The field of rheumatology is undergoing a transformation from a specialty whose members are overwhelmingly male to a specialty that is overwhelmingly female. This metamorphosis requires a close look at gender issues, including disparities, which must be addressed to accommodate the emerging trend and to protect the future workforce.
Gender issues are important considerations in evaluating any profession, but in the field of rheumatology today, the marked ongoing change in gender distribution is a dominant demographic factor that shapes the field’s current makeup and the future rheumatology workforce.
Facts and Figures
What is the gender makeup of the field of rheumatology today? Abby Abelson, MD, chair of the ACR Committee on Training and Workforce issues and chair and education program director at the department of rheumatology and immunologic disease at the Cleveland Clinic, Cleveland, cited the current gender distribution statistics as well as other ACR membership demographic facts in her presentation, “Gender Issues in the Rheumatology Workforce” at the 2011 ACR/ARHP Annual Scientific Meeting on November 8, 2011, in Chicago:
- 67% of the membership is male.
- 33% of the membership is female.
- The average age of today’s working rheumatologists is 52 years.
Predictions for the future, however, reveal a pending change for the field. The 2011 gender distribution of fellows in training was 34% male and 66% female. These figures also hold true for those applying for fellowship. In addition, a large number of rheumatologists now working are approximately 59 years old—the baby boomer generation—and many will be retiring over the next 10 years. The group replacing the retirees—now about 44 years old—has an almost equal distribution of men and women. Thus, natural attrition and the gender distribution of the current enrollment will result in an increase of women in the workforce and in the ACR membership within the next two decades.
Some think that the shift will occur even sooner than the predicted 20 years. “In the past five years, more women than men have entered the field, and within 10 years, women may dominate the field in leadership positions,” states Mary Crow, MD, physician in chief at the Hospital for Special Surgery and chief of the division of rheumatology at Weil Cornell Medical College in New York City. “Some women are doing fantastically well in the field.”
Explaining the Shift
Why is this shift occurring? Schedule flexibility and the lack of frequent, if any, emergencies in this field allow rheumatologists to plan their workdays. This kind of flexibility permits a workable integration of professional and personal schedules. “The field of rheumatology is more family friendly than some subspecialties and, thus, is attractive to women—and men—who are interested in a work–life balance,” says Michelle Kahlenberg, MD, PhD, assistant professor of internal medicine at the University of Michigan, Ann Arbor, who completed fellowship training in 2011.
Alfred Kim, MD, instructor of medicine in the division of rheumatology at Washington University School of Medicine, St. Louis, agrees. After three years as a rheumatologist, Dr. Kim emphasized that everyone in his generation is interested in “protecting the work–life balance,” adding that, at his institution, clinicians negotiating their contracts may request both maternity and paternity leave with the department chairs on a case-by-case basis. Dr. Kim also finds that schedule flexibility has a positive effect on both clinical work and research: “Flexibility allows me to do the amount of research I want to do without compromising my ability to provide outstanding clinical care or receive training.”
“Protected time for the family” is the phrase used by Joshua F. Baker, MD, MSCE, instructor in the division of rheumatology at the University of Pennsylvania in Philadelphia. In his fifth year as a rheumatologist, Dr. Baker values the time flexibility of the field, which, as the son of a rheumatologist, he has always perceived to be an advantage. Like his female colleagues, Dr. Baker appreciates the opportunities that the field of rheumatology offers to fulfill both professional and personal obligations.
It appears then that the current workforce shifts are often due as much to generational changes as to gender. Both women and men in training and starting their careers are interested in establishing and maintaining a balance between their professional and personal lives. Younger rheumatologists focus less on gender and more on opportunities and professional growth for everyone. “Everyone’s voice can and should be heard if there is an even distribution of men and women in the field,” says Dr. Kim.
Within 10 years, women may dominate the field in leadership positions.
—Mary Crow, MD
Despite the future trends, gender disparities do exist. What issues still need to be addressed?
- Compensation disparity is an ongoing issue. Dr. Abelson expresses concern about data from a study by Lo Sasso et al, indicating that in a controlled study of 8,000 physicians in New York, there was an ever-widening pay gap between men and women from 1999 to 2008.1 Data available through the Medscape Rheumatology Compensation Report of 2012 show that men earn a mean of $191,000 per year while women earn a mean of $149,000 per year.2
- Women rheumatologists are underrepresented in academic leadership roles, and the representation has remained unchanged for the past five years.
- It often takes longer for women to complete tenure track due to personal and family obligations. Flavia Castelino, MD, instructor in medicine at Harvard Medical School in Boston, points out that while her institution “protects time for the parenting gap through institutional grants, it requires that a physician reach the level of assistant professor before entering the tenure track.”
- Research funding for women can be a challenge if the time needed to become an investigator or to achieve tenure is prolonged because of time taken for childbearing or family responsibilities.
- Funding to maintain ongoing research while attending to personal and family responsibilities is not always available for women. There is a need for resources (technicians and other staff) to carry out research functions while the researcher is starting a family or balancing other obligations.
Fortunately, remediation for some of these issues is already underway. The ACR is developing ways to support the practice preferences of women so that their collaborative approach receives equitable compensation.
Academic and professional institutions are encouraging more women to assume leadership roles. Audrey B. Uknis, MD, professor of medicine and senior associate dean for admissions and strategy at Temple University School of Medicine in Philadelphia, finds that women “have many opportunities in academic careers including advancement in the areas of patient care, research, education, and administration.” As women take advantage of their choices, they are able to build careers that meet both professional and personal goals. The strides women are making in the academic setting, Dr. Uknis says, is setting precedent for both women and men colleagues who are seeking a work–life balance. “Women are, therefore, trailblazers,” she says.
Dr. Kahlenberg states that the University of Michigan “is in the process of lengthening the tenure clock to 10 years from 8 years to provide more flexibility.” Other institutions are considering more flexible tenure tracks, which again benefit both men and women.
Funding sources are also responding to work–life issues for women. Leslie J. Crofford, MD, Gloria W. Singletary professor of internal medicine and chief of the division of rheumatology at the University of Kentucky in Lexington, explains that “the National Institutes of Health allows a personal statement describing experience or qualifications that show suitability for the project that is the subject of the application. The applicant also can describe factors such as family care, illness, disability, and active military duty that may have affected scientific advancement or productivity.” The National Science Foundation also permits applicants to balance responsibilities in the lab and at home. “Funding agencies are getting it,” Dr. Crofford says.
What else can be done to help women achieve parity and to ensure that needs are met for the future—for both genders and for the field of rheumatology?
The ACR has already started working to foster parity and offer support. Alexis Ogdie Beatty, MD, instructor of medicine in the division of rheumatology at the University of Pennsylvania in Philadelphia, recommends the session on work–life balance at the ACR’s annual Rheumatology Research Workshop for young investigators. The session reviews parenting and mentoring guidelines for mothers and others interested in work–life balance. Dr. Kahlenberg appreciates these efforts to “keep disparities out in the open and on the radar.”
The demographic makeup of the fellows currently in training and that of the future workforce already predicts a shortage of rheumatologists. This is partially because those retiring are being replaced by those who may take time out to start and care for families or may work part time as they balance home and work responsibilities. Thus, replacing one retiring rheumatologist with another may not be an even exchange of clinician and time resources. That is why it is imperative that the ACR continue to focus on its goal of recruiting more and more medical students and residents to consider rheumatology as a specialty.
On the other hand, many of the changes in the needs of the future rheumatology professionals are as much generational as gender driven. Younger men want the same life-balance options as their female colleagues. That is why gender disparities must be identified and eliminated so that all rheumatologists, regardless of gender, can realize their individual professional and personal goals. The ACR’s Diversity Task Force summed up the underlying objective for the field of rheumatology as follows:
“To secure the future vitality and sustainability of the profession of rheumatology and rheumatology healthcare providers on behalf of patients we care for, the ACR must work to ensure diversity in its membership and to ensure that talents of all are fully utilized, their contributions recognized, and their unique problems addressed. To fail to increase diversity limits our effectiveness as health care providers, educators, researchers, and advocates for our patients.”
Ann Kepler is a medical journalist based in Chicago.
- Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30:193-201.
- Medscape. Medscape rheumatologist compensation report: 2012 Results. Available at www.medscape.com/features/slideshow/compensation/2012/rheumatology. Published March 22, 2012. Accessed September 7, 2012.