Gender and academic medicine: impacts on the health workforce
http://www.100md.com
《英国医生杂志》
1 Harvard Centre for Population and Development Studies, Cambridge, MA 02138, USA, 2 Rockefeller Foundation, New York, NY 10018, USA
Correspondence to: L Reichenbach laura@hsph.harvard.edu
Recent discussions about the "feminisation of medicine" raise critical questions for how academic medicine deals with gender issues. Addressing the gender dimensions of enrolment, curriculum, and promotion practices in academic medicine may be a good starting point
Introduction
How can gender questions be successfully incorporated into the campaign to revitalise academic medicine? Many are just beginning to be articulated; addressing them will require important changes in how gender is perceived and valued in academic medicine.
Building an evidence base
The first change needed is a commitment to collect evidence related to gender and academic medicine. This should include data on gender and promotion practices, mentoring systems, and how gender is valued in academic medicine. Constructing an evidence base will raise awareness about the utility of incorporating gender into academic medicine; illuminate new interventions; help decision making; and generate systematic analyses. It will allow questions such as "do women tend to practice particular medical specialities because of individual choice or due to gender biases?" to be addressed. Finally, an evidence base will make it possible to track progress in achieving gender equity in academic medicine. While creating indicators is not a straightforward process, it will generate debate about the best measures for gender equity in academic medicine.
Gender equality versus gender equity
The second change requires leaders in academic medicine to recognise the distinction between gender equality and gender equity. Gender equality refers to men and women having equal opportunity and access to resources, whereas gender equity strives for fairness and justice for men and women in the professional opportunity structure. In the past, academic medicine has addressed gender primarily through recruitment policies for enrolment in medical education. This has increased the number of female physicians, but they are more likely to be unemployed or less likely to practice in highly specialised areas of medicine than their male counterparts. Gender equity addresses underlying injustices in the professional opportunity structure and offers a more complete approach to addressing gender and academic medicine.
Summary points
Improving the health workforce through increased numbers and improved distribution and skill mix of providers is contingent on identifying and addressing the gender dimensions of enrolment, curriculum, and promotion in academic medicine
Gender equality in enrolment and graduation rates is not enough; gender equity will improve the extent, distribution, and skill mix of the health workforce
A better evidence base related to gender and academic medicine is needed
A more focused mentoring and support system throughout the academic medical process is also required
Both male and female leaders of academic medicine should rethink their traditional values
Challenging traditional values
The final change requires a fundamental shift in values and expectations among leaders of academic medicine. Expectations about what represents measures of success and performance may need to be reconsidered. For example, number of hours worked may not be an accurate measure of productivity without also taking into account some measure of the quality of care provided. Traditional expectations about who is best equipped to practise a particular specialty must also be revised. Students should not be pressured, directly or indirectly, to enter particular specialties because of social expectations about the professional strengths or weaknesses of men and women.
Gender presents challenging issues and critical questions for decision makers at all levels of academic medicine. As a conservative, male dominated institution, academic medicine may not easily examine the gender dimensions of its operations and values. However, it is critical to view the issues raised by gender as an opportunity to help revitalise academic medicine and strengthen its contributions to the health system rather than as a threat to the profession. Improving gender equity is essential to the future of academic medicine; ensuring the health system's most effective response to the public health challenges of the future may well depend on it.
We thank Michael Reich for very helpful comments and suggestions.
Contributors and sources: This article reflects research towards an edited volume on the gender dimensions of the global health workforce and does not reflect the opinions of either of the author's institutions. Sources of data include studies in the published literature and personal communication with individuals working in the area of human resources for health. Both authors contributed to the conception, design, and drafting of this article. LR is responsible for the final draft of the article and is guarantor.
Funding: LR's research on the gender dimensions of the global health workforce is supported by the Human Resources for Health and Development: A Joint Learning Initiative.
Competing interests: None declared.
References
Lorber J. Women physicians: careers, status, and power. New York: Tavistock, 1984.
Riska E, Wegar K. Gender, work and medicine: women and the medical division of labour. London: Sage, 1993.
Riska E. Medical careers and feminist agendas: American, Scandinavian, and Russian women physicians. New York: Aldine de Gruyter, 2001.
Brooks F. "Women in general practice: Responding to the sexual division of labour?" Soc Sci Med 1998;47: 181-93.
World Health Organization, Department of Gender and Women's Health. "En-gendering" the millennium development goals (MDGs) on health. 2003. www.who.int/mip/2003/other_documents/en/MDG3.pdf (accessed 17 Sep 2004).
Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G, et al. Responding to the global human resources crisis. Lancet 2004;363: 1469-72.
BBC News. "Women docs `weakening' medicine." 2 August 2004. http://news.bbc.co.uk/2/hi/health/3527184.stm (accessed 21 Sep 2004).
Heath I. Women in medicine: Continuing unequal status of women may reduce the influence of the profession. BMJ 2004;329: 412-3.
National Association of Universities and Higher Education Institutions (ANUIES). Annual estimates of professions, 1990-2001 . Mexico: ANUIES, 2004.
Yedidia MJ, Bickel K. Why aren't their more women leaders in academic medicine? The views of clinical department chairs. Acad Med 2001;76: 453-465.
Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine: glass ceiling or sticky floor? JAMA 1995;273: 1022-5.
Krieger N, Fee E. Man-made medicine and women's health: the biopolitics of sex/gender and race/ethnicity. In: Fee E, Krieger N, eds. Women's health, politics, and power: essays on sex/gender, medicine and public health. New York: Baywood, 1994.
Lorber J. Gender and the social construction of illness. Thousand Oaks, CA: Sage, 1997.
Jesani A, Madhiwalla N, eds. Gender and medical education: report of national consultation and background material. Mumbai: Centre for Enquiry into Health and Allied Themes, 2002.
Bickel J. "Women in medical education: A status report." N Engl J Med 1988;319: 1579-84.(Laura Reichenbach, resear)
Correspondence to: L Reichenbach laura@hsph.harvard.edu
Recent discussions about the "feminisation of medicine" raise critical questions for how academic medicine deals with gender issues. Addressing the gender dimensions of enrolment, curriculum, and promotion practices in academic medicine may be a good starting point
Introduction
How can gender questions be successfully incorporated into the campaign to revitalise academic medicine? Many are just beginning to be articulated; addressing them will require important changes in how gender is perceived and valued in academic medicine.
Building an evidence base
The first change needed is a commitment to collect evidence related to gender and academic medicine. This should include data on gender and promotion practices, mentoring systems, and how gender is valued in academic medicine. Constructing an evidence base will raise awareness about the utility of incorporating gender into academic medicine; illuminate new interventions; help decision making; and generate systematic analyses. It will allow questions such as "do women tend to practice particular medical specialities because of individual choice or due to gender biases?" to be addressed. Finally, an evidence base will make it possible to track progress in achieving gender equity in academic medicine. While creating indicators is not a straightforward process, it will generate debate about the best measures for gender equity in academic medicine.
Gender equality versus gender equity
The second change requires leaders in academic medicine to recognise the distinction between gender equality and gender equity. Gender equality refers to men and women having equal opportunity and access to resources, whereas gender equity strives for fairness and justice for men and women in the professional opportunity structure. In the past, academic medicine has addressed gender primarily through recruitment policies for enrolment in medical education. This has increased the number of female physicians, but they are more likely to be unemployed or less likely to practice in highly specialised areas of medicine than their male counterparts. Gender equity addresses underlying injustices in the professional opportunity structure and offers a more complete approach to addressing gender and academic medicine.
Summary points
Improving the health workforce through increased numbers and improved distribution and skill mix of providers is contingent on identifying and addressing the gender dimensions of enrolment, curriculum, and promotion in academic medicine
Gender equality in enrolment and graduation rates is not enough; gender equity will improve the extent, distribution, and skill mix of the health workforce
A better evidence base related to gender and academic medicine is needed
A more focused mentoring and support system throughout the academic medical process is also required
Both male and female leaders of academic medicine should rethink their traditional values
Challenging traditional values
The final change requires a fundamental shift in values and expectations among leaders of academic medicine. Expectations about what represents measures of success and performance may need to be reconsidered. For example, number of hours worked may not be an accurate measure of productivity without also taking into account some measure of the quality of care provided. Traditional expectations about who is best equipped to practise a particular specialty must also be revised. Students should not be pressured, directly or indirectly, to enter particular specialties because of social expectations about the professional strengths or weaknesses of men and women.
Gender presents challenging issues and critical questions for decision makers at all levels of academic medicine. As a conservative, male dominated institution, academic medicine may not easily examine the gender dimensions of its operations and values. However, it is critical to view the issues raised by gender as an opportunity to help revitalise academic medicine and strengthen its contributions to the health system rather than as a threat to the profession. Improving gender equity is essential to the future of academic medicine; ensuring the health system's most effective response to the public health challenges of the future may well depend on it.
We thank Michael Reich for very helpful comments and suggestions.
Contributors and sources: This article reflects research towards an edited volume on the gender dimensions of the global health workforce and does not reflect the opinions of either of the author's institutions. Sources of data include studies in the published literature and personal communication with individuals working in the area of human resources for health. Both authors contributed to the conception, design, and drafting of this article. LR is responsible for the final draft of the article and is guarantor.
Funding: LR's research on the gender dimensions of the global health workforce is supported by the Human Resources for Health and Development: A Joint Learning Initiative.
Competing interests: None declared.
References
Lorber J. Women physicians: careers, status, and power. New York: Tavistock, 1984.
Riska E, Wegar K. Gender, work and medicine: women and the medical division of labour. London: Sage, 1993.
Riska E. Medical careers and feminist agendas: American, Scandinavian, and Russian women physicians. New York: Aldine de Gruyter, 2001.
Brooks F. "Women in general practice: Responding to the sexual division of labour?" Soc Sci Med 1998;47: 181-93.
World Health Organization, Department of Gender and Women's Health. "En-gendering" the millennium development goals (MDGs) on health. 2003. www.who.int/mip/2003/other_documents/en/MDG3.pdf (accessed 17 Sep 2004).
Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G, et al. Responding to the global human resources crisis. Lancet 2004;363: 1469-72.
BBC News. "Women docs `weakening' medicine." 2 August 2004. http://news.bbc.co.uk/2/hi/health/3527184.stm (accessed 21 Sep 2004).
Heath I. Women in medicine: Continuing unequal status of women may reduce the influence of the profession. BMJ 2004;329: 412-3.
National Association of Universities and Higher Education Institutions (ANUIES). Annual estimates of professions, 1990-2001 . Mexico: ANUIES, 2004.
Yedidia MJ, Bickel K. Why aren't their more women leaders in academic medicine? The views of clinical department chairs. Acad Med 2001;76: 453-465.
Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine: glass ceiling or sticky floor? JAMA 1995;273: 1022-5.
Krieger N, Fee E. Man-made medicine and women's health: the biopolitics of sex/gender and race/ethnicity. In: Fee E, Krieger N, eds. Women's health, politics, and power: essays on sex/gender, medicine and public health. New York: Baywood, 1994.
Lorber J. Gender and the social construction of illness. Thousand Oaks, CA: Sage, 1997.
Jesani A, Madhiwalla N, eds. Gender and medical education: report of national consultation and background material. Mumbai: Centre for Enquiry into Health and Allied Themes, 2002.
Bickel J. "Women in medical education: A status report." N Engl J Med 1988;319: 1579-84.(Laura Reichenbach, resear)