Women computer programmers (early coders) made major contributions in the early 20th century and this was considered low-status work like switchboard operation; however, now the predominant gender of computer programmers and software developers is male (high-paying/high-status roles). Once an all-male occupation receives a large influx of women, the occupation often becomes virtually all-female, and this process rarely reverses. Common examples of occupations that have switched from being predominantly male to predominantly female include bank tellers, secretaries, teachers, and sales positions.

In medicine, as women have entered the profession, they have been encouraged to pursue and have gravitated toward specific specialties and career paths (i.e. pediatrics). The relative prestige and compensation of these fields (compared with all physician salaries) have decreased, which is consistent with the phenomena of tipping and devaluation. We have not seen a reversal to date.

No. For example, while women predominate in pediatrics, only 30% of the chairs are women. The pediatric chairs group has also discovered another phenomenon: women are more likely to serve in interim positions and not go on to become the permanent chair. Hence, while significant progress in numbers of women department chairs has been made, these leadership positions even in pediatrics remain majority male. Women remain underrepresented in obstetrics and gynecology leadership as well.

This concern could be extended to concern about the entire field of medicine: Will medicine become “women’s work”? If one looks at the physician composition throughout the world, while women have increased their numbers in many countries, medicine has not become predominantly female. The likely increase in numbers of women is thought to reflect their entrance into higher education and the accompanying workforce.

Creating cultures and opportunities for women and men in all specialties will guard against the issue of further gender segregation – which will benefit our profession and our patients.

While this situation represents a vestige of our relatively recent entry of significant numbers of women into the profession (40 years?), this should become less common with the inclusion of more women in visible roles. In the meantime, however, it is helpful to use data and evidence that is balanced in discussions; to speak even when women’s perspectives are not specifically called for; and to be cognizant of the times in which we live. That said – speaking up as a “diverse” perspective is critical to change!

Specialty societies can play a critical role in shaping the culture and consciousness of their specialty. Individual societies can push for changes in governance, using best practices to assure that there is opportunity for diversity in leadership – one of the most important aspects of culture change, because medical students and graduate trainees cannot be what they cannot see. A diversified leadership is especially important in the predominantly male specialties where limited entry of women into the field has persisted (i.e. orthopedics). Specialty societies should invest in the creation of pipeline programs and initiatives to engage individuals of all genders.

Here again the specialty societies can play a very important role, as they actively advise CMS on reimbursement through the RUC committee. The RUC (RVS Update Committee of the AMA) represents the entire medical profession, with 22 of its 32 members appointed by major national medical specialty societies. The lower reimbursement for primary care and other specialties which have attracted women and are the backbone of our healthcare system must be aggressively tackled. Additionally, it is at the RUC where disparate reimbursement for female and male specific procedures of the same complexity originates. Rectifying this inequity at the RUC level would be an important step in closing the gender pay gap in medicine since RVUs, for better or worse, continue to drive many of our compensation models.

Specialty societies can provide role models and mentors, using best evidence programs to attract students into their specialties. Likewise, the members of the GEMS Alliance (AMWA, CMSS, etc.) can facilitate student exposure and knowledge about the various specialties through targeted programs.

Men are powerful allies in our quest for equity and in driving change. Additionally, occupational gender segregation limits men’s professional choices and earning potential. For example, endocrinology 20 years ago was more highly valued and reimbursed; now, for two years of specialty training to care for a population with a large burden of disease, the healthcare system monetarily values an endocrinologist less than if they had not received this training.

Several lines of evidence support the importance of a balanced workforce in the delivery of health care. For example, patients may feel more comfortable and be more adherent to clinical recommendations if working with those who more closely resemble them, leading to better outcomes. Women physicians also demonstrate better quality outcomes and guideline adherence. Lastly, like all teams, diversity among caregivers likely provides a setting for better decision-making. Thus, it is not that the physician population must be a perfect demographic match for the patient population, but, rather, it is the diversification of the specialty field that leads to better patient care. The persistence and growth of occupational gender segregation will impact our ability to deliver the highest quality of patient care – the true calling of our profession. Thus, it is time to sound the alarm on occupational gender segregation!