A detailed pre-specified protocol is supposed to be the superpower of a systematic review: its contents literally put the “systematic” into review…
This, in 2008:
Women make up an ever-increasing fraction of the students who train to become biomedical scientists, but their career attrition is disproportionate to that of men. If these trends continue, this country will probably experience a shortage of biomedical scientists in the near future.
It was from a study by Timothy Ley and Barton Hamilton of the gender gap in NIH grant applications, and they concluded that a considerable number of women were leaving the NIH career pipeline early. What’s more, they wrote:
Female physician-scientists make this decision earlier and more often, perhaps because more attractive and/or flexible career options (e.g., clinical practice) are available to them.
Fast forward to 2019. And the Physician-Scientist Support Foundation (PSSF) is launched, with an opinion piece by Mukesh Jain and colleagues on “Saving the Endangered Physician-Scientist”. They speak of what they see as the good ol’ days:
The Vietnam War era saw the launch of a golden age of biomedical research at the NIH that spawned an entire generation of academic physician-scientist leaders whose work, in aggregate, has changed the way we prevent and treat disease.
But now, write Jain & co,
…the proportion of U.S. physicians engaged in research has dwindled from a peak of 4.7% of the overall physician in the 1980s to approximately 1.5% today.
The golden age they write of, from the late 1960s, was when people were still having to argue the case that it was worth training women in medicine. Between 1964 and 1975, though, 25 new medical schools opened in the U.S., and women started to come through the doors in bigger numbers – there’s a chart here showing the rise of women, as students and academic medical faculty, from less than 10% of medical graduates in 1965 to 45% in 2004. (Women were 7% of the U.S. medical profession in 1970.)
The bulk of that rise in the graduate population happened in the decade from 1975 to 1985. That’s a radical social change. And I think it makes gender a very big elephant in the room. As Ley and Hamilton point out, even a small amount of bias towards half your population is going to have a big impact over time.
It’s not that the PSSF group have completely ignored gender. They stress that diversity is critical to a new golden age. They only mention women once, though, and that is to say that at a critical stage of career development,
…many have increasing family responsibilities, which still represent a particularly important barrier for female physicians.
That as the only gendered consideration is … well … problematic. Sure, family issues matter, but it’s not as though women without family responsibilities have an equal shot, is it? I’ve tackled the argument that it’s about all motherhood before: multiple contributing factors, I wrote, even small ones, can contribute to cumulative advantage for men in science. That’s addressed head-on in a 2007 report from a trio of National Academies, and its title is critical: Bias and Barriers.
Dismantling barriers is great. But if you don’t face the biases chipping away at women and others, and they remain intact, then results will probably disappoint. We don’t have a magic bullet for ending gender, racial, and other social biases, either, but not explicitly considering them doesn’t engender confidence. Papering over them won’t help.
The PSSF piece talks about low pay, for example. But unequal pay for women is a major issue in U.S. medicine (see for example here and here). So if we want to talk about what’s a “particularly important barrier for female physicians”, then that’s one, eh? Pay can rise, and still do so unequally for half a community. And that extracts a toll.
As much as some think that we’re past having to address gender bias in science, or in leadership in science, we’re not – just as we’re clearly not living in post-racial times. I’m keen on the idea of promoting physician-scientists, although I don’t think they are the only clinician-scientists that matter by a very long way – or that doctors should be leading everything.
I think it’s great that PSSF is genuinely concerned with diversity. But you’ll be shocked, shocked, to learn that the President, Vice-President, and Chair of the PSSF Board are all men. There’s still quite a way to go, isn’t there?
* There is a sole woman in the leadership group of 6 founders of the PSSF, half of whom are people of color.
The montage of portraits in the top cartoon was inspired by this gallery at the NIH (my photo, on Wikimedia Commons):