Our (her)story
The seeds for AdvancePHM were planted when discussing the need for developing an organization focused on promoting the interests of women in pediatric hospital medicine and working to achieve equity for them.
State of Women in PHM
Over the past 20 years the specialty of pediatric hospital medicine (PHM) has grown and, in 2017, officially became a subspecialty of the American Board of Pediatrics.
During this time of growth and evolution into a fully defined clinical, research, and administrative specialty, we have noted similar struggles, as well as areas where PHM may be on the forefront of moving towards equity for women. At the 2014 PHM national meeting a plenary was convened with a panel of high-level leaders, including CEOs, COOs, and chairs of hospitals from across the US to talk about their experiences in leadership. All of the members of that panel were male. This point was specifically called out by members of the audience during the session. PHM has also had numerous examples of where women have been leaders in the field. Over the past five years, six of the nine PHM meeting chairs have been women. Hospital Pediatrics, the American Academy of Pediatrics (AAP) journal specifically focused on scholarship in PHM, had a woman for it’s first editor in Chief and more than half of the members of the editorial board are female.3 Multiple chairs of the sections, committees, or special interest groups in the AAP, Academic Pediatric Association (APA), and Society of Hospital Medicine (SHM) have been women. While all of this information appears promising, there is also a paucity of data regarding the experience of women in PHM. We are lacking information on the basic demographics of women in PHM, including practice location, faculty rank, salary, full versus part-time work, and leadership positions. Without this critical information, it is challenging to identify struggles or biases women face, and to advocate effectively for any needed strategic and systematic change.
Currently, the only data that provides the best snapshot of the number of women practicing in PHM is from the applicants for the first American Board of Pediatrics (ABP) certification exam for PHM from 2019.4 Two thirds of the applicants for this exam were women. The AAP Section on Hospital Medicine (SOHM) notes that roughly 70% of their section members are female. Given the relative youth of the specialty of PHM, we also surmise that many of these women are also early to mid-career, and therefore hold ranks or roles that put them in entry or mid-level positions in their institutions. We fully recognize that this data is not an exact reflection of women in the PHM workforce, for many women did not or were not eligible to apply for this first exam or are not members of the AAP SOHM, and may over or underestimate the current workforce demographics. However, this is the latest and most readily available data that our group can use to comment on the female workforce in PHM. We recognize that this is a shortcoming that our field needs to address.
In the summer of 2019, when applications for the ABP’s first certifying exam were being solicited and reviewed, members of the PHM community began to share personal stories, via PHM listservs and at the July, 2019 PHM meeting in Seattle, of denials to take the exam via the practice pathway due to interruptions in clinical practice. Concerns were then brought forward by a group of individuals regarding a concern for gender bias in the exam application process, as many of the “practice interruptions” were reportedly related to maternity or family leave.5 The PHM community developed a petition that was signed by 1,479 pediatric hospitalists requesting that the ABP revise their board certification eligibility criteria. The ABP responded to the petition with an analysis of application data that revealed that there was “no significant difference between the percentage of women and men who were denied admission to the exam.”4 The ABP also noted that the “majority of the sub-board members and medical editors were women”, and that the “PHM sub-board is composed of practicing pediatric hospitalists with a diversity of practice location, age, gender, and race.”4 This statement provided evidence as to the diversity of the group that developed the eligibility requirements for the exam and the actual exam form. Throughout the journey for PHM to achieve recognition as a board certified subspecialty, as well as the discussion during plenaries, workshops, and other sessions at national meetings over the past few years, it has become evident that there is ample work to be done to assess the current state of women in PHM, identify the presence of inappropriate biases or inequities in the field, and to promote equity, opportunity, and advancement for women in PHM. As a young specialty in which women are estimated to outnumber men 2:1 and that is still defining its culture, PHM is uniquely positioned to change the tide for current and future women in the field.
1. ABMS Officially Recognizes Pediatric Hospital Medicine Subspecialty Certification. https://www.abms.org/news-events/abms-officially-recognizes-pediatric-hospital-medicine-subspecialty-certification/. Accessed January 20, 2020.
2. Barrett DJ, McGuinness GA, Cunha CA, et al. Pediatric Hospital Medicine: A Proposed New Subspecialty. Pediatrics. 2017;139(3).
3. Hospital Pediatrics Editorial Board. https://hosppeds.aappublications.org/content/hospital-pediatrics-editorial-board. Accessed February 13, 2020.
4. Nichols DG, Woods SK. The American Board of Pediatrics Response to the Pediatric Hospital Medicine Petition. J Hosp Med. 2019;14:E1-E3.
5. Gold JM, Allan JM, Ralston SL, Fromme HB, Desai AD. Collective Action and Effective Dialogue to Address Gender Bias in Medicine. J Hosp Med. 2019;14(10):630-632.
History of ADVANCE PHM
During the 2018 PHM Annual Meeting a group of mid to senior career women in PHM began discussing the need for developing an organization focused on promoting the interests of women in PHM and working to achieve equity for them. The work of this organization would include identifying and addressing the explicit and implicit inequities that exist in PHM, creating a stable source of data on women in PHM, and advocating for women’s advancement in the field. The events surrounding ABP exam application eligibility in 2019 provided further evidence for the need for a proactive, strategic, and metric-based approach to advocating and promoting women in PHM.
Our steering committee began formally meeting in the late summer of 2019. While the steering committee was small, we expanded to ensure we had sufficient diversity based upon institution, race, location of practice, time in practice, and leadership roles. We also invited a number of men practicing in PHM to join our group and be a part of developing the framework of the organization, in addition developing a standard for what male allyship would look like in the organization. We also recognize the intersectionality of women to other groups that face inequity and bias based upon their race, ethnicity, and sexual orientation, and pledge to partner with other organizations working on behalf of those groups during our efforts.