By Reshma Jagsi, MD, PhD, FASTRO, Krisha Howell, MD, and Kirsta Suggs, ASTRO DEI
Women’s participation in the medical profession increased steadily after the enactment in 1972 of Title IX, which proscribed discrimination by educational institutions, including medical schools’ decisions for admissions, hiring and promotions. Before either physician author of this post entered medical school themselves, women constituted over 40% of the medical student body. However, even today, women comprise under a third of all radiation oncologists. They remain in an even smaller minority in positions of influence and authority in the field, ranging from professional society board members and honorees to institutional deans and department chairs.
At the national level, organizations such as the Association of American Medical Colleges have long been engaged in generating and disseminating evidence regarding the status of women in medicine. The National Academies explicitly included medicine in its Committee for Women in Science and Medicine in 2007, soon after publishing a landmark report on gender bias. This allowed subsequent efforts, including reports on the sexual harassment of women, promising practices to promote equity, and the impact of COVID-19 on the scientific workforce to specifically include recommendations relevant to women in medicine. These efforts generated observations that those who challenge the status quo, such as those entering a field from which they had historically been excluded, are often targets of hostility and harassment. Gender bias can be so pervasive that a name change at the top of a CV is enough to have a meaningful impact on whether a candidate receives a job interview or is hired. Moreover, gendered expectations of society lead to differences in family care responsibilities that can challenge women’s full participation in the professions, something that has been both highlighted and amplified by the COVID-19 pandemic. These types of challenges ultimately act to the detriment of all, given the demonstrated value that diverse perspectives bring to any endeavor, especially one as important as the improvement of human health.
Although efforts at the level of the profession as a whole have had great impact, needs still exist for work at the level of individual specialties. In radiation oncology, women’s participation among physicians reached approximately 30% over three decades ago and then essentially flattened. This pattern, which differs from what is observed in medical oncology and many other fields, requires focused attention. For as long as we can remember, the American Association for Women Radiologists (AAWR) has generated tremendous interest in its annual luncheon bringing women together at the ASTRO Annual Meeting. The AAWR celebrated its 40th anniversary during the pandemic and its impact in facilitating both the understanding and mitigation of challenges disproportionately encountered by women in both diagnostic radiology and radiation oncology cannot be overstated.
In more recent years, led primarily by newer members of the profession, a stronger desire for groups specifically focused on women in radiation oncology has emerged. This led to the founding of the Society for Women in Radiation Oncology and the Radiation Oncology Women Physicians Facebook group. At the same time, broader efforts within ASTRO to develop a robust committee focused on equity, diversity and inclusion led to the Committee on Health Equity, Diversity and Inclusion (CHEDI) and ultimately the more recent establishment of the Council for Health Equity, Diversity and Inclusion (HEDI Council). An ad hoc ASTRO task force that was first formed in 2020 and focused on gender equity was recently retired. In its place, a new Women in Radiation Oncology Affinity Group was formally created in the summer of 2022 as a component of the HEDI Council.
As the chair, co-chair and ASTRO staff liaison of this Affinity Group, we write this post to share its structure and goals with the broader community of radiation oncologists. We are excited that this task force is particularly well situated to advance equity with an intersectional lens, as one of six standing units within the HEDI Council. The membership currently includes a diverse group of 24 members, including physicians and physicists, ASTRO Gold Medalists and trainees. We have created three working groups that will focus on 1) gender bias and harassment, 2) family caregiving, and 3) mentorship, sponsorship and leadership development. These groups will focus on developing education, research, policy and other initiatives in their areas of focus.
In this way, we seek to collaborate with, and build on, the tremendous foundation of existing groups, including those mentioned above, to create a unified forum within the primary professional society of our field to pursue research and initiatives that will promote equity for women in radiation oncology. We invite all interested members of the field to bring their ideas to our working groups and engage with us to pursue our mission. Please feel free to email us and join the Gender Equity community on the ROhub to start a conversation.
By Kelly Paradis, PhD
Our first child was born in the summer of 2018. It had been an arduous road to get to that point, but we were ecstatic at the arrival of this tiny little girl who came screaming into the world. My husband Eric, a professor of physics, was amidst his summer semester and covertly disappeared into our rainy bubble of chaos, laughter, tears and precious few hours of sleep. I soon became convinced that parenthood was a conspiracy — how had I not realized how difficult this would be? I googled a thousand iterations of, “is it normal if baby poop looks like…” and crumbled into tears if I dropped clean laundry on the ground (this would later be diagnosed as postpartum anxiety). I took the equivalent of 12 paid weeks of leave from my job as a clinical medical physicist: Six weeks at 0% effort, and then another six staggered over several months. It was classified as “extended sick” time. Though six weeks of parental leave for the birth of a child was included in Eric’s contract, the implications were clear that taking it would impact his chances of achieving tenure. He returned to work full time in the fall. Meanwhile, I considered never leaving the couch again.
Our second child was born in late summer of 2020, a time characterized by a haze of masks and nasal swabs and rooms drenched in bleach. It was 3:00 a.m. when I nudged Eric to tell him I thought we might need to go to the hospital. The next two hours were a rush of drowsy toddler, quiet city streets lit by dim lamplight, frantic phone calls to colleagues and Eric arriving moments before the birth of our second daughter. I was desperate to leave the hospital, where every interaction seemed dangerous and every surface menacing. At one point, while clutching my day-old child to my chest and standing barefoot in a half-tied hospital gown, I declared, “I think we are going to go home now,” to which our very patient nurse replied, “Ma’am, that’s not how this works.”
During this second rodeo, I took 12 consecutive weeks of what was then newly classified as maternity/parental leave by my institution. Eric, tenure in hand, negotiated a modified fall schedule that was the equivalent of six weeks of leave. We were largely alone, my family too far away to travel safely, and Eric’s family forcibly separated from us by border closings. Months earlier I’d had a phone conversation with a U.S. Customs and Border Patrol officer about whether Eric’s mother crossing the Canadian border a few weeks before my due date to ensure Eric could be there for the birth of our child constituted as “essential travel” (it did not). Together, we did the best we could with the resources we had. And, I have to acknowledge how incredibly privileged we were to have access to paid parental leave at all, as many in the United States still do not.
While sufficient paid leave for the birthing partner is critical, the fact that leave for non-birthing partners is frequently ignored is a clever assault on gender equity. It defaults mothers to caregiving-focused roles, where their careers are deemed less important compared to their partners’, and exacerbates biases in hiring, the gender pay gap, the dearth of women in leadership roles and attrition. If we must make a “business” argument, academic medical institutions know how extraordinarily expensive it is to replace faculty. Equal and adequate paid leave for both partners when a child is added to the family, beyond simply being humane, is also the economically sound path.
The stigma against men who take parental leave remains a significant barrier. U.S. Secretary of Transportation Pete Buttigieg recently had to defend attacks against him for taking parental leave after he and his partner adopted twins. Palantir co-founder Joe Lonsdale articulately responded that any man taking six months of leave was a “loser.” Relatedly, a 2019 study published in JAMA Network Open found that in a survey of 844 physician mothers, less than 10% of partners took leave from work, and only 3% took more than two weeks. For non-birthing partners with access to paid leave who returned to work early, 44.9% of first-time parents cited a personal preference to return to work earlier, and 33.3% had intrinsic feelings to not take leave because others did not take paternity/domestic partner leave.1 Clearly, there is work to do.
I am grateful to the American Board of Medical Specialties for their new policy stating, “Member Boards must allow all new parents, including birthing and non-birthing parents, adoptive/foster parents, and surrogates to take parental leave.” In the 21st century, it should be embarrassing for an institution to have varying leave policies dependent on a parent’s gender or specific path to parenthood.
Four years ago, when I was pregnant for the first time, my mother gently said to me that I didn’t realize how lucky I was that Eric would be home with me for the first few months after our baby was born. She was right, not only in that I didn’t realize this (how hard could it be?), but also about the impact that it would have on our family for years to come. What’s more, without him at home, I’m not sure I would have returned to work at all. Eric, you’re my hero. Thank you for changing all the diapers while I cried about the laundry.
Kelly C. Paradis, PhD, is an associate professor of Medical Physics and associate chair of Equity and Wellness in the Department of Radiation Oncology at Michigan Medicine.
References
- Juengst SB, Royston R, Huang I, and Wright, B. Family Leave and Return-to-Work Experiences of Physician Mothers. JAMA Netw Open. 2019;2(10):e1913054.