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For other articles and previous issues click here. October 11, 2004 The Lack of
Women Radiologists While 46% of students enrolled in U.S. medical schools are female, only one-quarter of diagnostic radiology residents are women. And unlike many specialties, the numbers aren’t improving. Researchers are looking to quantify the reasons why. Diagnostic radiology is on Victoria Potterton’s
short list of career possibilities. If Potterton were to eventually choose a career in diagnostic radiology, it would be unusual. That’s because she’s female. While 46% of students enrolled in U.S. medical schools are female, only one-quarter of diagnostic radiology residents are women. As part of her studies, Potterton, who has an interest in healthcare management, recently looked at the literature to see whether or not she could help explain why women medical students are not choosing diagnostic radiology as their specialty when the number of imaging procedures is dramatically increasing. Seeking the “Why” Other authors were fellow student Shuolun Ruan, an undergraduate at Yale; Jonathan H. Sunshine, PhD, senior director for research at the American College of Radiology (ACR); Kimberly E. Applegate, MD, MS, a pediatric radiologist and immediate past president of the American Association for Women Radiologists; and Howard P. Forman, MD, MBA, founder and director of the MD/MBA program at Yale and an associate professor of diagnostic radiology and management. Sunshine says the ACR—which serves more than 32,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists—supported and participated in the research because it is concerned that the percentage of women coming into radiology is lower than it is for other fields. “All fields of medicine ought to try to make themselves attractive to both sexes just as they try to make themselves attractive to people of all origins and backgrounds,” he says. The gender of the diagnostic radiologist may not be as important to patients as those specialties where doctors have more direct contact with their patients. For example, Sunshine says, women who prefer female gynecologists are probably less concerned whether the physician interpreting their mammogram is male or female. “Still,” he says, “it is desirable to give women—indeed, all patients—as much choice as possible.” The authors of the study agree. In the paper, they write: “The moral and ethical justifications for gender equality are obvious. In addition, a reasonable and representative distribution of medical abilities is important for the sake of patient access to health services. Medical practitioner gender and ethnicity should be distributed across specialties by criteria that address the quality of care and equal and efficient access to medical services.” Better for Everyone Sunshine says the paper by Potterton and colleagues is just a first step in addressing an important issue. “This article was the beginning of the research. There is more research underway.” Further studies are planned that will involve focus groups and surveys designed to not only identify but also quantify the reasons female medical students do or do not choose to enter diagnostic radiology, Sunshine says. At its annual upcoming major meeting, the ACR has scheduled a discussion on how to attract more women to radiology. The meeting will include women who have been leaders in radiology and who are nearing the end of their careers, as well as young women who are just starting out, Sunshine says. The annual conference session will be held at RSNA 2004. Applegate, a pediatric radiologist and associate
professor at Indiana University’s School Fewer Women Granted, Applegate says, the data from the residency match was for only one year. “But it’s counterintuitive,” she says. “Diagnostic radiology offers many of the characteristics that are often desirable to women when choosing specialties, such as reasonable call hours, flexible scheduling, high salaries, and opportunity for part-time work. So why aren’t they choosing it as a career?” Potterton says the literature suggests a number of factors may be responsible, including lack of women role models in the specialty and discrimination and gender bias that is found everywhere in medicine, but in diagnostic radiology even more so. In a way, the problem may be a catch-22, Potterton says. Studies show that exposure to role models clearly affects one’s choice of specialty. One study Potterton cites found that a woman’s choice of surgery as a specialty correlated with a higher proportion of women on the surgical faculty at the student’s medical school. Yet with relatively few women in diagnostic radiology, there are few to serve as role models in practice. Potterton found studies that showed the situation in academic diagnostic radiology was no better. Female radiologists published fewer articles, were less likely to be lead authors, and were less likely to become associate or full professors, she says. However, she notes, the barriers encountered by women in academic diagnostic radiology were similar to those described by women in other fields of academic medicine. Gender-Blind Environment Discrimination and gender bias also appears to be an issue when it comes to specialty choice for women students, the study found. A 1986 survey found that while female diagnostic radiologists felt they could function in any practice, their male counterparts stated that women were better for general radiology. The authors of that study, Potterton writes, “concluded that in general, ‘women are viewed as valuable colleagues in radiology, but often not as true equals.’” Another survey in 1987 found that 80% of female diagnostic radiologists reported experiencing discrimination during their career. The situation has not improved much over the years, Potterton writes. In 1999, female diagnostic radiologists were still reporting incidences of gender-based harassment in their work environment. Women in the study detailed subtle hostility, such as off-color comments, jokes, and other incidents “small in nature, but not trivial in effect.” The situation is no better for women who choose academic radiology over or in addition to private practice. Potterton cites an analysis of women in the sciences at the Massachusetts Institute of Technology in Cambridge, Mass., by biology professor Nancy Hopkins, PhD, that suggests “there is an inherent bias against women in academia” and that found “female faculty are 2.5 times as likely as male faculty to report perceived discrimination in an academic environment.” How to Change Things Practicing physicians have given electives in radiology favorable reviews. Those reviews suggest that when medical students are exposed to radiology, they tend to have a positive experience, according to the study. “A committed institutional effort will improve gender relations and encourage equality with documented success,” Potterton writes. A 1995 study in Academic Medicine of medical students changing specialty choices while in school found that roughly the same number switched to diagnostic radiology as from it. The finding suggests that more women could be recruited to diagnostic radiology by improving access to positive experiences during medical school, such as small group sessions with medical students, research, mentoring programs, and rotations in radiology, Potterton says. The study’s authors also believe positive lifestyle issues factors could be used as a major attraction to diagnostic radiology. They cite a 1999 career satisfaction study of female physicians that found that specialties with a “controllable lifestyle” correlate with higher satisfaction than primary care specialties, except in diagnostic radiology. The highest level of dissatisfaction among women was reported among those in general internal medicine, general practice, and diagnostic radiology. Twenty-two percent of women in each group reported dissatisfaction. Their most common reasons were work stress, lack of control, and encounters with gender bias or sexual harassment. However, the authors of the JACR article also point to story in The New York Times earlier this year that suggested that medical school graduates were increasingly choosing specialties with less time on call and reasonable, defined work hours. “As controllable lifestyle factors becomes an increasingly important factor in specialty choice, diagnostic radiology has the potential to attract an increasing number of talented women,” the authors suggest. Applegate believes that because women often carry greater family responsibilities and consider this role when choosing a specialty, diagnostic radiology has lifestyle characteristics that would be desirable to women with families. Diagnostic radiology offers reasonable call hours and potential for flexible scheduling, she says. The authors also suggest that academic and medical institutions update and modify their promotion criteria to better reflect a woman’s values and contributions to teaching, mentoring, administration, and collaborative research, especially if the institutions’ current criteria were established when there were far fewer women in practice than there are today. Such policies would help equalize numbers of women in all specialties, the authors conclude. Resident Interaction “The interview day and personal interactions with current residents were the important sources of information for applications, [presuming] current residents are satisfied with their experiences, are comfortable initiating conversations with both male and female applicants, and, if at least one female resident and a faculty member are available and are willing to speak with applicants,” the authors wrote. Finally, the authors suggest that in addition to
setting up mentoring programs for women, medical schools should
also provide information about national women’s organizations
such as the American Medical Women’s Association; the Association
of American Medical College’s group, Women in Medicine; and
the American Association for Potterton and her colleagues hope that by bringing gender issues to the forefront, “medical schools and residency programs might respond to gender differences between specialties” and ensure that all medical students—male and female—choose careers with the most information and experience possible. — Beth W. Orenstein is a freelance writer based in Northampton, Pa. She is a regular contributor to Radiology Today. |
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