Introduction
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
States5,6, 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 colleagues12,13 - 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 1980s33–35; 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 participating20,45,46; 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.