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Women in otolaryngology-head and neck surgery.

Women are now well established in medicine, but historically this was not always true. Hence, it seems reasonable for each specialty to analyze itself from time to time to determine where it stands on the inclusion of women in practice and in leadership positions. While otolaryngology-head and neck surgery has generally been considered a woman-friendly surgical subspecialty, we, too, should assess our field to be certain that we are doing as well as we might think we are.

In 2010, the Association of American Medical Colleges (AAMC) reported that nearly 40% of physicians in the United States were women; 28% of accepted medical school applicants and 49% of graduating medical students were women? Those figures represent substantial progress. For example, only 9% of accepted applicants and 7% of graduates in 1965 were female. (1) As of July 2010, 1,346 women in otolaryngology were active members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), representing 12.4% of the membership. (2) As of March 2011, 1,724 out of 11,868 (14.5%) members of the AAO-HNS were women (with 220 members unidentified by gender). (3)

AAMC data show that two-thirds of women physicians practice in six specialties) One is anesthesiology; the other five rank among the lowest-paying specialties in medicine (family practice, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry). The reasons for this disproportionate distribution are uncertain. While some of these fields have shorter residencies (if fellowships are excluded) than some of the surgical fields, the old argument about better lifestyles is certainly open to challenge, as anyone who has taken call in obstetrics or pediatrics knows well.

Additional AAMC data indicate that women have been pursuing residencies in other fields with increasing frequency: Over the past decade, 22% of urology residents have been women, and 13% each of orthopedic surgery and thoracic surgery residency positions were held by women. (1)

I made multiple attempts to determine what percentage of applicants to otolaryngology residency programs are women and what percentage of accepted residents are women, but this information is not available through AAO-HNS, the American Board of Otolaryngology, the Association of Academic Departments of Otolaryngology-Head and Neck Surgery, or numerous other sources.

Women surgeons have taken various approaches to involvement in organized medicine. The board of directors of AAO-HNS established a section on Women in Otolaryngology (WIO). Interestingly, female otolaryngologists organized their efforts within the Academy rather than separately. This makes Otolaryngology-HNS the only surgical subspecialty that does not have a women's organization established outside the subspecialty's academy, rather than within the traditional organization. WIO has already become a valuable influence within the AAO-HNS and the field of otolaryngology.

Nationally, women have become more prominent in leadership positions in the past decade. According to the AAMC, between 2003 and 2008, the number of women associate and vice-chairs increased by 73% (all fields of medicine), and the number of women division chiefs more than doubled. (1) There are female deans at 16 U.S. medical schools (12%). (1) The first woman medical school dean in the United States was Leah Lowenstein, who was appointed to the position at Jefferson Medical College, Thomas Jefferson University, in 1982.

For the purposes of this editorial, I surveyed many of the major otolaryngology journals to determine the number of women who serve as their editors and on their editorial boards. Of all the journals surveyed, only the Journal of the Association for Research in Otolaryngology has a woman as its editor; the Journal of Otolaryngology-Head and Neck Surgery has a man and a woman as coeditors, and the rest have men as editors.

The number of women, total number of members, and percentages of women on editorial boards are as follows: *

* Acta Oto-Laryngologica: 11 of 100 (11%)

* American Journal of Otolaryngology-Head and Neck Medicine and Surgery: 10 of 54 (18.5%)

* American Journal of Rhinology & Allergy: 4 of 36 (11%)

* Annals of Otology, Rhinology & Laryngology: 9 of 51 (17.6%)

* Archives of Otolaryngology-Head 6. Neck Surgery: 5 of 28 (17.9%)

* Ear, Nose & Throat Journal: 23 of 160 (14.4%)

* European Archives of Oto-Rhino-Laryngology: 3 of 54 (5.6%)

* Head & Neck: 15 of 89 (16.9%)

* Journal of the Association for Research in Otolaryngology: 6 of 15 (40%)

* The Journal of Laryngology and Otology: 1 of 32 (3.1%)

* The Journal of Otolaryngology-Head & Neck Surgery: 3 of 9 (33%)

* Journal of Vestibular Research: 3 of 15 (20%)

* Journal of Voice: 35 of 109 (32.1%)

* The Laryngoscope: 11 of 113 (9.7%)

* Operative Techniques in Otolaryngology-Head and Neck Surgery: 0 of 27 (0%)

* Otolaryngology-Head and Neck Surgery: 7 of 66 (6.1%)

* Otology & Neurotology: 12 of 149 (8.0%)

* Skull Base Surgery: 0 of 36 (0%)

* I received no response from Folia Phoniatrica et Logopaedica and The International Tinnitus Journal.

Despite these advances, there are still discrepancies between male and female medical professionals. One important issue is reimbursement. For example, Lo Sasso et al evaluated New York data from 1999 through 2008 and discovered that newly trained male residents earned a mean of $16,819 more than female residents in 2008, compared with a difference of $3,600 in 1999. (4) The gender gap extended across specialties, practice types, and locations. According to the authors, it could not be explained by the number of hours worked.

Unfortunately, otolaryngology is no exception to this disparity. In 2008, the mean starting salary for male otolaryngologists (who represented 1.4% of all physicians starting practice in the United States) was $207,329. (4) Female otolaryngologists (0.4% of all physicians) started with a mean salary of $175,122. (4) This is a difference of about 15.5%. Having read the literature, I am unable to discern a reason for the gender gap in compensation in our field, or in other fields. It has been suggested that "female physicians may be seeking out employment arrangements that compensate them in other, nonfinancial ways, and more employers may be beginning to offer such arrangements." (4)

While it is possible (as has been speculated) that women are earning less money by choice in order to have more flexible lifestyles, minimize unpredictable weekend on-call commitments, etc., I am not aware of any data investigating those possibilities, let alone confirming them. I believe it is dangerous for us to make that assumption. Along with the rest of medicine, otolaryngology should study this important issue to be certain that gender bias has been eliminated from our specialty.

References

(1.) American Association of Medical Colleges. Women in U.S. academic medicine statistics and benchmarking, 2009-2010. www. aamc.org/members/gwims/statistics/. Accessed July 14, 2011.

(2.) Malekzadeh S. Women in Otolaryngology Committee. AAOHNS Bulletin. July 2010, p. 48.

(3.) Personal communication. Lani Cadow, AAO-HNS. March 22, 2011.

(4.) Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Aff (Millwood) 2011;30(2):193-201.

Robert T. Sataloff, MD, DMA, FACS

Editor-in-Chief

EAR, NOSE & THROAT JOURNAL
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Author:Sataloff, Robert T.
Publication:Ear, Nose and Throat Journal
Article Type:Editorial
Geographic Code:1USA
Date:Aug 1, 2011
Words:1171
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