Gender equity paves the way for gender equality, so to get to gender equality we need to first focus on achieving gender equity. Gender equity is the means to correct the societal barriers that have kept women back and left them behind. Gender equality means providing men and women with the same equal opportunities - like the ability for a woman to be a physician - but if barriers are in place that keep that same woman from earning the same salary or advancing as far in her career as her male colleague, then there is no equity.

Interesting. Gender equality is end goal and gender equity is how we get there? Curious if anyone's employer uses tools like: pipelineequity.com/how-it-work...

I would be curious to learn more about if tools like this are (1) accurate in linking improved gender equity with better financial metrics (2) a priority for most large employers.

I think it's a challenge addressing this issue because the difference between gender equity and equality is not clear to many, and making the distinction clear is a first step towards positive change. While gender equality focuses on men and women having the same opportunities (the hoped end result), gender equity focuses on removing barriers that have so long been placed in front of women that puts them at a disadvantage, i.e. in education, work, etc. This equity mentality shift prioritizes providing extra support to women to help lift them up, as opposed to just "treating them as equal". Equality doesn't take into account that women differ in their abilties, background and experiences. Looking at equity first can give women the resources and education to succeed at the same opportunities men have.

One quote I found that sums it up well..."Equality focuses on creating the same starting line for everyone. Equity has the goal of providing everyone with the full range of opportunities and benefits – the same finish line."

Regarding gender disparities, digital tools can help us better understand the current situation and track change over time. As an example, I love that natural language processing has been leveraged by researchers to identify gender bias within letters of recommendation. That leads to questions as to whether women's roles are actually different (yes) and whether we think about their performance differently even within the same roles (yes). That in turn leads to different types of solutions.

We are all learning, particularly now in relation to the challenging reckoning with race in our country, just how structural these issues are. We are all somewhat blind to the experience of others and many people inadvertently contribute to the problem, whereas others actively try to hold onto their position of privilege.

Root causes include: very early societal gender norms (that even one's peers adopt); differences in educational and experiential opportunities throughout one's career related to those norms; difference in response to similar behaviors based on those norms (man is assertive / woman is bitchy) the misperception that hazing makes you stronger ("Don't get so upset, I was just kidding"); the lack of role models; and lack of diversity among those with the power to determine the futures of others.

In the inadvertent realm, I experienced many challenges or issues that simply "had not occurred" to those in power. Voicing the issue sometimes led to change. In the deliberate realm, I am curious to learn the strategies of others. I had a continuum of responses - if no one else (patient, student, etc) were harmed, I may let it slide. Of course that wears on you over time (death by a thousand small cuts) and I probably allowed too many things to slide into that category out of shear fatigue. But if the issue was more serious, response could escalate from reflecting back to the individual ("not sure you meant that the way it came out"), to seeking support of allies, to making a strong stance regardless of the potential career risk (as when pinned in a call room by a male attending and threatened with a poor evaluation unless I "fooled around" - got out of there, job be damned!)

A big recognition for me was that a small portion of the men were testing me to see if I was worthy of inclusion in their club. Realizing that I was not there for their club - that I simply wanted to care for patients - was liberating & made them much smaller!

I also believe having strong female role models is essential to gender equity. I agree that many times men in power are just not aware of the issues that females face and having more women in those positions empowers a new generation of women. I have personally benefited countless times from having strong female mentors.

Despite the fact that the majority of medical students are women (50.5%), historically, the fields of medicine and health care innovation were dominated by men. We are very slow to change the landscape- particularly the leadership landscape. There is not a critical mass of women in leadership, and a critical mass is needed to significantly change the culture; a solo woman in leadership is vulnerable. Implicit bias is another factor. At Grand Rounds presentations, a study found, when a male is the introducer, there is a biased approach to introducing the speaker, often not referring to their professional titles whether it be a male or female speaker. Female introducers, however, nearly always use the proper professional titles – whether male or female. The pay gap- Women are paid between $0.76 and $0.90 per $1 paid to men across department and degree types. Women underinvest in social capital- and their networks work differently, therefore, women don’t experience the benefit of sponsorship as much as men do. These issues occur in other fields, including business.

I'd love to know, what has been successful in addressing these root causes (gender norms, lack of role models, etc.) at an industry level, from within your organization or by you personally?

To move the needle, we need more women in key positions of leadership that get it. By getting it, I mean recognize the need for more. How many women are CMIOs, CMOs, Division Chiefs, or hold other C-suite positions? I'm sure it's not because we don't want those titles or lack the experience. We need allies and advocates who encourage us to take the leap and chart new territories. Like Dr. Miller, I've had great female role models and mentors but I also had female leaders tell me that I was too young or too inexperienced to be a director. I even had one to tell me she'd give me my old job "when all of this telehealth stuff goes away" - hmm. So, I encourage us all to recognize the female talent around us and bring them to the table. Tell others what we are doing. When I started in telehealth 7 years ago, no one in my circle knew what it was (including myself). Since then, I've spoken at middle and high school career days as well as professional conferences to share my experiences. It's important that we share knowledge and understand that when one of us succeeds, we all do.

The long hanging fruit is to gain the attention of men in leadership who are supportive but may be oblivious to challenges women face. We must educate them to generate actionable steps, such as:

-greater attention to promoting women for their expertise (consciously identifying speaking or leadership roles for women faculty)

-setting up mentoring committees (more powerful than interacting only with individual mentors) to help young academics balance clinical/education/scholarship roles and prioritize work in ways that lead to promotion (learning to say "no" to tangential tasks)

-encouraging women to self-promote (encouraging updates from women about work they are proud of; promoting women to ask leadership for nominations for internal and external awards or leadership positions relevant to their work)

-ensuring the search for every position has a balanced slate of candidates (and that the search committee is balanced)

-review of one's own letters of recommendation for gender bias
etc.

jamanetwork.com/journals/jaman...

drive.google.com/file/d/1hOOXT...

mobihealthnews.com/news/femtec...

I too waited until I had finished my surgical residency to start a family and was fortunate to have fairly easy pregnancies at ages 34 and 36. I was in private practice first, with my son, so basically "bought" my leave in advance by taking double call during my third trimester. For my daughter, I had transitioned back to academics and received real leave without a "make-up" cost. Breastfed both kids up to one year, which made for some interesting antics with "pumps in low places"!

But I cherished the months I spent focusing on being a mom. The return to work was initially fraught with guilt -either feeling guilty for not being home with kids or guilty for leaving the hospital. Had to get over that and get over the image of motherhood in the style of my mom (think Martha Stewart - pre controversy - plus Bob Villa) vs what I could accomplish in my context. Do not shy away from hiring help so that time at home is focused on being together and not consumed by chores!

I had my son in 3rd year of medical school, so maternity leave wasn't really an option per se. I took off 1 month (May) to study for step 1 and took off the rest of April when I went into labor. That was it. I think the maternity leave/support conversation needs to extend to medical students also. We are all adults at different phases of life while in medical school. Since then, I've worked in several environments, and up until now, none offered maternity leave as ED docs are often hourly independent contractors. Even when I worked federal, I was shocked to find out there was no maternity leave... the nurses in my department were pregnant and storing up their PTO for post-delivery. Pretty sad.

Both of my pregnancies were unplanned and I'm happy it ended up that way. Having my daughter during my last year of med school was not so bad. Now, carrying twins in residency (prior to the change in work rules), was challenging to say the least. I remember so many times being looking upon as an imposition to my class. I can't tell you how many times someone would say things like "you should just quit". Eventually, due to complications and the fear of preterm labor, I was put on bed rest around my 5th month. This ended up being such a blessing as my twins were born with cleft lip and palate and would need several surgeries in the first few months of life. I was able to carry them to term and my chief residents and interim division chair helped develop a plan for me to reintegrate into residency after their second surgeries. What I didn't know was that the new chair that was in place during my leave did not agree with such a plan. I remember very distinctly him saying that he thought it was admirable for women to cancel their career plans to focus on raising a family and maybe I should rethink my decision to return. Needless to say, I didn't do that. Thank God for the few women mentors and colleagues who encouraged me to stick it out.

I think the bigger issue is this unspoken rule that we should not get sick or need time off in residency. I'm sure things are different now but then, we got 4 days off a month with 2 weeks vacation for the year. I know women who tried to store up these days for a make-shift maternity leave. No one wanted to use their day off to rest during a bad cold! It was almost like there's always this choice we have to make between caring for others or caring for ourselves/our family. Usually, we make the decision to not impose on our team or our classmates. When is the idea of self-care going to make it to the healthcare industry? To academic medicine?

Thank you for sharing your experience! Too often we find that those who are charged with taking care of others (doctors, teachers, nurses) are the least able to tap into mechanisms and policies for care themselves! Add on that, a male dominated industry and boy, are we all glad for female mentors and colleagues! These systems were not built for women and the unique needs of women--so we need more of us in the field and in decision-making positions at hospitals, etc, to actually "SEE" women and their lived experience in medicine.

This is shameful. Women are forced to "McGyver" their own solutions (bubble gum this and spitball that ) when policies fail to include women--all of the roles women play in their lives including Mother and carer. When will Mothering be valued as important work that is worthy of federal paid leave and time to heal?

Kudos for the breastfeeding! And yes, sometimes we have to ask, where can we use outside resources to lighten the load? Getting support and letting go of any "I can do it all" notions are so important!

I had both of my daughters as a faculty member. While I had access to maternity leave, I did feel some guilt about being away from my practice and potentially increasing work for my partners and did not take the full amount with my first child. However, when I returned from maternity leave, I realized that no one had suffered from my absence! My patients were excited to hear about the baby and my partners did not see a significant increase in patients because I was away. With my second child, I took the full amount of leave! And, had no guilt about it at all!

I also breastfed both of my girls until they were 1 year old. Pumping between patients in clinic and the OR was challenging, but so rewarding to "provide" for my kids even when I was working!

According to the American Association of University Women, women make up only 28% of the workforce in STEM, with highest gender gaps in fields such as computing (26% women) and engineering (16% women). Let's combine that with evidence from academic medicine. According to the Association of American Medical Colleges 2019 report, although women form half of medical school classes, women comprise only 41% of faculty positions and only 25% of full professors (in my field of surgery, those of us women attaining full professor status represent only 8% of that rank). Stats for women of color are even worse.

Implications for innovation are significant. I have a distinct memory of being chastised in 4th grade for asking too many questions and "embarrassing the boys" by doing well in science and math. If young women are not exposed to role models in STEM and medicine, one can assume they will not be adequately represented in the digital health space. Not only is that a loss of opportunity for women, but lack of diverse perspectives will lead to flaws in design and implementation likely to drive poor outcomes for key portions of our population.

The stats for academic medicine aren't good from a gender equity standpoint, and they're even worse when you look at digital health companies and health care startups. I'm linking below to Rock Health's report on gender equity in health care startups and VCs (note the all-woman author panel). One of the striking takeaways is that if these companies hire women at a rate of 50% of new hires, it will still take almost a century to achieve gender parity in this workforce. I'm reminded of this every time I attend a digital health conference where it's so dramatically visible how male-dominated this industry is.
rockhealth.com/reports/the-sta....

Thank you for also highlighting the fact that the stats for women of color are worse. Innovation will always be limited by the lack of diverse perspectives / experiences.

A recent study published by Kauffman Fellows ( kauffmanfellows.org/journal_po... ), shows that ethnically diverse teams outperform homogeneous teams by about 3.5X.

So for those who aren’t moved by moral or ethical imperative, the data clearly shows that it’s time for digital health companies and investors to see the value of diversity.

Thank you for sharing such a poignant memory Dr. Lomis. How, if at all, have you seen women elevated as role models either in STEM, digital health, or elsewhere? Are there any examples or best practices that you've seen recently?

My little 4th grader experience may give some insight into subtle forces that influence women's behavior at scientific conferences. This team out of Stanford identified that women are much less likely to ask questions at conferences, even when they comprise a reasonable proportion of attendees. Since participation (unlike presentation) is self-initiated, there must be some internal factors at play. ncbi.nlm.nih.gov/pmc/articles/...

Their team enacted a policy that the first question following a presentation should always come from a trainee (many of whom are women), and that helped raise female participation in the entire discussion.

Recent acknowledgement of the prevalence of the "manel" - a male-only panel - at scientific conference has been important. Leaders of organizations hosting conferences or other public forums should actively pursue inclusive representation in all podium appearances.

Gordon Research Conferences are an example of taking this farther, instituting a "Power Hour" at every conference in which participants discuss challenges of inclusivity faced by those representing all forms of diversity.

In thinking about this issue, I reached out to 2 rising stars in this arena. Dr Ariel Kniss and Dr Jessica Wen medschool.vanderbilt.edu/midp/... are the first graduates of Vanderbilt's Medical Innovators Development Program, in which engineering PhDs complete medical school with special programming in innovation and entrepreneurship.

Ariel confirmed that there was a real lack of female role models and that the panels to whom she and Jess practiced "pitching" were all or mostly male. But she highlighted that male mentors in the program went out of their way to support and amplify their work. Now, of course, these two exceptional women will be the role models for the future of tech in medicine!

Can't expect any different when 90 percent of VCs are male, and 87 percent of VC funding goes to all-males.
Also, this report by Doximity found that the national gender gap among physicians is 24.7% --> blog.doximity.com/articles/dox...

Ashlee and Shireen- really great points. There's a disheartening stat out there that 97% of funded startup founders are male, 2.7% are women and 0.2% are women of color. Before founding my own healthcare start-up, I was a healthcare investor and I currently run a healthcare initiative for a venture community. I've noticed some dynamics that I think are fueling this disparity:  (1) When pitching to investors, women are often asked questions around downside potential (and existing traction) whereas men are often questioned around potential and growth. Here is an article that discusses this dynamic: hbr.org/2017/06/male-and-femal... (2) The VC process is often predicated on warm intros and is biased towards second time founders that have already had an exit. This creates a dynamic where VCs tend to fund people they know well personally or have already funded before. Network diversity of VCs (or lack thereof) therefore can be constraint(3) Through the healthcare initiatives I run, I often notice that on average, women founders have more traction, but when they pitch, they are referred to mentoring resources rather than being invested in. It seems often women (especially Black and Latina women) are over mentored and underfunded, despite stronger performance.
While this sounds bad, I wonder if the following can help: (1) Answering prevention oriented questions with promotion heavy answers. (2) Offering connections to other female founders. To make it tangible, happy to do this for anyone in this network (especially physician entrepreneurs b/c we need more drs in leadership). (3) Point out that this dynamic of being underfunded and over-mentored exists (I know this is weak, I have run out of ideas). 

ama-assn.org/about/leadership/...