Abstract
Dear Editor:
Female physicians were 61.7% of graduating fellows from U.S. hospice and palliative medicine (HPM) fellowships in 2017. 1 Dame Cicely Saunders, the founder of palliative care (PC), would have been pleased, but not surprised, and would have likely asked, “So how much are they doing to influence the future of the field by leading it?” More than ever before, there is recognition of the value and need for women equality and leadership in medicine, and it should be no different for women in PC. The percentage of women in leadership roles, specifically in research, education, clinical care, and policy, in PC should reflect the increasing percentage of female palliative physicians.
Research and scholarly activity are, most importantly, opportunities to not only shape the direction of the field but also necessary for promotion in academic PC practices. More women should be conducting and leading scholarly work. Between 1970 and 2005, research in PC has increased fourfold; however, only a small percentage of studies were published by women physicians. 2 Of the studies published in cancer PC in 2005, only 14% were by women physicians as first authors and only 8% were by women physicians as senior authors. There was also no significant change for 15 years prior. 3 A gender gap in scholarly work is not unique to PC, but the continued size of this gap may be. 4 Although research provides the evidence for clinical care and program development, it is also a platform to achieving individual professional growth.
Leaders of fellowship programs, peer-reviewed journals, and national professional organizations are the publicly recognized representatives of the field. In this study, women are more equally represented. Slightly more than half (51.7%, 51 of 145 programs) of all HPM fellowship directors are women. This varies somewhat by region with the Northwest having the greatest (65%) and the West having the lowest (39%) percentage of women directors. Half of the editorial boards (range, 41%–56%) of seven major journals that are related to PC/medicine, hospice, or pain and published in the United States are women. The 2018 American Academy of Hospice and Palliative Medicine Board of Directors is 58.8% women, including the president, immediate past president, president-elect, and treasurer, and the 2018 National Hospice and Palliative Care Organization Board of Directors is 54.2% women. To have an average of 50% women in leadership positions across the country is encouraging.
Although women physicians in HPM are actively engaged in leadership positions in HPM, their representation in research and scholarly activity lags. It is unclear what accounts for this difference specifically in HPM, but if women hope to continue advancing the field and achieving academic promotion, finding mentorship and advocating for dedicated research time are important steps that should be supported and encouraged. Ensuring women physicians have a strong and equal role in the direction of the field is vital.