Conditions Are Better for Women in Oncology But More Work Needs to Be Done

Inas Abuali, MD, FACP

I recently attended a CV writing workshop where the male speaker discussed how it helps to include personal information to provide your interviewer with a glimpse of who you are outside of work. He spoke about how he personally writes a blurb about being a father and how talking about his children has been a great ice-breaker in many interviews. A female colleague said she would be hesitant to do the same for fear of being judged as someone less devoted to work, pointing out that women’s discussions about their home lives provoke different reactions and are associated with various biases.

Over the years, many of my colleagues have made similar statements. I distinctly remember a conversation with a friend who was told that her pregnancy was “ill-timed” and would mark the “end of her career.” Many of my colleagues have voiced frustrations about vague, nonconstructive performance evaluations with scathing remarks that were not backed by any objective findings. As women, we, unfortunately, face obvious discriminatory behaviors and not-so-obvious microaggressions in our careers.

It is true that we have come a long way since 1847 when Elizabeth Blackwell, MD, was accepted into Geneva Medical College—an incident that began as a prank but that culminated in the long-delayed inclusion of women in medicine. Dr Blackwell, inspired by the death of a close friend who said her suffering would have been much alleviated if her care had been provided by a female physician, decided to apply to medical schools. As a joke, the all-male student body at Geneva voted “yes” to her application, assuming she would never join their ranks. In 1849, against all odds, Dr Blackwell was the first woman to receive a medical degree from a US medical school, paving the way for all of us who follow in her footsteps.¹

In 2017, for the first time in US history, more women (50.7%) than men entered medical schools. Women now make up an estimated one-third of US physcians.²

Results from a study published in JAMA assessing outcomes for elderly hospitalized patients showed that female internists tended to use more patient-centered communication and provide more preventive care, and were more likely to adhere to clinical guidelines than their male counterparts.

The difference in clinical practice may translate into a difference in patient outcomes. The investigators concluded that patients treated by female internists had lower mortality and fewer readmissions.³

Despite the strides made by women over the past 170 years, significant disparities remain, especially in academic medicine. Medical education literature has looked at bias during evaluation of female trainees, including polarizing and contradictory feedback and preconceived notions regarding how women are expected to conform to certain stereotypes.

Many institutions report the “leaky-pipeline” phenomenon, in which women faculty drop out at earlier professional levels, leading to their underrepresentation in advanced leadership positions. This talent drain has been attributed to conflicts between work and family responsibilities, disparities in recognition of efforts, inequalities in promotion opportunities, and lack of mentorship.⁴

More recently, results from a survey of sexual harassment and gender disparities among gynecologic oncologists were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting. Lead author Marina Stasenko, MD, a clinical fellow in gynecologic oncology at Memorial Sloan Kettering Cancer Center, and colleagues found that 71% of female respondents reported experiencing some form of sexual harassment during their training including sexist, offensive remarks; unwanted sexual advances; and being asked for sexual favors in exchange for academic advancement.⁵

Although respondents said there was a workplace policy on how to report this behavior, most did not report the incidents due to fear of reprisal or concern of nonaction. Furthermore, women reported being denied opportunities for training and career advancement and receiving lower performance evaluations compared with their male peers, solely based on gender.

Nevertheless, it is an incredibly exciting and rewarding time to be a female oncologist, and awareness is growing about the unique challenges we face. Institutions are now openly acknowledging the gender gap and implementing various corrective initiatives, such as increased transparency regarding hiring decisions and professional advancement, ensuring a more equal representation of women in various committees, and education regarding unconscious biases that may be at play.

As a hematology/oncology trainee and early career physician, here are a few resources I personally find helpful:

Both the American Society of Hematology and ASCO have championed initiatives dedicated to improving diversity and inclusion in the hematology/oncology workforce. Each organization's annual meeting includes unique networking opportunities for women. Furthermore, special funding is available through Women Who Conquer Cancer, a program run by the ASCO Foundation nonprofit Conquer Cancer, that offers grants to young women researchers and clinical investigators to support their academic careers.

Social media has become a powerful tool for connection, with both Facebook and Twitter serving as forums to connect women, providing support and networking at all stages of your career.

Join your local women in medicine group. Most institutions have one. If you can’t find one, then consider starting one. Such groups provide space to discuss challenges and explore solutions with your colleagues, forge friendships, and create an invaluable support system.

Finally, remember to always pay it forward. No matter where you are in your career, there is always someone more junior who can use a mentor. An empowered woman can empower other women. Many professional societies, including ASCO, have a formal mentoring program, which is a great way to get involved.

As the saying goes, “Behind every successful woman is a tribe of other successful women who have her back.” Not only is that true, but it is imperative that our male colleagues also acknowledge our unique obstacles and take active steps to correct deeply ingrained biases and create a more collaborative and inclusive environment. It is essential that we, women and men, support each other in overcoming the gender disparity that still exists in our field and help pave the way for the incoming generation of women in oncology.

This article was written by Inas Abuali, MD, FACP, Hematology/Oncology—PGY5 University of Cincinnati Medical Center.

References

1. Markel H. How Elizabeth Blackwell became the first female doctor in the U.S. PBS Newshour website. to.pbs.org/1JZfCbg. Published January 23, 2014. Accessed October 15, 2019.
2. More women than men enrolled in U.S. medical schools in 2017 [news release]. Washington, DC: Association of American Medical Colleges; December 18, 2017. news.aamc.org/press-releases/article/applicant-enrollment-2017/. Accessed October 15, 2019.
3. Tsugawa Y, Jena AB, Figureroa JF, Oray EJ, Blumentha DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213. doi: 10.1001/ jamainternmed.2016.7875.
4. Sklar, DP. Women in medicine: enormous progress, stubborn challenges. Acad Med. 2016;91(8):1033-1035. doi: 10.1097/ACM.0000000000001259.
5. Stasenko M, Tarney CM, Veith M, et al. Survey of sexual harassment and gender disparities among gynecologic oncologists. J Clin Oncol. 2019;37 (suppl; abstr LBA10502). ascopubs.org/doi/abs/10.1200/JCO.2019.37.18_suppl.LBA10502?af=R.