Increasing Roles and Visibility for Women in Dermatology

Introduction

Leadership is the ability to guide, influence, and inspire individuals or groups toward achieving common goals or objectives. The proportion of female dermatologists has drastically increased in the last half century but they continue to be under-represented in leadership positions. In 2020, 51% of active physicians in dermatology in the USA were women, making dermatology one of the most equally represented fields in medicine.[1] Despite this, women are the minority of leaders in dermatology. Gender disparity persists in academic dermatology, medical school leadership positions, professional societies, and editorial boards of journals. As indicated by recent research, women fall far behind their male counterparts when it comes to leadership roles.[2] This paper will analyze these disparities and highlight the need for increased roles and visibility in medical professions, with a special emphasis on dermatology.

Global positioning of women in the medical profession

Until the nineteenth century, there were no female doctors.[3] Women started entering the medical profession only in the late twentieth century, and a high proportion of female doctors have been observed in the last two decades.[4] A recent study on medical specialties in the UK showed that 58% of consultant physicians with a minimum of 8 years of training are male.[5] The only specialties in the UK with an even gender split are rheumatology and hematology. Dermatology is among the top three specialties with the highest percentage of female doctors. Women comprise 62% of dermatology trainees and 54% of practicing dermatologists.[6]

Women in academic dermatology and professional societies

Currently, more than half of academic faculty in dermatology, 50% of dermatologists overall, and 33% of chairs in dermatology are female; in comparison 39% of other specialists and 19% of chairs of other departments are female.[7] Nonetheless, only 17% of women are full professors, whereas male full professors are about 65%.

Karol et al.[8] studied the global gender disparity in dermatologic society leadership. It was noted that across all professional societies, the role of president was more frequently held by men as opposed to women. Female leaders were less likely to hold concurrent academic positions as deans/chairpersons/directors (83.33%) than their male counterparts (92.06%).

Moreover, men are more likely to be invited to submit their work to journals, publish in high-impact medical journals, be reviewers, be on editorial boards and be Editor-in-Chief.[7] A pay gap has also been noticed between both genders in academic dermatology. Sachdeva et al.[9] studied the salary trends in the USA among men and women of the same rank in academic dermatology. It was found that men earned a higher median salary than their female counterparts in all faculty ranks except instructor: assistant professors, +16.2%; associate professors, +21.2%; professors, +6.8%; chiefs, +0.5%; and chairs, +9.7%. Among the reasons for the low number of female professors in academia globally, in comparison with men, are reduced drive toward publishing their research, hesitation to take advantage of a range of experiences and the difficulty with balancing both academic and family-related responsibilities. Other possible reasons are lack of mentoring for women, fewer female role models and having less ambitious career goals than men [Figure 1]. All these factors affect the advancement of women in the medical profession.[7]

Figure 1.

Possible causes of minority women leaders in academic dermatology and professional societies

Gender bias and sexual harassment

In 2020, DeWane et al.[2] conducted a survey on the impact of gender bias and gender-based harassment in dermatology. According to the responses obtained from that survey, 55% of respondents reported perceiving gender-based biases as obstacles to success in their dermatology careers. Fifty percent of the respondents reported being possibly left out of opportunities for professional advancement based on their gender. Almost half of respondents thought that their pregnancy had negatively impacted their career.

How we got here and how to make progress

The “slippery slope” of the competitive demands of professional and personal life along with lesser job satisfaction and increasing household and parental responsibilities result in the inevitable “burnout” for most women.[10]

Possible solutions to bridge the gender gap in dermatology include facilitating mentor-ship and encouraging more risk-taking, the ability to accept failure and try again, adopting flexible work and household schedules, delegating responsibilities and asking for help [Figure 2].[9]

Figure 2.

Solutions to bridge the gender gap in dermatology

Roles and visibility

Various factors contribute to the reduced visibility of women dermatologists in professional societies and academia. Women are under-represented in authorship while publishing their work. It is a personal observation by authors that not only are women’s papers cited less often, it is observed that women tend to cite themselves less often than men do. Also, they cite other women less often than men cite other men. They are less likely to be credited with playing important roles in conceptual processes and more likely to have done more of the work. Women are less likely to give oral presentations at conferences and more likely to decline invitations to give talks.

In a study conducted by Bansal et al.,[10] it was noted that 73.23% had not been in a leadership position as compared to 57.89% of men. Most (58%) dermatologists agreed that the majority of the leadership positions around them were occupied by men.

Zlakishvili et al.[11] conducted a study on gender disparities in high-quality dermatology research over the past 15 years. Female authorship was found in 43%, 31% and 37% of the first, last and total authors. Trend analysis revealed a decrease in the last 15 years in senior female authorship.

Meetings and conferences are good opportunities for visibility of junior female dermatologists but women tend to ask fewer questions after sessions compared to men. More questions are asked by women if the majority in the room are females and if the speaker is male or internal.

Factors cited for the reduced participation are not being bold enough, feeling inadequate in knowledge or ability to ask the question well, worried about missing or misunderstanding content and having concern about a question being appropriate. In fact, many ask questions privately after the session.

To enhance visibility, women need to know their own professional goals and values. Another tip is to learn more about the institution and its leaders to understand how to contribute to institutional success in addition to personal success. If institutional leaders are aware of a woman’s strengths and interests, the likelihood of being asked should an opportunity arise is greater.

One should widen one’s influence by getting to know other leaders and approaching them for mentorship. Stretching beyond one’s comfort zone by volunteering and sharing expertise, such as through participating in panel discussions, teaching or writing/blogging are other important ways to increase visibility.

The Indian Women’s Dermatologic Association (IWDA) offers a women’s leadership program- IWDA- Loreal Women Dermatologists’ Leadership Program for dermatologists. This program is designed to empower female dermatologists and increase their representation in dermatology bodies in India. The program selects 5 to 10 young female dermatologists each year. This grant provides winners with the opportunity to take a leadership course with a leadership coach to build soft skills and leadership skills.

Conclusions

Gender disparity appears to be prevalent across all work settings in dermatology globally. Possible measures to narrow down this disparity may include enhancing institutional support, more platforms for mentorship and sponsorship for women dermatologists.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.