Go, ladies, go: The goal is ahead!
2019; Elsevier BV; Volume: 144; Issue: 6 Linguagem: Inglês
10.1016/j.jaci.2019.10.006
ISSN1097-6825
Autores Tópico(s)Retirement, Disability, and Employment
ResumoIt is July 7, 2019, and the US women’s soccer team has just played the finals of the World Cup. Their exciting 2-0 victory marks their fourth World Cup win and brings them to number 1 in the World Soccer Federation (FIFA) rankings. The beaming picture of captain Megan Rapinoe and her teammates was front-page news in the New York Times and the Boston Globe.1Das A. U.S. wins record fourth World Cup Title. New York Times.https://www.nytimes.com/2019/07/07/sports/soccer/usa-vs-netherlands-score.html?module=inlineDate accessed: August 23, 2019Google Scholar,2Peterson A.M. US defeats Netherlands to repeat as Women’s World Cup champions. Boston Globe.https://www.bostonglobe.com/sports/soccer/2019/07/07/defeats-the-netherlands-repeat-women-world-cup-champions/A54sN0ettiKqCERQRHl3MP/story.htmlDate accessed: August 23, 2019Google Scholar It has been a long road, but finally, these extraordinary athletes are being recognized for their skills and their ability to entertain. Starting in 1972, Title IX outlawed gender-bias discrimination for federally based education programs, spurring the creation of female college soccer teams across the United States. In 1985, the first US women’s team competed internationally at the Mundialito in Italy, losing to the Italians. Since then, the women of the US soccer program have become some of the most accomplished and best-known athletes in the world. This team has captivated the imagination of little girls of all races and colors, who now dream of becoming the next Mia Ham or the next Megan. With great success comes great responsibility, and these female athletes have become global leaders and role models. As of March 2019, 47 years after the passing of Title IX, Alex Morgan, Megan Rapinoe, Carli Lloyd, and their teammates are suing the United States Soccer Federation over gender discrimination. Their goal is to reach pay equity and improve working conditions for all female athletes. How did we not see this coming? Blumenthal et al3Blumenthal K.G. Huebner E.M. Banerji A. Long A.A. Gross N. Kapoor N. et al.Sex differences in academic rank in allergy/immunology.J Allergy Clin Immunol. 2019; 144: 1697-1702.e1Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar tell us a similar story in the landmark publication “Sex differences in academic rank in allergy/immunology.” The study looks at the sex differences in academic rank in the allergy and immunology workforce and, through a cross-sectional study of allergists in 2014, attempts to dissect the factors influencing academic rank. Of 507 academic allergists in the 20 top universities, two thirds are male, and one third are female, with female allergists being 10 years younger than their male counterparts (47 vs 56 years of age). The total number of publications for male allergists is over twice that of female allergists (28 vs 12), with male allergists being first or last authors close to 3 times more often than female allergists (21 vs 8). Male allergists had more National Institutes of Health (NIH) funding (23% vs 13%), were more frequently clinical investigators (16 vs 10), and generated twice the amount of Medicare annual revenue ($44,000 versus $23,000). Although female academic allergists are 25% less likely than male academic allergists to be full professors (26 vs 152), when the authors correct the number for multivariate analysis (age, years since residency completion, faculty appointment, research productivity, NIH grants, clinical involvement, and Medicare payments), rates are not significantly different among male and female allergists. First, I congratulate the authors on presenting granular data regarding our specialty and giving us the first glimpse of the sex differences in academic allergy. Although their findings appear to lay the groundwork in support of equal opportunity for female academicians, the sample size is small and the data are cross-sectional, indicating that we cannot identify a trend. Are the data in 2014 reflective of an improvement in academic advancement over time, or are they stagnant? Other specialties, such as surgery, psychiatry, emergency medicine, cardiology, and infectious diseases, have identified sex differences that persisted despite multivariate analysis, indicating that there is no continuous trend for equality and that apparent improvement might have a long lag time. The good news is that more and younger female allergists are entering academia and that their chances of academic advancement appear realistic. We should discard the notion that allergy/immunology is an "easy" specialty. Allergy/immunology encompasses sophisticated and complex patient care, clinical research, bench research, epidemiology, population and genetic studies, and safety and quality studies. Similarly to the soccer team, female allergists take academic challenges with energy, optimism, and fierce determination to succeed, and full professorship appears within reach. The bad news is that they lag behind in publications, first/senior authorship, research grant funding, and Medicare payments (Fig 1), and the reasons are not fully elucidated and have not been studied in depth. Some have invoked lower-quality mentoring, less protected research time, and gender bias in hiring and appointments. Women might be appointed to administrative roles (eg, training program director), which result in less time for research and possibly lower salaries if the administrative work is done instead of an incentive-based patient session or funded research. Surveys indicate that part-time work is an option chosen by as many as 30% of female allergists, likely during reproductive years and motivated by a desire to take on more family responsibilities and spend more time with their children. Interestingly, there is a recent trend indicating that more male spouses are sharing parenthood responsibilities, taking parental leaves of absence and responsibility for raising children and managing the household, sometimes leaving their jobs and allowing for the female allergist to be the sole breadwinner. One question to be answered is this: How helpful is this new male role for women in terms of academic career advancement and promotions? Because the rules of engagement were created before female physicians entered the field of allergy in significant numbers and before they were sitting on decision-making committees, these rules might need to be revamped to allow for an equal playing field. Despite some encouraging data, the female allergist’s perception is that the path to academic promotion is not a fair climb. When I became a full professor in 2017, my female colleagues in the division and across other institutions profusely congratulated me. However, my success was perceived more as an oddity than a path to follow because truly there was no path. Because so few female allergists had climbed the ladder, I never had female mentors to look up to, and I became a female climber in a male-defined path. While slowly climbing, I witnessed female colleagues in other fields present the same growing pains. I was the allergist at MIT Medical Services in 1999 when the landmark study, “A study on the status of women faculty in science at MIT,” provided evidence that there were fewer female faculty and students, female faculty salaries were lower, and female faculty were less likely to be promoted than their male colleagues.4Chisholm S.W. Friedman J.I. Hopkins N. Kleitman D. Matthews J.L. Potter M.C. et al.A study on the status of women faculty in science at MIT. MIT Faculty Newsletter.http://web.mit.edu/fnl/women/women.html#The%20StudyDate accessed: August 23, 2019Google Scholar The results were widely disseminated and prompted an increase in female salaries and promotions. Nevertheless, the gap still exists today. Twenty years later, only 251 of 1056 total faculty are women, and salary inequalities persist. More female physicians are entering the field of allergy, but are they educated in the requirements and rules for academic advancement? How is pregnancy accounted for in the productivity and advancement of female academicians? Being penalized for bearing children and having to work even harder to make up for time off after delivery is not an acceptable answer. Are academic female allergists more burned out than their male counterparts? Unlike female players on the soccer team who sued the federation, we should explore potential avenues and solutions to achieve equal opportunities. One critical aspect is to form partnerships and/or be mentored by male colleagues, which can provide advocacy and opportunities. Serving in leadership positions, engaging in committees, and looking for ways to integrate the female voice into division and university-wide decisions is a definitive goal. Cooperation, support, and networking should be key elements of the female allergy team, as was done for the soccer team, which led to resounding victories. The female allergy academic team is composed of passionate, dedicated, and hardworking players who serve many leadership, editorial, and mentorship roles in the American Academy of Asthma, Allergy & Immunology; the NIH; and the American College of Allergy, Asthma & Immunology. Recently, many enthusiastic young female allergists have taken the baton and are climbing the steep ladder and can look at the older female academic allergists who started in male-only allergy/immunology divisions and can provide precious insight and role modeling. Task forces should identify the barriers with specificity and granularity in our specialty, and we should start addressing how to overcome these barriers now. Academic advancement will require extreme cohesion, a team approach, and of course the collaboration of the Y chromosomes in our lives and our divisions. Female academic advancement in allergy will permit advances of other minorities by changing the rules of engagement and by having more voices to embrace change. This important landmark article is the tip of the iceberg: no other study examining academic disparities in allergy exists for the allergy and clinical immunology specialty, and no other study exists looking at academic disparities in allergy in the world for comparison. In addition to academic allergists, where are the nonacademic female allergists? How are they doing? Are they happy with their professional status and pay? How is burnout treating them? These questions require answers through rigorous studies that will make our specialty advance in the right direction. We should avoid the time, effort, energy, and price that the female soccer team is now pursuing through legal action to achieve career advancement, respect, and equal opportunity and pay. Let us work with our colleagues across the aisle from academia and other fields to add the XX chromosome’s value to our specialty. Go ladies, go: the goal is ahead! Let’s embrace the challenge. We can do this together. I thank Bernardo Perez Ramirez, Alejandro Perez-Castells, and Kalim Aun for their critical, helpful, positive review from the YX perspective. Sex differences in academic rank in allergy/immunologyJournal of Allergy and Clinical ImmunologyVol. 144Issue 6PreviewFemale physicians are significantly less likely than male physicians to be full professors, even after accounting for age, experience, specialty, and measures of research and clinical productivity. Full-Text PDF
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