Please take your feet off my neck.

“I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks.”—As quoted in the documentary RBG via Reuters (Hurley, 2020).

The day after Thanksgiving is historically a day of relaxation in our home. While sitting on our screened in porch in Florida, I was reading the Wall Street Journal while sipping my morning coffee. On the front page of the business and finance section was an article written by Vanessa Fuhrmans (2020) entitled “Women make strides as Fortune 500 CEOs”. The article’s first sentence was “In a year especially hard on many working women, the corporate world can hail one major milestone: A record 41 female CEOs are slated to be soon running Fortune 500 companies.” I looked up from the paper and asked my husband the obvious question: Aren’t there 500 companies in the Fortune 500? Doesn’t that mean that only 8.2% of these companies are run by women? This figure was striking when compared with the 2019 World Population report that estimated that 50.4% of the world's population was male and 49.6% female (Stauffer, 2019).

That same day, I read an article in the New England Journal of Medicine, entitled “Women physicians and promotion in academic medicine” (Richter et al., 2020). The authors reported that there had been little to no progress from the 2000 landmark study that demonstrated that female physicians were less likely than their male counterparts to be promoted to associate or full professor or be appointed department chair (Nonnemaker, 2000). How could that be? The Washington Post had published an article on December 13, 2019, entitled “The big number: Women now outnumber men in medical schools” (Searling, 2019). The author wrote that “For the first time, women make up the majority of students in U.S. medical schools. In 2019, 46,878 medical school students (50.5%) are women and 45,855 (49.4%) are men, according to a new report from the Association of American Medical Colleges (AAMC)” (Searling, 2019). Therefore, in 2020, despite women making up almost half of the population and more than half of the medical school student body, women were still not being advanced at the same rate as men.

Why are women underrepresented in Fortune 500 companies and upper academic faculty ranks or leadership positions? Why are women less likely than men to be promoted to full professor or chosen for leadership positions, such as dean, associate dean, and department chair, even after adjustment for academic productivity? (Carr et al., 2018). Does the “old boys club” mentality still persevere? Is there an issue for women in balancing their home life and work life? Does the burden of family responsibilities still remain disproportionally on the back of women? This most recent New England Journal of Medicine publication cited other peer-reviewed articles that have demonstrated that women in academic medicine are paid less than their male counterparts, with one third reporting having experienced sexual harassment, and most female physician-mothers have reported feeling discriminated against while pregnant or on maternity leave or while still breastfeeding (Richter et al., 2020). Why do we allow this to continue?

Without a doubt, the recent COVID-19 pandemic has put additional stress on women in the workforce. In an article entitled “How COVID-19 sent women’s workforce progress backward”, 865,000 women were reported to have dropped out of the labor force, compared with 216,000 men, due to loss of child care and school supervision (Kashen et al., 2020). A similarly themed article published in the Washington Post entitled “Coronavirus child-care crisis will set women back a generation” stated that one in four women (twice the rate compared with men) became unemployed because of a lack of childcare (Modestino, 2020). The Brookings Gender Equality series also recently published an article that stated that 17% of all working women (10 million women) rely on childcare and schools to keep their children occupied and safe while they are at work. Despite the recent trend of more men helping with childcare, women have remained the primary caregivers in their families, exemplified by the fact that full-time employed women are reported to spend 50% more time caring for their children than fathers who work full time. The burden created by COVID-19 fell disproportionately on the shoulders of women (Bateman and Ross, 2020). Finally, the Wall Street Journal published an article entitled “How the Coronavirus crisis threatens to set back women’s careers,” which recounted the tale of a single-mother orthopedic surgeon whose support childcare system disappeared when the pandemic struck, turning her delicately balanced home life–work life into chaos. The authors suggest that the painful choices women are required to make during this pandemic may “threaten to unravel recent advances in gender equity – in pay, the professional ranks and in attaining leadership positions” (Weber and Fuhrmans, 2020).

Surprisingly, residency directors are still predominantly men, which results in fewer female role models and mentors in a position to help other women advance (Long et al., 2011). Women are still underrepresented on editorial boards of medical journals, again resulting in fewer female role models and mentors (Association of American Medical Colleges, 2012, Amrein et al., 2011). As noted, the proportion of female-to-male medical students is currently 50:50 female:male and since 2019 women have slightly outnumbered men. Therefore, since the early 2000s, gender discrepancies theoretically became less of an issue (AAMC, 2012). The year 2000 is 20 years ago! At what point will equality be achieved? What are our bottlenecks? I cannot help but be disappointed in how little we have progressed despite the recent election of a woman as the incoming vice president of the United States. As a mother and grandmother to a daughter and granddaughter, I cannot tolerate this any longer.

What can we do? Those of us who are senior women need to not only step up to mentor other women but also advocate for them so that they are given leadership opportunities. If we band together and help each other, there is no limit to what we can accomplish. There are mentorship programs we can join via the Women’s Dermatology Society and American Academy of Dermatology. We should also ensure that mentorship is available at our local university dermatology departments. However, it should be noted that historically women have not always been helpful to each other. For example, Margaret Thatcher, prime minister of the United Kingdom from 1979 to 1990, did very little to help other women. In an article entitled “What did Margaret Thatcher do for women?” (Murray, 2013), the author relays that “Thatcher’s answer, when pressed on her tendency to pull the ladder of equal opportunity up behind her, was invariably that none of the women was good or experienced enough to rise through the ranks.” Really?

We need to not only look to our male colleagues but to ourselves to answer the question of why women have not progressed in academic medicine at the same rate as men. Perhaps not only men but also other women have their feet on the necks of younger women? Whomever has their feet on the necks of these incredibly talented women coming up the ranks, please join me in dislodging this impediment!

Funding

None.

Study approval

The author(s) confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.