestingly, women were trailblazers in the field of nephrology even before it was recognized as a distinct specialty. Women such as Phyllis Adele Bott, Margaret Mylle, Muriel MacDowell, and Dr. Alma Elizabeth Hiller made profound contributions to our understanding of renal physiology (2). Pauline M. Hald authored one of the first papers on how to measure electrolytes in 1946, but it was not until 1972 that a woman nephrologist became an international leader. Dr. Priscilla Kincaid-Smith, an astute researcher on analgesic nephropathy, was the first woman president of the International Society of Nephrology (ISN) (3).

Women nephrologists recognized the critical need for representation and mentorship in our field. On December 5, 1983, Dr. Nancy Gary, Dr. Lois Katz, Dr. Sandra Levison, and Dr. Mabel Purkerson founded Women in Nephrology (WIN). The main objective was twofold: to enhance professional development and career opportunities for women in this field and to advocate for inclusivity and gender equality throughout the field of nephrology (Figure 1). Since its beginning, WIN has been steadfast in its mission to facilitate career and leadership development and to increase representation of women nephrologists. WIN has sponsored an annual professional development series as part of the ASN pre-Kidney Week meetings in past years and additional workshops, as well as the annual Dr. Nancy Gary luncheon lecture during Kidney Week meetings. Career development workshops sponsored by WIN have also been held at other national kidney organizations, including the National Kidney Foundation (NKF), the Renal Physicians Association (RPA), and, this year, at the ISN World Congress of Nephrology. An annual WIN Leadership Conference with purposes to create mentorship and networking opportunities and facilitate leadership training was begun by WIN in 2020. The second annual Leadership Conference is planned for September 24, 2021, in Birmingham, AL. The first WIN Speakers Bureau, including women and men nephrologists with specialized expertise in many areas of nephrology, was created by WIN this past year in response to the need identified by event organizers and repeated requests for suggested names received by WIN. Although WIN has actively provided mentorship on a case-by-case basis since its inception, a new formal Mentor Match program was initiated a few years ago.

Since the creation of WIN, there have been 4 (of 55, or 7%) female presidents of the ASN, including the current president, Dr. Susan Quaggin, and others serving on the Council in preparation for the presidency; 3 (of 24, or 12.5%) female physician presidents of the NKF, with a past leader of WIN serving as president-elect this year; and at least 1 chairwoman of the NKF. Women have also served as presidents of the ISN (3 of 25, or 12%) (4), including the current president who is a WIN leadership alumna. Through the efforts of WIN in collaboration with ASN and its Diversity, Equity, and Inclusion Committee, the number of women moderators increased by 47% and women speakers by 40% at Kidney Week in 2019 (5). There are more women in leadership roles locally, serving as medical school deans, Department of Medicine chairs, division chiefs in nephrology, program directors, and associate program directors. The advancement of women in the field of nephrology is the result of the dedicated and determined efforts of many individuals as well as organizations such as WIN, ASN, NKF, RPA, and ISN. The use of social media to contribute to women's career advancement cannot be underestimated, as many women have used social media to build global networks and create opportunities for self-promotion. The establishment of a professional online presence will increasingly be important in advancing careers (6).

Although we have made some progress toward gender equity in the field of nephrology, there are still important challenges we have yet to overcome. We must sustain the woman leadership pipeline to reflect the diversity of patients with chronic kidney disease (CKD) and to provide diverse role models for trainees. In 2020, only 27% of academic women physicians were professors, whereas 59% of women were instructors. There is also a great need for women of color in nephrology. Black women make up 5.2% of faculty; American Indian or Alaskan Native 0.1%; Asian women 35%; Hispanic, Latina, or Spanish women 5.7%; and Native Hawaiian or Pacific Islander 0.1%, whereas White women are 38% of women faculty (7). Pay equity continues to be a major issue (8). According to the 2020 Medscape Nephrologist Compensation Report, male nephrologists still make 18% more than women (9). Although men spent on average 7.1 more hours than women with patients, gender disparities in compensation continue to exist in both academic centers and private practices (9). Gender equity also encompasses the support of women who choose to become mothers. Maternity leave, lactation rooms, and additional support for childcare continue to be important areas of concern for many women nephrologists, contributing to added stress. The COVID-19 pandemic, coupled with continued disproportionate responsibility for family care by women (e.g., elder- and childcare, household work), presented additional barriers to the advancement of women in our field, as many expanded their care-taking roles in the home. The pandemic highlighted these challenges by upending the precarious patchwork of support for home-based care that women have utilized in the past to sustain careers. Although COVID-19 put in stark relief the impact of the burden of household demand on productivity, one feature of the pandemic may offer future advantages that are particularly relevant to women. With the advent of virtual talks, many women who have declined opportunities due to household demands may be able to utilize the flexibility of doing these talks from their home base. Continuing to provide this advantage may have significant implications on the advancement of those previously underrepresented in these offerings. The long-term consequences, positive and negative, of the COVID-19 pandemic on productivity and promotion of women are crucial areas for further investigation. Reflection on ways to continue implementation of these flexible paradigms in the future is warranted.

We must sustain the woman leadership pipeline to reflect the diversity of patients with CKD and to provide diverse role models for trainees.

Gender equity also includes increased representation. Achieving equity will require intention at all levels (Table 1) to enhance inclusion and avoid selecting only “who you know.” Although 50% of medical students are women, only 36% of nephrology fellows were women in 2019 (10). It is prudent that we extend our recruitment efforts to include women across the pipeline from fellows to clinicians and physician-scientists in every facet of nephrology. To promote interest and retention of women in our field, rigorous efforts must be made to reduce burnout; increase opportunities for networking, partnership, mentorship, and sponsorship; and provide real-world role models. Generous parental leave, tenure clock stoppage or extension, research, and pay equity must also be a priority (4). These potential areas for change represent opportunities to improve life-work integration and to transform the culture of medicine.

tbl1

To ensure a more diverse and inclusive workforce in the field of nephrology, we must all maintain a strong commitment toward equity. This means taking a steadfast stand against discrimination and bias and providing additional training on bias and discrimination for trainees, program directors, clinicians, researchers, and society leaders. Moreover, it entails the establishment of multiple measures to promote transparency and accountability such as monitoring and tracking systems to evaluate compensation and promotion practices. Finally, additional opportunities for networking, mentorship, and career advancement that are intentionally inclusive of LGBTQ+ women, women of color, transgender women, and gender-expansive people in nephrology must be our priority.

References

  • 1.

    Lederer E. Women in nephrology today. Clin J Am Soc Nephrol 2018; 13:17551756. doi: 10.2215/CJN.07650618

  • 2.

    Martín-Gómez MA, et al. The role of women throughout the history of nephrology. Nefrologia (Engl Ed) 2019; 39:1517. doi: 10.1016/j.nefro.2018.08.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Eknoyan G. Women: Medicine, their kidneys, and nephrology. Adv Chronic Kidney Dis 2013; 20:382389. doi: 10.1053/j.ackd.2013.03.003

  • 4.

    Weinstock Brown W, Anderson S. Women in nephrology leadership. Adv Chronic Kidney Dis 2018; 25:519522. doi: 10.1053/j.ackd.2018.08.014

  • 5.

    Malieckal DA, et al. Trends in the proportions of women program chairs, moderators, and speakers at American Society of Nephrology Kidney Week 2011-2019. Clin J Am Soc Nephrol 2020; 15:265266. doi: 10.2215/CJN.08140719

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Dave NN, et al. An introduction and guide to becoming a social media savvy nephrologist. Nephrol Dial Transplant 2020, 17. doi: 10.1093/ndt/gfaa067; https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa067/5834661

    • Search Google Scholar
    • Export Citation
  • 7.

    Association of American Medical Colleges. Diversity and Inclusion. Diversity in Medicine: Facts and Figures 2019. Table 13. Practice Specialty, Males by Race/Ethnicity, 2018. https://www.aamc.org/data-reports/workforce/data/table-13-practice-specialty-males-race/ethnicity-2018

    • Search Google Scholar
    • Export Citation
  • 8.

    Butkus R, et al. Achieving gender equity in physician compensation and career advancement: A position paper of the American College of Physicians. Ann Intern Med 2018; 168:721723. doi: 10.7326/M17-3438

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Martin KL. Medscape Nephrologist Compensation Report 2020. May 20, 2020. https://www.medscape.com/slideshow/2020-compensation-nephrolo-gist-6012736

    • Search Google Scholar
    • Export Citation
  • 10.

    Brotherton SE, Etzel SI. Graduate medical education, 2019-2020. JAMA 2020; 324:12301250. doi: 10.1001/jama.2020.14635

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