We have long been aware of gender gaps in academic medicine and there have been many efforts to remedy these disparities, ranging from recruitment initiatives to bias training.^1–4 Indeed, a PubMed search on the term ‘gender gap medicine’ results in over 3,000 publications; over 2500 in the last 10 years alone. These disparities are gaining attention because they persist. While representation of women in medicine has increased to achieve gender parity in the profession as a whole in both Canada and the United States^5,6, equity in recognition of women’s contributions has not matched pace.^57–10 Women are less likely to obtain jobs in the competitive world of academic medicine¹¹ and, when they do, they earn less than their male colleagues^12,13 - even when studies control for factors such as family commitments, years of experience, and research productivity.^14–18 Their academic contributions are likewise under-recognized through critical metrics such as authorship on academic publications¹⁹, representation in leadership ^20,21 and engagement as keynote speakers.^22–25 In the context of authorship, the COVID-19 pandemic has only served to magnify this gap.^{19,26,26–28,28–32} Clearly, our current strategies for remedying the gender gap are insufficient.

A large part of the problem with current strategies may be the assumption that increasing women’s representation would be enough to ensure equity. In other words, if women were given enough time to progress through the ranks, they would eventually achieve parity at higher levels of recognition. Simultaneously, many advocates in many fields believed that increasing awareness of gender inequity was the key to safeguarding women’s progress through the leadership pipeline, but this strategy was failing as early as the 1980s^33–35; patience and increased awareness has not triggered significant improvements. Though they were coined nearly 20 years ago, the metaphors of the ‘leaky pipeline’ (i.e. the consistent and noticeable reduction in the proportion of women, compared to men, at each progressive step up in promotion toward senior leadership) and ‘Matilda effect’ (i.e. under recognition and denial of contributions from women, compared to men) remain very relevant today.^4,15,36

Another strategy that has met with significant criticism and very little change, encouraged women to ‘lean in’, and ‘step up’.^37,38 Encouraging women to “step up” and be part of the solution or ‘lean in’ to the problem implies in part that the gender gap’s presence and persistence is caused by a lack of effort on the part of women. What all of these strategies have in common is a failure to recognize the cultures and systems that waylay women’s efforts to succeed - they suggest representation will automatically lead to equity, that awareness is sufficient to change practice, or that more effort on the part of women will lead to change.³⁹These strategies reinforce the belief that women need to find a way to work within the existing culture and systems, instead of requiring the culture and systems to change in ways that recognizes the value of equity and diversity.^9,40 Given the resilience of the gender gap despite these efforts, we may only exacerbate the problem by placing additional burdens on women to fix or adapt to the problem.

Recent strategies call on allies to take the burden of change-making off of women’s shoulders; through allyship, men can support women’s advancement, sharing the goal and responsibilities involved in the fight for gender equity. Allyship is a particularly important strategy in achieving gender equity given that significant power remains in the hands of men, and, thus, male allies may often be in a better position to change systems and ensure equitable recognition.^40–42 As an example, women and allies have targeted the ‘manel’ (a panel of presenters dominated by men) for extinction.^22,41,43 Allies that are aware of the “manel” problem can use their power to mindfully recruit speakers, considering inclusivity and equity.⁴⁴ However, there remain significant and complex psychological and structural issues that prevent women from participating^20,45,46; allies must understand that their role is not limited to simply extending more invitations to women. The anecdote in Box 1 and Figure 1 highlight this reality and illustrates some of the complexities involved in the work of allyship. Even when allies advocate for representation of women and women might benefit from such recognition, there are often unseen barriers that hamper progress.