The challenges for women in medicine are well documented: Women get paid less than men (1, 2). Women are under-represented in leadership positions at academic institutions (3, 4). Women bear more of the burden at home in dual professional households (5). The headlines are so familiar that it can be difficult for one to muster outrage. Although there are increasing victories in the struggle for equality, such as the inclusion of female voices on academic panels, systemic changes are needed to level what has historically been an uneven playing field. In an era when recruitment to nephrology is a struggle, and burnout is high (6, 7), we want medical students, residents, and fellows of all genders and backgrounds to see aspirational figures at the top of their fields. We should be intentional in selecting women for nominations, promotions, and speaking opportunities. Although groups, such as Women in Nephrology, have driven many effective changes in this area, the burden of championing women should not rely on women alone.
The COVID-19 pandemic has demonstrated how much societal burden rests on women, with large numbers of women leaving the workforce nationwide—including in health care—due to an inflexible system (5, 8). Particularly in academia, there is one path that has been established, which starts with scant financial support just out of fellowship and high expectations in the early stages of one's career that then sets the stage for future success. Does this inflexible model make sense? This uncompromising system imperils many clinicians and researchers who may stumble into competing priorities at various stages of life, whether it be raising children, caring for elderly parents, or attending to one's own health. It is possible that many would consider an alternate career path once any of the aforementioned competing priorities might occur. Thus, facilitating mid-career entry into research tracks would allow more clinician scientists—men and women—the chance to advance the science of our field.
Transparency is also critically important in driving change. This includes establishing concrete goals for the percentage of women proceeding through academic promotion and allowing practice members access to the salary information of their peers. Making gender equality an explicit goal of the practice may help drive additional conversations and changes that are unique to each setting. Examples include developing a sensible parental leave policy, building in time to busy clinic calendars for lactating women, and not penalizing physicians who may choose to work part-time when their children are young and need more direct care at home. Anecdotally, many women early in their career feel guilt or anxiety about asking for what they feel is “special treatment” when it comes to issues surrounding motherhood. That is why it is so critically important to state these policies explicitly and to provide safe venues for communicating what is and is not working.
Increasing recruitment, building the next generation of nephrologists, and supporting our colleagues through their varied life paths will benefit all nephrologists, regardless of gender (Table 1). Not every woman has the same desires or demands on her time. Not every woman has a family or wants to focus her energies on raising one, and that choice should not influence how she is perceived and what her options are. Women are as varied as we are capable, and it is time the structures of health care shifted to meet our needs.
Challenges and opportunities for women in nephrology
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Sethuraman KN, et al. Here to chair: Gender differences in the path to leadership. Acad Emerg Med 2021; 28:993–1000. doi: 10.1111/acem.14221
Bernardi K, et al. Gender disparity in authorship of peer-reviewed medical publications. Am J Med Sci 2020; 360:511–516. doi: 10.1016/j.amjms.2019.11.005
Soares A, et al. The impact of COVID-19 on dual-physician couples: A disproportionate burden on women physicians. J Womens Health (Larchmt) 2021; 30:665–671. doi: 10.1089/jwh.2020.8903
Nakhoul GN, et al. “What do you think about nephrology?” A national survey of internal medicine residents. BMC Nephrol 2021; 22:190. doi: 10.1186/s12882-021-02397-9
Roberts JK. Burnout in nephrology: Implications on recruitment and the workforce. Clin J Am Soc Nephrol 2018; 13:328–330. doi: 10.2215/CJN.09870917
Reese TA, et al. Supporting women in academia during and after a global pandemic. Sci Adv 2021; 7:eabg9310. doi: 10.1126/sciadv.abg9310