Where Are All of the Women in Retina?

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I recently attended the 2018 American Association of Retina Specialists Annual Meeting in Vancouver. Among the amazing presentations and the opportunity to network with colleagues, there was a painfully obvious disproportion: This is a male-dominated field.

Looking around the room revealed a sea of men in dark suits, and only a very few women scattered throughout. On the first full day of speakers, the morning lectures were dominated by men: only two out of twenty-four speakers and moderators were women, and one of those women was speaking on behalf of a man who was unable to attend at the last minute.

For those of you doing quick math, that’s fewer than 10% of speakers. Thankfully, the numbers increased slightly in the afternoon and thereafter, but it is no secret that the field of vitreoretinal surgery is predominantly comprised of men.

According to a Women in Ophthalmology article, using data from the American Academy of Ophthalmology in 2015, only 14% of retina specialists are women. The disparity between men and women in medicine is not a new concept, but there is surprisingly limited information addressing this specifically in Ophthalmology as a whole, not to mention retina.

Data regarding the gender gap in medicine are widely known: women physicians and surgeons earn less than their male counterparts, women physicians and surgeons hold fewer positions of power, and women physicians and surgeons are more likely to be overlooked for promotions and recognition. The questions remain: What is holding us back, and how do we overcome whatever “it” is?

Obviously, our societal structures are large factors. Sexism and bias runs rampant in society, and the medical community is not immune from larger societal issues. The #MeToo movement has brought sexism and harassment to the forefront and started a national conversation on the treatment of women.

However, not all of the sexism and bias that women physicians and surgeons must navigate is as obvious. The other, much more indolent forms of sexism include men claiming women’s ideas as their own and taking the credit amongst their peers; institutions not promoting women at the same rates as men; and even things as simple as women being addressed by their first names instead of Dr. Whomever within their practice and at speaking engagements.

At one session at ASRS, a female fellow expressed frustration with the questions she is receiving during her job interviews. Seeking feedback, she asked the women panelists how she should approach potential employers who ask how her husband feels about relocating for her new position. The employers have suggested that her family’s decision to move is weighted more heavily on her husband’s job, or that he holds more say in their decision than she does. While it may be something which she and her husband discuss privately, it has no place during an interview, and is not a conversation we frequently hear men trying to navigate with prospective employers.

Her situation is not unique among women in medicine. Despite being illegal to do so, I have been asked questions during interviews which were related to my marital status, my future family plans, and my childbearing intentions. Friends who have been pregnant on the interview trail have put in extra effort to hide their pregnancy for as long as possible, and I even know some women who have taken off their wedding rings to avoid discussions on their family plans.

Perhaps, though, the factors aren’t entirely external. At least one high-profile woman retina specialist believes that it’s women who hold themselves back from being on a level playing field with men. She states that women tend to be divisive and to alienate others in the quest for our own success. While saying “women are the problem” oversimplifies the issue, and is dangerous in itself, there are some aspects of this self-defeat which show up in the retina community.

For example, ASRS has a group called “Women in Retina” (WinR), which focuses on peer connection, mentoring, and uplifting other women within the field. Despite this, many women don’t join WinR, and some voice opposition to it. Curious to learn what others thought and what objections to WinR they had heard, I discussed this with colleagues during the meeting. Some of my colleagues stated that women don’t need any extra help achieving their career goals. They believe that WinR is exclusionary and not necessary. Others choose not to join because they think it will portray a poor image to their male colleagues.

Despite not wanting something formal, it seems that some of these same women recognize the need to support each other. For example, a group of women at the meeting who trained together and remain friends with each other managed to form their own unofficial group. They seek to achieve some of the same goals as WinR: they lift each other up, promote each other to speaking roles, and champion each other’s accomplishments. They even had a panel at ASRS titled “Women in Retina: How to Succeed in Different Practice Environments, From Academia to Private Practice,” where they spoke about women’s perspectives on topics like starting a solo practice, overcoming sexism, and practice patterns. In general, however, this group does not seem to be heavily involved in WinR and, ironically, one member of the panel spoke openly about resistance to joining “women’s groups.”

The issue of advancing women in medicine and closing the gender gap is multi-faceted, and without a quick-fix. In considering my experience and that of my colleagues, I do think that the tipping point may lie with women. The structure of medicine is not set up to promote women, so we need to promote each other. Instead of being cohesive and speaking up to promote and cheer on all women, we hope that if we keep our heads down and work hard, or stay within a selected small group, we’ll advance solely through individual effort.

We are more comfortable promoting and encouraging those women that we know and are familiar with, but this is not enough. We need to expand our networks and take advantage of every opportunity to amplify our successes and encourage women that we meet and interact with, not just the ones we trained with. We are more effective when we unify, echoing each other’s struggles, and lift each other up. Diversity strengthens groups, and by women having a greater presence in retina, and all of medicine, we will be able to advance excellence in clinicians and surgeons. This is absolutely necessary to our field, and we need to be cohesive to do it.

Our field has been a “good old boys” club for decades, where men mentor men, elevate men, and encourage men. It’s time for women to come together and do the same.

Dr. Jessica Randolph is an assistant professor of Ophthalmology at Virginia Commonwealth University School of Medicine.

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