Racial, socioeconomic, and gender disparities in health have been heightened by pandemics throughout history, demonstrating that they are not only a biologic but also social phenomena. In the 1849 cholera outbreak in America, those living in impoverished inner-city areas bore the brunt of morbidity and mortality. In the 2014-2016 West African Ebola outbreak, women were more likely to be infected due to their predominant roles as caretakers and health workers. We’ve only begun to see the influence of the current COVID-19 pandemic on racial disparities with COVID-19 cases and deaths over-represented in racial and ethnic minorities.

In addition to these troubling racial and ethnic disparities, gender inequities in the workplace may also be exacerbated by the COVID-19 pandemic. The last several decades have seen women entering the workforce in larger numbers than ever before, especially in healthcare settings where women now account for the majority of the workforce. Yet, even prior to the COVID-19 pandemic, women in academic medicine have faced inequities in nearly every marker of career advancement, and these disparities are even more marked for American Indian, Black/African-American and Latina women at all ranks and leadership levels. Furthermore, while Asian women may not be underrepresented in academic medicine as a whole, their percentages decrease with increasing rank. Evidence is abundant that female faculty are underrepresented in leadership positions, are promoted more slowly than their male peers, are compensated less for their work, achieve fewer publications in peer reviewed journals, attend fewer national meetings, and are invited to speak as an expert less often. A heavier load of nonprofessional responsibilities may contribute to this gap, and a study of physician-researchers who had received career development awards from the National Institutes of Health (NIH) confirmed significant gender differences in burden of time spent on domestic activities among those with children.

As the COVID-19 pandemic has resulted in widespread school and daycare closures, cancellations of summer camps, and shelter-in-place orders, the childcare needs, caregiver responsibilities, or household demands of most families have dramatically increased. In turn, the support systems that women faculty have used to balance their responsibilities have been stripped away, jeopardizing the work-life integration of working parents. In a recent publication in Nature Human Behavior, authors surveyed over 4,500 faculty or PIs (1.6% response rate is an acknowledged limitation) during April 2020 and found that female scientists reported larger declines in the time they could devote to research than their male colleagues (5%). Overall, scientists with a child 5 years or younger reported the largest decline in time dedicated to research (17%). As research, grants, and publications are important for promotion at many academic institutions, it is clear where women can fall further behind in the face of a pandemic, an area already shrouded in gender inequity with women physicians advancing more slowly through academic ranks.

This is a difficult problem and the solution isn’t clear. Vanderbilt University Medical Center has attempted to address some of these inequities by continuing childcare at its Medical Center daycares and identifying additional childcare opportunities for those with school-aged children. Vanderbilt medical students were quick to create sitter services for essential employees when student rotations were interrupted during the pandemic and Vanderbilt University leadership extended the tenure clock for tenure-track faculty. But as the pandemic continues and the timeline remains unclear, the labor of domesticity will weigh heavily on the future of women in medicine, especially as clinical duties ramp up back to pre-pandemic expectations.

But with these concerns lies optimism. Awareness is essential for the development and implementation of strategies to promote the success of both men and women. In the initial phases of the pandemic, many medical centers quickly moved to telehealth visits. Educational opportunities and board meetings moved to virtual platforms. And with that came additional flexibility for working women. Calls could be taken at home and physicians could exert more autonomy regarding their schedule and workflow without the limits of physical space constraints. Zoom meetings could be taken on walks or outdoors, offering an opportunity for self-care. This workplace flexibility may be the very thing that women faculty need for additional career advancement in the future.

As the hidden responsibilities of women are moved clearly into view, medical centers have an opportunity to be more adept at understanding and addressing factors that may contribute to gender inequities such as bias and discrimination, differential in salaries, and fewer female leaders from diverse racial ethnic backgrounds. Continuous and systematic assessment of gender inequities, including a focus on the barriers faced by women from backgrounds that are under-represented in medicine, and implementations of strategies and best practices to eliminate inequities are critical both during the COVID19 pandemic and in academic life beyond.

Maribeth Nicholson, MD, MPH, Assistant Professor; Alexandra Russell, MD, Assistant Professor; Kecia N. Carroll, MD, MPH, Associate Professor, Director of Faculty Inclusion and Diversity in the Pediatric Office of Faculty Development; and Kelly Fair Thomsen, MD, MSCI, Assistant Professor

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