Wednesday, 22 May 2019

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The Gender Gap in Rheumatology Leaders

Leadership positions in medicine are disproportionately filled by men. Although the enrollment of medical schools are equal male: female or even some have more women (1, 2), 40% of American medical institutions lack programs for recruiting women, or for retention and promotion of female faculty (3).

This may also be true in rheumatology, which is now attracting more women than men as trainees (1). I recently wrote an article in the Lancet about mentoring women in medicine (4) and suggested ideas for improving the gender gap in leadership.  

I can relate to why women may not choose to be leaders. From early on in medical school, they may be conditioned to choose lifestyle specialties. I have been fortunate enough to have had children during internship, residency, my clinical fellowship, a research fellowship, and as an assistant, associate and full professor (yes 7 in total). I have personal experience with rounding on the wards with morning sickness and making excuses for disappearing. I have written exams with a baby at home and left the Royal College exam first so I could breast feed. I have had to juggle daycare while on call, have the school call to pick up a sick kid while in a busy clinic or teaching, and have had to run to a code with a stroller at hand. 

As a member of my department’s finance committee I have seen salaries where inequities of starting amounts occur despite a standardized template. This is often due to men bargaining more than women – the latter accepting what is offered and the former requesting more.

All junior faculty should be advised to request more than what is offered as all future salaries are based on the initial one and it is the role of the Division Heads in Rheumatology to help in the process for new recruits. 

Are we doing better in rheumatology with respect to a gender gap in leadership? 

The American College (ACR) Board of Directors consists of Dr. David Daikh (president), Dr. Paula Marchetta (president elect) and 17 members (9 men and 8 women) and also 2 ex-officio members (men), so the odds in ACR leadership are nearly equal (

Conversely, EULAR (European League Against Rheumatism) presidents since 1947 have all been men ( 

I suggest a call to action to increase awareness and leadership skills for rheumatology trainees and young faculty. It is not that we need equal representation but we should have the best people in leadership including those representing a diversity of ideas.

During the Renaissance, great artists and thinkers changed our world (such as Leonardo da Vinci, Michelangelo, William Shakespeare and Nicolaus Copernicus to name some of the great people). However, women were not in a position to contribute and I assume that we missed half of the great thinkers and artists during that time and many other periods in history.

I don’t want this to keep happening. 


1. Association of American Medical Colleges. The state of women in academic medicine: the pipeline and pathways to leadership, 2015–2016. (accessed Dec 31, 2017).

2 Kuhlmann E, Ovseiko PV, Kurmeyer C, et al. Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union. Hum Resour Health 2017; 15: 2.

3. Carr PL, Gunn C, Raj A, et al. Recruitment, Promotion, and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities. Womens Health Issues. 2017;27:374-381

4. Pope JE. Mentoring women in medicine:  a personal perspective. Lancet;391:520-21, 2018. 


The author has no conflicts of interest to disclose related to this subject

Dr. Janet Pope is a Professor of Medicine in the Division of Rheumatology at the University of Western Ontario (UWO), Schulich School of Medicine, London, Ontario, Canada.  She is the Division Head in Rheumatology at St. Joseph's Health Centre, London. Her research includes studies in scleroderma, SLE and RA, including outcome measurements, clinical trials and disease manifestations. She has published over 450 peer-reviewed articles, 15 chapters, 500 abstracts and several Cochrane meta-analysis reviews. Mentoring of research students and trainees numbers more than 125. She has received the Distinguished Investigator Award from the Canadian Rheumatology Association, Rheumatologist of the Year from the Ontario Rheumatology Association, Department of Medicine Research Achievement Award, and the Dean’s Award of Excellence in Research. She has been inducted into the Canadian Academy of Health Sciences.


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