Towards gender equity in neuro-oncology Free

Significant social movements have been challenging traditional cultural norms of gender roles and highlighting the significance of gender equity across institutions including medicine and science. Concurrently, patient advocates and caregivers elevate care issues that reinforce caring for people living with central nervous system cancer is complex and extends far beyond diagnosis and traditional cancer-directed therapeutic approaches. Patients must perceive their health care not only as efficacious but as socially and culturally acceptable if it is to be successfully implemented. Healthcare professionals are the literal faces of healthcare systems patients expect to provide that socially and culturally acceptable care.

Despite women representing about 70% of the global workforce in the healthcare sector, compensation inequities and barriers to advancing women in healthcare leadership persist.¹ According to a joint report by the International Labour Organization and the World Health Organization published in 2022, in the health and care sector women earn 24% less than men which is a larger gender pay gap than in other economic sectors.¹ The 2022 Doximity Physician Compensation Report found similar disparities among men and women physicians across the United States with women physicians on average earning 26% less than their male counterparts even when controlling for specialty, location, and years of experience. When examining the physician gender pay gap by specialty, there were no medical specialties in which women earned the same or more than men.

Moreover, although women outnumber men in most healthcare organizations, they are underrepresented in leadership.² In academic medicine, they represent only a fraction of deans, department chairs, and full professors and when they do, they earn less than men.³ According to the Association of American Medical Colleges’ 2022 report, only 28% of full professor positions in US medical schools are held by female physicians and this number is even lower for leadership positions, such as center directors, division chiefs, department chairs, and deans where only 22% of interim and permanent department chairs are women.⁴ There is also inequity in leadership roles that are offered to women. The leadership roles held mostly by men carry higher financial and other organizational resources, more influence, grander titles and significantly higher salaries than those leadership roles typically held by women.³ Furthermore, when in a leadership position, many women experience gender-based bullying and mistreatment which result in harming their career advancement, mental health, reputation, and relationships with others.⁵

The benefits of addressing gender inequity in medicine extend beyond the women physicians to impact the overall health of society. Studies have shown that female patients have a preference for female physicians, and that women physicians in average spend more time with their patients.^6,7 Cumulative evidence supports that sex or gender discordance between patients and physicians (particularly among male physicians and female patients) is associated with worse rapport, lower certainty of diagnosis, lower likelihood of assessing patient’s conditions as being of high severity, and even worse surgical outcomes highlighting the unique and significant role of women physician.^8,9 Further, having more women in leadership has been associated with increased organizational productivity and maximizing the value of women in the workforce.²

In this issue of Neuro-Oncology Practice, Le Rhun et al. report results from a digital survey by the European Association of Neuro-Oncology (EANO) Disparity Committee. This survey collected the opinion of 262 individuals mostly practicing neuro-oncology in Europe to explore gender balance and actions suitable to promote gender equality.¹⁰ This is a timely initiative as very little information is available in neuro-oncology with no evidence to assume that there is better gender equity for women in neuro-oncology. In this survey, equal salary for similar positions, paid overtime, number of permanent positions, protected time for research, and training opportunities were considered the most reliable measures to achieve gender balance. Notably, more than 25% of the respondents didn’t find positive actions to enforce the role of women in neuro-oncology necessary.

Such initiatives are the first step in challenging the status quo in gender inequity. How EANO and other professional organizations utilize these data to promote awareness of gender barriers and establish mitigation strategies towards gender equity and advancement of women in leadership in field of neuro-oncology is of great interest. Active and transparent support for gender equity in leader selection and promotion; increasing numbers and visibility of women at all levels of leadership; formal and structured as well as informal and unstructured mentoring; leadership training and development programs are among interventions that have proven to enhance the careers of women in healthcare.² Professional organizations such as EANO are uniquely positioned not only to increase awareness about the pervasive issue of gender inequity in neuro-oncology if not medicine but also to deliver change by establishing clear, measurable goals and consistently tracking and monitoring the outcome of these interventions until the gender gap is closed. Last but not least, as our perceptions of gender and gender roles continue to evolve, every effort should be made to ensure that our professional organizations, healthcare and academic institutions fully embrace societal progress and foster diverse, equitable and productive environments for work, research, and delivery of the best care to our patients.

Conflict of interest statement

None declared.

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