One in Five Female Oncologists Considering Leaving Academia, Survey Finds

Sharon Worcester

January 24, 2022

Gender equality remains elusive for women in academic oncology, a survey of nearly 700 US female oncologists suggests.

More than half of respondents in academic medicine said they believe their gender adversely affects their likelihood for promotion, and 1 in 5 said they were considering leaving academia in the next 5 years.

Given the percentage of female oncologists planning to exit academia, "gender inequality is at high risk of continuing if the culture is not addressed," write the authors in their study, published online December 30 in JAMA Network Open.

Although women currently outnumber men in US medical schools — a shift that first occurred in 2019 — female representation in academic oncology dwindles at more senior levels. Women represent 45% of hematology and oncology residents, only about 36% of academic faculty, and an even smaller percentage of leadership positions in academic medicine. Women, for instance, occupy about 31% of the chair positions in medical oncology, 17.4% in radiation oncology, and 11% in surgical oncology.

A team of researchers led by Emily C. Merfeld, MD, of the University of Wisconsin Hospitals and Clinics, Madison, set out to understand the factors influencing female oncologists' decisions to pursue academic vs nonacademic career paths.

Merfeld and colleagues analyzed survey responses from 667 female oncologists between August 1 and October 31, 2020 — 422 (63.2%) in academic medicine and 245 (36.8%) in nonacademic practice.

Overall, 1 in 4 oncologists said their spouse or partner and family "extremely or moderately" affected their decision to pursue academic practice.

Almost 43% of academic oncologists perceived time spent with loved ones as the biggest sacrifice related to pursuing a career in academic medicine. Approximately the same percentage (41.6%) of nonacademic oncologists perceived the pressure to achieve academic promotion as the most significant sacrifice associated with academic oncology, whereas only 22.4% perceived less time with loved ones as the biggest sacrifice.

"Although work-life balance was a concern for academic oncologists and may be a factor in female oncologists leaving academia, survey data suggested that women in nonacademic practice faced similar challenges," the authors write.

More specifically, women in academic oncology reported working 2 more hours on the weekends compared to women not in academic medicine; however, both groups worked a similar number of hours during the week.

On the hiring front, almost 24% of academic oncologists said their gender had a "negative or somewhat negative" impact on their ability to get a job compared to 21% of nonacademic oncologists. Conversely, nearly 28% of academic oncologists said their gender had a "positive or somewhat positive" influence on whether they were hired compared with 41.2% of nonacademic oncologists.

Respondents, however, perceived gender strongly influenced promotion opportunities. More than half of the respondents — 54.6% of academic oncologists and 50.6% of nonacademic oncologists — believed they were less likely to be promoted than their male colleagues.

This perception aligns with findings from prior studies, which "found women were less likely than men to be promoted to associate professor, full professor, or department chair positions," the authors write.

Overall, most respondents in each group — 71.3% in academic medicine and 68.6% in nonacademic practice — said they would choose the same career path again. But almost 22% of those in academia said they were "likely or very likely" to leave academic oncology in the next 5 years. Of these women, 28.2% said they would switch to industry employment and 25% would move to community practice.

"Contrary to popular assumptions," the researchers note, "a spouse or partner and/or family were not a major factor in female oncologists favoring nonacademic careers, because this factor was similarly important to both academic and nonacademic oncologists."

However, they note, "the increased financial compensation in nonacademic oncology may play a large role in some women's career decisions."

Making Headway on Gender Equality?

In 2013, oncologist Katherine Reeder-Hayes, MD, MBA, now an associate at the University of North Carolina, Chapel Hill, published a study on gender equality in oncology in which she concluded that despite "an increasingly significant presence in the oncology physician workforce” women remained "underrepresented in leadership positions and at the senior levels of academic medicine."

Since then, Reeder-Hayes says that she has seen progress, but recognizes the need for more.

"To some extent, I think that representation is improving over time due to factors outside the workplace — women are entering medical school in large numbers and may have more supportive partners and more social support for pursuing a professional career in general [compared to] a decade or two ago," Reeder-Hayes told Medscape Medical News.

On a personal level, she noted, "I do see many mid-career women assuming key leadership roles in my own institution." However, she added, "I think the translation of those good candidates into increased representation in leadership probably varies widely across different institutions."

In a 2019 editorial, researchers highlighted this variation while calling attention to the "notable progress" made by the American Association for Cancer Research (AACR). Specifically, the editorialists reported that women represent 40% of AACR members, 45% of the AACR Board of Directors, and half of the last 10 association presidents.

Editorial co-author Elizabeth Jaffee, MD, deputy director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, and former AACR president, told Medscape Medical News that she attributes this progress to "concrete measures to ensure equality throughout the organization," which include gender balance on nominating and program committees as well as research meetings and providing opportunities for mentoring, leadership training, and networking.

Despite this positive change, the COVID-19 pandemic threatens to widen the gender imbalance. In a recent article, Julie Silver, MD, an expert in gender equity in medicine, told Medscape Medical News that she anticipates trouble ahead.

"There are many indications that women are leaving medicine in disproportionately high numbers," said Silver, associate chair and director of cancer rehabilitation in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. "A lack of fair pay and promotion opportunities that were present before COVID-19 are now combined with a host of pandemic-related challenges."

In addition to salary and promotion disparities, the US continues to suffer from "a chronic shortage of available, affordable, and high-quality childcare, and a lack of federal-level policy initiatives or employer initiatives to broaden paid family leave and develop childcare infrastructure and workforce," Reeder-Hayes said. Providing extended leave for new parents and on-site childcare could go a long way to improving this problem, she said.

However, Reeder-Hayes noted that perhaps the "leaky pipeline" problem in oncology highlights the fact that women "are making good decisions that reflect balanced life priorities," she said. “If we don't structure job responsibilities, childcare, and pacing of promotion and tenure in ways that allow people to nurture other parts of their lives, employees will feel they're being asked to sacrifice key things."

In other words, she said, "it's the workplace that needs to change if we're going to convince [women], and many men with similar values, to stay."

JAMA Open Network. Published online December 30, 2021.Full text

Sharon Worcester is an award-winning medical journalist at MDedge News, part of the Medscape Professional Network.

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