Gender divide persists in diabetes care
Clinical and academic medicine, particularly in the field of diabetes, are not free of gender disparities, according to an all-female panel of industry leaders held at the recent 78th Scientific Sessions of the American Diabetes Association (ADA 2018).
“The gender gap in medicine is real, and with an ongoing commitment throughout the healthcare infrastructure, we can affect change,” said Dr Elizabeth R. Seaquist, Director of the Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota.
In her presentation, Seaquist outlined some of the ways in which the medical sciences are biased against women. For instance, she cited a 2015 study which showed that in 2014, of all the medical school faculty members who completed their residency programme in the 1980s, 1,089 were men while only 230 were women. [ADA 2018; JAMA 2015;314:1149-1158]
This was true for faculty who finished their residencies in the 1990s (1,320 vs 606) and in the 2000s (1,550 vs 969).
In the same way, the ADA has suffered from the same biases. According to Seaquist, since 1940, only four women have held the organization’s presidency. The first woman to break the all-male streak was Dr Kathleen L. Wishner, PhD. She won the position in 1994, more than 50 years since the organization was established.
Seaquist points to sexual harassment as a driving force behind the gender gap. This was highlighted in a 2018 Viewpoint by Dr Karen Antman of the Boston University School of Medicine, where she revealed that 4.3 percent of the 2017 graduating medical students in the US received unwanted sexual advances during medical school. [JAMA 2018;319:1759-1760]
Moreover, 5.8 percent believed that they had received lower grades due to gender rather than performance, and 14.8 had been subjected to offensive sexist remarks. Some students (0.3 percent) also reported being asked to exchange sexual favours for grades or other rewards.
“Addressing sexual harassment and gender discrimination will require ongoing commitment of all to change culture,” Seaquist said.
To add to this, Dr Felicia Hill-Briggs of the Johns Hopkins University School of Medicine, said that gender disparities in specific healthcare disciplines further reinforce the bias that women are up against. For instance, women predominate patient care: nursing (83 percent female), psychology (70 percent female), social work (82 percent female), and dietetics or nutrition (91 percent female).
“These disciplines often face undervaluing of their science—sometimes denoted as ‘soft science’— inequities in their professional standing and fewer opportunities for advancement within academic medicine, as a consequence of larger societal systems of gender and gender bias,” said Hill-Briggs.
“Gender-bias systems have contributed to lower priority and professional status for these expert disciplines and professionals,” she added.
On the other hand, women are less likely to hold positions of leadership in major medical or professional organizations and are more likely to be assigned as co-leaders than men. As a result, patient care is essentially divided along gender lines, which may contribute to suboptimal outcomes. For example, in male-dominated disciplines, there is less emphasis on social, behavioural and lifestyle-associated care.
Moreover, the lower male participation in services and care may lead to a stigma and notion that such professions are feminine or are for women only.
“To achieve goals of diabetes prevention as well as improved outcomes from diabetes management, the potential contributions of gender bias to lowering the professional status and value of women-predominant disciplines in medicine and health must be examined,” noted Hill-Briggs.
“Gender bias will otherwise limit the population of people with and at risk of diabetes from receiving optimal benefit from the very disciplines that hold expertise in the largest drivers of diabetes outcomes,” she added.