Know Your Strength: An Update

How do you think the career outlook for women in pathology and laboratory medicine has changed since our original article in 2019?
Diana Kremitske: The unprecedented times in which we are living have created great focus on laboratory medicine – and medicine in general. Given the global events of the past year and a laboratory workforce being dominated by females, this presented women with many opportunities to be involved when laboratory medicine leadership was crucial. Beyond the tireless efforts brought about by the pandemic, the emphasis on test utilization remained a constant within organizations to improve patient care and better steward healthcare resources. The laboratory is front and center on appropriate test utilization efforts, providing still more opportunities for women to lead. Despite these existing opportunities, I am not sure much has changed in terms of the actual proportion of female pathologists selected for physician leadership roles.

The operations side of the laboratory also gives women opportunities to be promoted to higher (management or supervisory) roles in the laboratory. Supervisory retirement rates over the next few years are not inconsequential throughout our industry. In the ASCP’s 2018 vacancy survey (1), substantial vacancy rates for supervisors were noted in several disciplines, including specimen processing (25 percent), core lab (30.87 percent), microbiology (32.17 percent), and point-of-care (38.39 percent), to name a few. For those who desire to advance their careers, the retirement numbers will offer upward mobility.

Perhaps one of the ways to help influence the outlook for women in our field is to shine a light on women’s contributions in all clinical laboratory roles during the pandemic. This is one small step toward changing the outlook for women in clinical laboratories – and now is the time to take that step.

Suzy Lishman: The career outlook for women remains better in pathology than it does in many medical specialties. I would previously have said that two years is not long enough to see significant changes, but the combination of increased use of digital pathology and the impact of restrictions introduced in response to the COVID-19 pandemic have resulted in an unprecedented rate of change in working practices.

The pandemic has increased the need for, and desirability of, working from home – in pathology as in many other occupations. Whether shielding, self-isolating, or reducing contact in the lab, pathologists have been working from home in numbers never seen before. It is likely that this will continue to some extent after the pandemic is over. This is especially true now that digital images can be viewed and reported from anywhere in the world, meaning that pathologists no longer need a microscope to work – and that working from home is easier than ever.

For some women – and men, too – the increased flexibility of working from home has been beneficial for their work-life balance. Long commutes are cut out of the day and work can be scheduled around other commitments. However, school closures have meant that many children are being educated from home. Studies have shown that women are disproportionately taking on homeschooling responsibilities, with many having to reduce or change their working hours. Although many schools remain open to many children of key workers, after-school clubs and care provided by other family members are often no longer available, increasing the childcare responsibilities of many parents – particularly mothers.

So, at least in the UK, working from home during the pandemic has been a mixed blessing. However, the rapid adoption of more flexible ways of working is likely to be beneficial in the longer term, because women may be more able to work full-time, fitting a full workload around other commitments.

The UK Department of Health and Social Care’s recent review of the gender pay gap in medicine found a 14.8 percent gap in total pay between male and female doctors working in pathology, where women make up 59.4 percent of the medical pathology workforce (2). This is lower than other specialties, such as surgery, where the gap is 21.7 percent (31.3 percent female workforce). The same group looked at the impact of the pandemic on the gender pay gap and found that inequalities were increased, particularly for women from Black, Asian and minority ethnic backgrounds (3).

Sherrie Perkins: The pandemic has put progress for many careers in pathology – particularly academic pathology – on hold. Work-from-home orders stopped many basic research labs and normal pathology services markedly decreased during the early days of the pandemic. The lockdown impacted many women pathologists as they tried to balance having children at home and remote learning with their work duties. Although some faculty benefited from the slowdown in having time to write papers or grants, other clinic-based pathologists (both men and women) saw salary reductions that increased stress. Even though workloads normalized as the pandemic wore on, many pathologists still had children at home and needed to balance the needs of family with work. Some practices pivoted to at least partly remote work, but very few were able to achieve full-time remote operation. There were fewer childcare options and the burden of this – in addition to supervising remote learning – seems to have fallen disproportionately on women. There is a slow return to normal for many women pathologists, but momentum has been lost and the message of women pathologists’ “lesser” productivity of women pathologists due to the increase in family and childcare needs has had an adverse impact on many careers. Although I still think pathology is a great career for women, I have seen many female faculty and trainees really struggle over the past year – not just in pathology, but across all of medicine.

Marilyn Bui: There is a lot more awareness of diversity, equality, and inclusion than there was in 2019. The leaders of various pathology practices, education entities, and societies are taking steps to promote women in pathology and laboratory medicine.  For example, my department has 43 percent women pathologists and the residency program I am associated with has 50 percent women pathology residents. A survey conducted by the College of American Pathologists (CAP) indicated that women had a strong desire to volunteer on committees or take leadership positions, but felt they were given fewer opportunities to do so. I applaud the CAP’s effort on this and felt invigorated after I was elected by my peers to join a seven-member leadership team of the CAP’s House of Delegates (HOD) Steering Committee. Five of the team are women, including the Speaker of the HOD – a wonderful role model for all women pathologists.

What do you think is the single biggest gender-specific issue facing women in pathology and laboratory medicine today?
DK: From my viewpoint, the biggest gender-specific issue facing women in the laboratory is the degree of scheduling flexibility needed for home responsibilities, whatever they might be – caring for children, elders, loved ones, or overseeing virtual schooling activities for children at home. Recent times have allowed a degree of flexibility for some administrative roles through work-from-home arrangements that connect users virtually with the workplace. However, these arrangements should be used judiciously because visibility and direct support from the laboratory administration team are important to staff who are onsite carrying out daily work – and who cannot work from home. Creative scheduling practices should be explored to help women fulfill their family obligations and, ultimately, to help with workforce retention.

SL: The biggest issue facing women in pathology, as in other medical disciplines, is the impact of caring responsibilities, whether for children or elderly parents.Women are more likely to work fewer hours across their careers to accommodate caring for others, which affects income and career progression. Women more commonly take breaks from work, work less than full-time, apply for jobs with lower seniority and pay, and undertake less unpaid overtime (often recognized by discretionary additional pay) than men. The current model of medical employment and remuneration was designed with a male workforce in mind and has not adapted sufficiently to recognize the contribution of women. As the UK Gender Pay Gap Report states, “The pay gap is narrowing very slowly, and it will continue to disadvantage women for many years to come, unless we speed things up.”

SP: The biggest gender -specific issue remains the expectation of childcare and childrearing in addition to work. The pandemic appears to have affected women more than men with the increased demands imposed by the closing of schools and childcare facilities, remote learning, and lockdowns.

MB: The ability to balance work and life remains the biggest gender-specific issue. Many talented women pathologists in the early stages of their careers constantly struggle with balancing family responsibilities and professional development. Often, family takes precedence over career ambition. What works for many is the ability to leverage supportive life partners, accommodating work environments, and wellness practices to recharge. Although COVID-19 challenged our lives in many ways, it also motivated us to realign our priorities, reset work-life balances, and embrace the future. I assure you any women pathologists reading this that yes, you can have it all – a happy family, a successful career, and an impactful and rewarding life.

Read the original article online at tp.txp.to/know/your/strength