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Even though precise data are lacking, according to the Organisation for Economic Co-operation and Development (OECD) Health Statistics 2021, the proportion of female physicians has increased in all OECD countries over the past two decades. The average proportion of female doctors increased from 45% in 2010 to 50% in 2020. The increase was particularly rapid from 2000 in the Netherlands, Spain, Denmark and Norway. However, the proportion of female doctors varies considerably between countries, with a stronger female representation in Eastern European countries such as Latvia (73.9%) and Estonia (73.2%). In contrast, fewer than one in four doctors in Asian countries is a woman (24.5% in Korea and 22.7% in Japan). Female doctors tend to work mostly in general practice and in medical specialties historically related to childcare, such as paediatrics, but less in surgical specialties. In the medico-technical sector, women are generally underrepresented. In medical imaging, for example, women accounted for 26.5% of radiologists in 2019 in the US according to the Association of American Medical Colleges.
In contrast to many sectors of the business world, medicine has a long socio-cultural history of male dominance and male honour. Although women enter medicine in large numbers nowadays, and despite the fact that the intellectual capabilities of men and women have long been considered equal, the rate of change higher up the hierarchy does not reflect what is happening at entry level. Just as women’s right to vote did not naturally lead to gender equality in politics, it would be naïve to think that larger numbers of women in the medical workforce will naturally lead to gender equality in the academic world and that equality at the top is just a matter of time.
In the field of nuclear medicine, the Women in Nuclear Medicine (WINM) task force founded by the Society of Nuclear Medicine and Molecular Imaging (SNMMI) in 2018–2019 has led the way in promoting women in nuclear medicine and molecular imaging. Subsequently, the European Association of Nuclear Medicine (EANM) Working Group on the Promotion of Women was founded in 2021 with a view to promoting and valorising the participation of women involved in nuclear medicine and to redressing the gender imbalance within the EANM. A recent survey conducted by the EANM [1] showed that the main areas of nuclear medicine where women are underrepresented are in academic careers, in involvement in international societies and in scientific work. For example, in the study by F. Gelardi and N. Gozzi, the H-index, which quantifies the scientific productivity and impact of a scientist according to the level of citation of his or her publications, was systematically higher for male members of the editorial boards of the EANM family of journals [2]. The study also revealed the underrepresentation of women on these editorial boards.
As reported in that survey, the main challenge for women in nuclear medicine is to maintain a balance between family and work. The underrepresentation of women in the above-mentioned fields is partly due to the interconnectedness of work and family, which forces women to juggle competing responsibilities. Opportunities for career development in academia tend to occur at the childbearing age. It is therefore not uncommon for women with young children to become submerged by the long process of qualifying for an academic career due to limited time for research, high levels of stress and/or competing behavioural expectations. Furthermore, the so-called linear career pathway is based on the male model, from which women tend to deviate. Rather than calling these careers deviant or non-linear, we should embrace and stimulate diverse careers.
One of the latest events that threatened the precarious work−life balance was the COVID pandemic. All over the world, policy decisions during the 1st months of the crisis focused on 'essential work' while neglecting to support areas essential to women's social and economic well-being (e.g. schools, childcare), thereby increasing the burden of informal domestic work. Although this did not initially appear to have a significant impact on women's scientific productivity in the field of nuclear medicine [3], it should be a warning.
Other factors also contribute to the lower H-index and the lesser representation of women in academic and scientific committees. For instance, what if part of the underrepresentation of women is because they receive less recognition for their work? We are probably all familiar with historical examples of women’s work being undervalued when compared with that of their male contemporaries, not only in science, but also in the arts and in literature. However, does this tendency persist in the twenty-first century? The recent research by Ross et al. addressing this question confirms that women still systematically receive less credit for their achievements [4]. By means of large-scale quantitative and qualitative analyses on research input and output, the authors show that when compared with male team members, women are less likely to be mentioned as authors of an article or a patent, and women’s contributions are systematically less likely to be recognized. The data obtained from questionnaires showed that women report having been excluded from a paper to which they had contributed more often than men. The most important reasons for this exclusion were an underestimation of their scientific contribution and, less frequently, gender bias and discrimination [4]. In addition, women were found to have to contribute more than men to be included as an author. Lastly, the qualitative data of the study highlighted the importance of defending oneself in order to receive the credit one deserves, the lack of clarity concerning authorship rules, the role of power imbalances within the team, and the negative long-term effect on careers of being denied authorship. Although much has already been said and written about gender equality at work, these findings once again show that the socio-cultural production of gender and the overarching social context of male power and the complex workings of power are at the heart of the problem.
The current and future quests for equality at all levels of the workplace may not only come from women. The family model is changing, with a trend towards dual-career couples. With such social changes in gender roles, men and women are progressively tending to attribute the same importance to their professional and family environment. In line with this, the old-fashioned ‘family-detrimental’ way of climbing up the career ladder is serving less and less as an example for young doctors. Hospitals and universities may have much to gain in being a part of this social change, for example by incorporating family-friendly policies to support the work−life balance of both their male and female employees. Indeed, organisations that invest in work−life balance initiatives are increasingly realizing that it is not an expense. Rather, such initiatives tend to have a positive impact on employee productivity, work climate and team spirit. Furthermore, through digitalisation and social networks, the young generations are becoming ambassadors for quality of life in the workplace. Digitalisation is an important lever for quality of work life as it facilitates social and professional relations, the organisation and content of work, and professional fulfilment and development.
Let us conclude by citing the American feminist theorist bell hooks who stated that “Feminism is for everybody”. The feminist combat for gender equality in nuclear medicine, and in medicine and science in general, will not only be beneficial for women but also for men. It will liberate both sexes from the gender stereotypes that tend to reign. Although old habits die hard, we predict that both women and men will request and benefit from a wide range of actions and initiatives, including those taken by universities and scientific societies, that aim to foster happier and more balanced personal, professional and academic lives. Furthermore, the growing awareness in the twenty-first century of the blind eye that has historically been turned on female achievements painfully confronts us with the misogynistic context in which medicine and science have been practised up till now. Promoting equal recognition and credit, greater transparency on authorship rules, a better power balance within teams, career diversity, parity within committees (thereby inviting women for their competences and not purely as ‘tokens’ just to get the numbers right) and attributing an equal weight to female and male voices will all contribute to greater equality. Such developments would be fruitful steps forward in the quest for greater equality in our nuclear medicine community.
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We gratefully thank Lioe Fee de Geus—Oei for her insightful comments on this manuscript and Ray Cooke for the language editing.
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Lasnon, C., Quak, E. Fair play: towards gender equality in nuclear medicine. Clin Transl Imaging 11, 1–3 (2023). https://doi.org/10.1007/s40336-022-00532-6
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DOI: https://doi.org/10.1007/s40336-022-00532-6