Healing the Gender Gap featuring Drs. Sharon Straus, Gianni Lorello, Tara Kiran and Michelle Cohen

How do we heal the gender gap in medicine?  That question lead the discussion of the Ontario Medical Associations' second thought leadership series OMATalks held virtually on November 27, 2020. Over 300 physicians joined Dr. Sharon Straus, Dr.  Gianni Lorello, Dr. Tara Kiran and Dr. Michelle Cohen for an evening of thoughtful dialogue.

For more information on the event please visit: https://www.oma.org/expert-advice/oma-talks-speaker-series/

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Spotlight on Health - Season 2, Episode 4 - Healing the Gender Gap featuring Drs. Sharon Straus, Gianni Lorello, Tara Kiran and Michelle Cohen

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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.

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Introduction: On this podcast, physicians focus on healing the gender pay gap.

We will be hearing from Dr. Tara Kiran, the Fidani Chair in Improvement and Innovation and Vice Chair Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto. She practices family medicine at St. Michael's Hospital Academic Family Health Team and is an associate professor at the University of Toronto, a scientist in the MAP Centre for Urban Health Solutions at St. Michael's Hospital, and an adjunct scientist at ISES.

Dr. Tara Kiran: It's fantastic to be here today.

Introduction: From Dr. Michelle Cohen, a family physician in Brighton, Ontario, an assistant professor in the Queen's Department of Family Medicine, and co-chair of the Advocacy Committee of Canadian Women in Medicine.

Dr. Michelle Cohen: Thank you so much.

Introduction: From Dr. Sharon Straus, a geriatrician and clinical epidemiologist, the director of the Knowledge Translation Program and physician-in-chief at St. Michael's Hospital, as well as a professor in the Department of Medicine at the University of Toronto.

Dr. Straus: Thank you so much.

Introduction: And from Dr. Gianni Lorello, a staff anesthesiologist at Toronto Western Hospital, University Health Network, and an assistant professor at the University of Toronto, the inaugural chief diversity officer of the Department of Anesthesiology and Pain Medicine, a selected member of the Diversity, Equity, and Inclusion Working Group at the Canadian Anesthesiologist Society, and a member of the Civility, Diversity, and Inclusion Committee for the Ontario Medical Association.

Dr. Lorello: Hi. I have made it my mission to provide a space and voice for women and for all socially marginalized people.

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Dr. Kiran: The gender pay gap is real. It doesn't relate to women working less, or less efficiently. Those are common myths. Rather, it relates more to the type of work we do and how that work is valued. And ultimately, it relates to issues of sexism and discrimination throughout a woman's career.

And there's a gap, no matter—you know, whether you're looking at the type of specialties, so general family practice versus diagnostic specialty or medical or surgical—there's a gap no matter what kind of geographic location you're in, urban or rural. So, we see this pervasive gender pay gap.

Dr. Straus: Compared to men, women academics, first of all are paid less, receive fewer invitations for talks, we're less likely to be introduced as "Doctor" when we do give talks, we have our work judged more harshly—yet we have similar assessments when peer reviews are blinded to gender—and we receive lower teaching evaluations despite similar scores.

Women academics are expected to do more service work, and we're also expected to do more special favours for our trainees. Women are also more likely to experience harassment.

And we did a systematic review a few years ago showing how common female medical trainees, as well as throughout your career, if you experience harassment—and it's much more likely to happen with women physicians—that we experienced it more than our, than our male counterparts.

Dr. Cohen: Women consistently earn less than men, and this is demonstrated throughout the research. This difference exists both between and within the specialties, so it's pervasive throughout our profession. There have been estimates that over a 30-year career the gender pay gap amounts to $2.5 million.

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Dr. Kiran: In medical school, many women are, either overtly or subtly, actually dissuaded from entering those certain specialties that have higher pay because they're told that they're too demanding. They assume that women want to have a greater role in the home and that by doing so they wouldn't be able to actually contribute and be successful in those demanding specialties.

We know, often, recruitment occurs through informal networks, and often those are male informal networks perpetuated by male leaders. Often, women, they feel a lot of imposter syndrome when they go in and try to negotiate for themselves. But some

of that imposter syndrome is actually based on real-life experience of being made to feel bad for negotiating, of seeing inequities in starting salaries.

The networks pay off for men often, and we see many more men in leadership roles.

Dr. Lorello: Women anesthesiologists in leadership positions, ironically, have difficulty of internalizing a leadership identity, expressed experiencing discrimination, and articulated family responsibility-related barriers, as well as ingrained societal expectations, as barriers to academic progression into leadership positions.

Dr. Cohen: We need better transparency and better competition to eliminate that old boys network that really perpetuates the glass ceiling in medicine, that prevents so many women from moving into those leadership roles.

Ideally, we would want gender parity on our hiring selection committee. There's a good deal of research to show that having a single token female, or single minority, on a hiring committee of any kind does not improve representation for that underrepresented group. That's something that definitely needs to be worked on. So, we need to actively seek women for leadership roles.

Dr. Lorello: Diverse teams focus more on facts and have been found to produce fewer errors, are better at solving problems, and are more innovative and creative. Large and complex companies benefit more from increased diversity.

Healthcare and diversity is generally less well-studied than within the business world. However, equity, diversity, and inclusion initiatives have been gaining traction within medicine. Baby Boomers, Gen Xers, and Millennials have a common goal to make a positive impact on their organization and help solve social challenges.

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Dr. Kiran: Many people wonder, is the pay gap a result just of women working less? More women work part-time, isn't that it?

The data suggests that, yes, women often do work fewer hours than men, but ultimately, the differences in the number of work hours in no way seem to explain the size of the gap. Really, what the gap is related to is more the type of work and how that work is valued.

Female surgeons earn 76 cents on the dollar per hour compared to male surgeons. Female surgeons were more likely to do less lucrative procedures. And one of the reasons was that they were more likely to operate on women, and the surgical procedures being done on women are valued less in our schedule of benefits than surgical procedures done on men.

So again here, we're not seeing that women work less. In fact, often women were spending more time per patient. Female physicians—primary care docs—generated nearly 11% less annual visit revenue than otherwise similar male family doctors in the same practice. But they were spending more time with patients per visit per day and per year.

So, this revenue gap that they found was really driven mostly, almost entirely, by differences in visit volume, which were not really explained by women working fewer days, but rather by women spending more time per patient.

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Dr. Straus: The other thing that the data is showing is that, although the teaching and clinical loads may not have increased during the pandemic, home responsibilities increased. And in particular, 50% of the women are primarily responsible for the homeschooling of their children compared to 8% of men.

Dr. Kiran: Women bear, often, a greater set of responsibilities in the home, when there's evidence to kind of back that up that, even in dual physician couples, women are doing more of the domestic responsibilities in a domestic partnership, even without children—still more likely to work part-time and spend more time at home and have a greater share of the domestic responsibilities.

Dr. Straus: It's also about creating appropriate work-life integration and thinking about that flexible workplace, thinking about parental leave, childcare on site.

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Dr. Straus: One of the things that's happened as a result of the pandemic is that it really has shone more of a light, internationally, on anti-black, anti-indigenous racism in particular. And, certainly, we have seen this now in medicine as well.

Dr. Kiran: We are talking about the gender pay gap. But of course, ideally, we'd be speaking about other pay gaps as well, related to race or ability. But we just don't have that data, unfortunately. And we're also looking at gender in a very binary way.

It’s hopefully something that we can keep in mind as we're having this conversation, that just because there's no data on it doesn't mean we shouldn't be talking and acting on it.

Dr. Cohen: For our male allies, I think it's a valuable question to consider—what power can you yield to women and to other underrepresented groups? This is not just a male ally question; this is for all allies with respect to underrepresented groups.

Dr. Lorello: I want to understand how a continuum model of gender can shift our academic dialogue and avoid the current polarization that leads to segregation and isolation rather than diversity and inclusion, to improve conditions for all who are discriminated against, and discuss the need to move beyond gender binaries, and the importance of intersectionality in everyday language, and its effects on people and policies.

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Dr. Straus: The impact of ongoing microaggressions is actually worse than a single egregious action. Because a lot of times what happens, if there was a single bad behavior that you experienced, usually something is done about that. But when there's these microaggressions that are going on in an ongoing basis—locker-room talk, pejorative language, overtalking during meetings, or constant interruptions—all of these things can lead to this perceived undervaluing of female faculty, but also affects the workplace culture.

Dr. Kiran: I think ultimately, it's about thinking about how you concede power, recognizing that you have power that you may not even recognize, and how can you see it—how can you give it to somebody, who can you give it to, and how can you do that?

Secondly, I think it's about having the courage to speak up, especially speaking up right in the moment. That is so hard to do sometimes, and sometimes it will come at a cost to the person who's speaking up.

But if you see somebody treating somebody not well—making a misogynistic remark, dismissing a woman's comment, speaking over a woman at a meeting—you can be an ally by picking up on that, calling out explicitly what it is that you're seeing, and standing by.

Dr. Lorello: And we men have a role to play. I have started better understanding the gender disparities that exist, and in moving forward to better understanding the mechanisms that perpetuate these disparities. Let's not close the door and remain open to different ways of seeing and different ways of knowing.

Dr. Cohen: This is something that allies can do with their privilege, is to lean back.

So, we hear a lot about women leaning in and being more aggressive and more assertive and grabbing for powerful positions and roles in leadership. But a lot of the time, there's a sort of blockade of that glass ceiling and those men in those established networks. It would be very helpful to lean back and to have men step back and say, "Let's get some underrepresented voices into these committees and

onto these boards and into these leadership roles." So, leaning back is a powerful step that allies can take.

And then, on a personal level, we need to support women at home by leaning in domestically. It behooves all of us to eliminate that second shift that so many women do. And this is outside of medicine, this really involves all working women.

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Dr. Cohen: Anti-oppression training is important for those in all leadership positions, and arguably most important in healthcare leadership. We know that healthcare, or access to healthcare, is not equitable over the country, that race and gender and other intersecting inequities can also contribute to inequities in healthcare. That's important for us just as healthcare leaders to be aware of.

So, anti-oppression training is training on how those systems of power and privilege can interact. And what it can do with respect to the gender gap, and the gender pay gap specifically, is illuminate the underlying power structures that can be hard to see that can contribute to the pay gap.

Dr. Straus: We all need to think about being a strong ally, and by ally meaning that we're joined together for a common purpose.

As a white woman I have privilege in my position, and thinking about—what can I do in this role that I can lend privilege? So, I think that's one of the things that we should all be thinking about as well, and promoting allyship.

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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.

For more information, please visit our website at oma.org.

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