Where does one begin talking about challenges the pandemic has not only posed to the world, but also to women and women academics in particular? Even before the COVID-19 pandemic, physicians have suffered systemic biases, unequal work-life balance, and unrealistic expectations that produce stressful work environments. The COVID-19 pandemic has also brought into focus the pressures on women physicians who are juggling work with family priorities, trying to be more accommodating and risking professional and career progress. According to Brubaker, “Historically, more women physicians chose (or were encouraged to choose) to modify career progress or reduce professional work hours so that the proportion of women physicians who have reduced professional work hours exceeds that of their male peers.” There is also the expectation that women academics, many of whom are highly driven professionals, should make the sacrifices in their life pursuits should a conflict arise: “As a woman you should consider lesser demanding paths, like pathology or dermatology,” said one surgeon to his female medical student in the middle of a complex surgery, taking it upon himself to offer unsolicited career advice, while I rolled my eyes from the other side of the drapes! In COVID-19 research, similar to other scientific areas, women academics are consistently under-published (JAMA 2020;324:835-6; eLife 2020;9:e58807).

During the pandemic, all physicians faced increased clinical responsibilities, surge ICU work, and extremely clinically complex patients in almost unimaginable numbers. Women played important roles in sharing these responsibilities as well as leadership and surge planning, including creating new clinical protocols, managing staffing challenges and being flexible in the duties they were called upon to fulfil. However, or perhaps due to this, the overall academic productivity of women has fallen in 2020. The graphs presented here (Figure) from a recent study by Andersen et al. show a decline in first and last authorships in academic papers published in 2020 compared to just 2019 (eLife 2020;9:e58807). In a year where scientific manuscript submission has increased markedly in major journals (11,000 articles submitted to JAMA compared to 4,000 in 2019), the proportion of contributions from women has fallen dramatically. Women account for only about a third of all authors who published papers related to COVID-19 (BMJ Glob Health 2020;5:e002922).

Figure:

Comparison of First and Last Authorships, 2019-2020; Andersen et al. 2020

Figure:

Comparison of First and Last Authorships, 2019-2020; Andersen et al. 2020

Publications by women physicians and underrepresented minorities remained remarkably low in medical literature to 2020. There is a dearth of in-depth data pertaining to reasons behind this inequality, alluding to a need for additional research targeting the understanding of the reasons behind these disparities and development of ways to amend these issues. Despite this lack of quantity of scientific output, several key landmark articles have been contributed by women – the Surviving Sepsis Campaign Guidelines on the Management of Adults with Coronavirus Disease 2019 (COVID-19) (Crit Care Med 2020;48:e440-69), guidelines on COVID 19 coagulopathy (J Thromb Haemost 2020;18:1023-6), and a survey on burnout among anesthesia critical care-trained physicians, and others. The inequity faced by women academics also extends to promotions. In an important paper in the NEJM by Richter et al., it was observed “that over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chair, and there was no apparent narrowing in the gap over time” (N Engl J Med 2020;383:2148-57).

Women physicians generally spend more time on home and family care activities. Childcare responsibilities and worries have grown exponentially with school closures during the pandemic, making it difficult for women to fulfill academic promotion requirements and their clinical responsibilities with equal vigor. Some have been infected with COVID-19 due to exposures at work or have taken time off to quarantine from children and other family members, all from their allocated vacation time. Others have had to juggle single parenting or single wage earner positions during the pandemic and are close to burnout. Traditionally, women are also caring for elderly parents who may be sick or in quarantine (J Intensive Care Soc 2020;21:12-7).

Women, minorities, and younger physicians also experience unconscious systemic biases and stress to a greater extent than the larger physician population (asamonitor.pub/32P3zzV). These perceptions need to be better explored and understood before interventions can be designed. It is more effective to engage different groups of the workforce rather than simply employ blanket diversity initiatives. “Cognitive dissonance” can be corrected when behaviors of change are encouraged and rewarded. Mentorship, coaching, and sponsorship are other ways to chip away at biases in academics and create specific paths for women academics and researchers. Structured mentorship programs are better at accomplishing this than asking individuals to find their own mentors; however, studies published in Harvard Business Review mention how it is more difficult for women and minorities to find willing and enthusiastic mentors (asamonitor.pub/32P3zzV).

There is a need for greater gender equity in academics and research. The COVID-19 pandemic has made the “flawed narrative of life-work balance” in medicine glaringly apparent. Women physicians do not have trouble balancing competing demands any more than men physicians do; the pandemic is requiring additional adjustments to the professional lives of all physicians. It is simply a more common expectation that women physicians will adjust their professional and personal lives to fit their roles at work and home. “Women and men physicians should be able to share the joy and the work of their lives equally. The COVID-19 pandemic may just be the catalyst needed to achieve that goal” (JAMA 2020;324:835-6).

Some suggestions proposed to improve representation by women academics are that (J Respir Crit Care Med 2017;196:425-9):

  • “Various professional societies establish diversity policies for populating speakers in meetings and panels

  • Journals adopt a more diverse Editorial board and encourage a balanced representation of work by gender

  • Authors document and journals report the principles and methods of panel composition for professional document development

  • Gender parity policies be incorporated into bylaws and policies with targets which reflect the adequate representation of women and minorities

  • Training on diversity and unconscious bias be available for all academics, especially those in leadership positions.”

Shahla Siddiqui, MBBS, D.ABA, MSc, FCCM, Attending Anesthesiologist and Intensivist and Ethicist, Beth Israel Deaconess Medical Center, Boston.

Shahla Siddiqui, MBBS, D.ABA, MSc, FCCM, Attending Anesthesiologist and Intensivist and Ethicist, Beth Israel Deaconess Medical Center, Boston.