RFS news highlights resources, issues, and news relevant to in-training members of the ACR. If you have a topic idea or would like to contribute to the blog, please email RFS Secretary Patricia Balthazar, MD.




What Might Be Driving Women Away From Radiology?


Radiology has been slow to attract women. Although medicine in general saw equal representation of the genders around 2008, the field of radiology has only 25 percent women. More importantly, the gender disparity in radiology has not changed significantly in 30 years.

Ample evidence indicates that there is no difference in skills between men and women, and contrary to popular belief, that women and men have similar inclinations and attitudes, including those toward family and career. Furthermore, radiology espouses features traditionally necessary for women as primary childcare providers who typically bear greater burden for household management. My group’s work also showed that the percentage of radiology research first-authored by a woman has increased nearly 300 percent since 1980 — suggesting that female scholars in the field of radiology are highly productive — and yet the percent of female radiology residents in a similar time period went from 19 to 24, a mere 26 percent increase.

Despite what women clearly bring to the table, a 2016 study published by JAMA of over 10,000 physicians across the country found that women are paid less than their male counterparts, “even after accounting for age, experience, specialty, faculty rank, measures of research productivity and clinical revenue”, and a sample of 2018 data shows that the gap persists. Rather than hard work affecting pay, when women take over a male-dominated field, it seems that the mere fact of being female devalues the job. Other studies indicate that women are less likely to have institutional support of their work or support at home.

The system selects against women all along the training pipeline, where the void of early successes decreases chances of future success. It is important to look at systemic factors that oppress female candidates, and not overly emphasize “selecting the best” by narrow numerical targets, since that argument is sometimes used to pick men and reinforce the disparity. If women do not appear to compete against their male colleagues on paper, they still have tremendous potential and are qualified. I would argue that the many women who are as competitive as men on paper also have additional, understated strengths, such as the tenacity to persist in an environment that they know tends to select against them. When a woman’s potential goes unrealized, bias and discrimination hurt medicine as a whole, including the patients of these women who lose their potential level of caregiving.

Hospitality for women necessitates critique of excessively masculine training and work environments and investigation of possible harassment. The common shame-based teaching technique, often referred to as “pimping” or the “Socratic method,” which is widely adopted by radiology, may also create a dynamic more punishing to those who experience the low self-confidence of the “imposter syndrome” as a product of being a minority: women. A 2018 National Academies Report cited sexual harassment as highest in medicine compared to all other science fields (recently shown to be true in our field too), and showed the importance of measuring intervention outcomes, as some interventions sparked resentment and backlash — especially when top leaders use mandates rather than efforts to build consensus and respect.

Something in radiology keeps highly accomplished, highly capable women from joining its ranks. Explicit bias against women? Maybe. Lack of mentors? Maybe. A toxic masculine training culture? Maybe. We need data that supports how best to attract women into radiology and ensure that they thrive — and participate meaningfully — with impact as authors and leaders. While ensuring equal pay and facilitating mentorship are great first steps, we need more. We need specific training and educational programs to help students, interns, residents, fellows, etc., learn how to identify and counter their own implicit biases. We need to look critically at our methods of teaching and design educational programs that reaffirm women’s place in radiology.

As a woman who has gravitated towards male-dominated fields most of my life, I know my own reasons for choosing radiology, but I am not a spokesperson for all the women we hope to attract. Minorities who have broken through the glass ceiling are unique. They self-select based on their ability to survive and thrive in an environment that often feels — and is evidenced to be — unwelcoming, even hostile. Efforts aimed at attracting and supporting women in radiology need to focus especially on women physicians who showed interest in but ultimately did not choose radiology, and the perceptions of younger generations in the pipeline. The success of women who are in radiology, however, provides a valuable resource for analysis of what factors are associated with the advancement of women.

We must consult the tremendous amount of literature outside of our specialty on this topic. The work of Harvard Business School professor Dr. Robin Ely is my personal favorite reference and the National Academies Report includes an extensive list of actionable recommendations, which include diffusing hierarchical power structures. We can enlist experts from appropriate fields into our program development teams and employ “learn-do” plans that aim for reasonable targets, such as 50 percent representation of women in radiology residencies within 10 years. Editor-in-chief of USA Today, Joanne Lipman, points out that demonizing men will make things worse. In her recent book, she outlines suggestions for engaging both genders in cultural change — stressing that there are many men who fully support equality and sincerely want to help. I direct your attention to the work of our colleagues Dr. Lars Grimm, Dr. Andrew Rosenkrantz, and my research team of men: Dr. Howard Forman, Dr. Christoph Lee, and Dr. John Scheel.

Gender diversity (and really any kind of diversity) challenges the mind out of its stale thought patterns, helps people understand their own bias, and has been strongly associated with increased financial returns and better science. The presence of women can free men from feeling obligated to assume stereotypical male behavior. General productivity and wellness of entire enterprises improves when women are included. Presumably, what a woman asks for out of necessity, such as professional behavior and time for family including leave for new parents, benefits all, including our patients.

By Crystal L Piper, MD of Yale Radiology, and edited by Dr. Kristina Talbert-Slagle of the Yale School of Medicine, with special thanks to Drs. Howard Forman, Christoph Lee, and John Scheel, and the mentorship of organizational psychologist Dr. David Berg.

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