By Carolyn Crist

(Reuters Health) – Gender disparities in medical careers – in position, pay and publishing – start early, but even small systemic changes in training programs could begin to narrow these gaps, says a group of Harvard Medical School doctors.

They noticed a difference at their hospital in how often male and female trainee doctors, known as residents, were recognized by the training program for achievements like having an article published or receiving an award. When the program made small changes to ensure accomplishments were publicized equally, the results were welcomed by both male and female trainees, the authors of an opinion piece write in the Annals of Internal Medicine.

“I knew my peers were publishing and doing important work, and realizing the situation at hand motivated us to change it,” said coauthor Dr. Lisa Rotenstein, an internal medicine resident at Brigham and Women’s Hospital in Boston.

Women are less likely to become full professors and receive lower salaries than their male counterparts. Although current trainees and faculty realize this, many in the forward-thinking residency program thought such disparities were a relic of past, Rotenstein and her colleagues write.

“At the same time, female physicians are shown to have better outcomes than male physicians in certain ways,” she told Reuters Health in a phone interview. “Implicit bias is at play, and we wondered how we could do a better job as doctors start their careers.”

The authors had originally noticed that informal email “shout-outs” sent from the residency program director about recent publications more often highlighted the work of male residents. Work by female colleagues also wasn’t discussed as much informally among residents.

At Brigham and Women’s Hospital, women make up 47 percent of the internal medicine residency class, which is similar to the national average, the authors note, adding that more than half of the program leadership is female. Even so, when leadership first heard about the email disparities, they were skeptical, but after some reflection, realized it was true.

In response, the residency program’s administrative staff created a systematic search for resident publications each month in the medical literature and the popular press. They also developed an online form that residents could use to notify the office about their own publications. The program director emailed the results to all residents monthly.

Previously, about 17 percent of the emails touted publications by female authors, Rotenstein’s group calculated. Six months after the systematic search was put in place, 42 percent of the 64 featured publications were by female authors.

Overall, the systematic approach and intentional promotion of equity has helped, Rotenstein said. Although the new approach requires greater effort and organization, it has uncovered authors who wouldn’t have been recognized otherwise, she added. During a conference meeting, several female residents expressed gratitude and relief.

“The challenge was to think about how to quantify the disparity so it wasn’t based on feeling,” Rotenstein said. “We needed to create an environment that invited self-promotion and accepted input from everyone.”

“No matter the workplace, make certain you keep these issues at the forefront of what you’re doing to find that equity,” said Dr. Phyllis Carr of Massachusetts General Hospital in Boston, who wasn’t involved in the opinion piece.

Carr and her colleagues in the Research Partnership on Women in Science Careers are looking for funding to implement interventions that could reduce the gender pay gap, such as equal starting packages and ways to increase the number of women in endowed chairs.

“We need the ingenuity of both men and women in this country to hold our leadership in medicine and science accountable,” she said in a phone interview.

SOURCE: Annals of Internal Medicine, online July 17, 2018.