Before she heads out to teach at the University of Cincinnati College of Medicine, Heather Christensen, PhD, preps for the at-home school day of her three children. After work, she makes dinner and does bedtime with the boys all under age 7 followed by work tasks until around 1 a.m.

But thats a lot better than early in the pandemic, when Christensen was educating her kids solo her husbands job cant be done from home making her math teacher, grammar expert, head chef, and school principal. Meanwhile, she was also figuring out how to redesign her medical school courses, which COVID-19 had driven online.

I had what felt almost like PTSD, with extreme fatigue and emotional exhaustion, she says. I couldnt keep doing it.

Now that Christensen has found other people to teach her children, the assistant professor is hoping to return to the research she set aside months ago research that is so crucial to her professional advancement.

Ive been incredibly frustrated, and my sentiments are repeated by almost every woman I speak to, from front-line COVID-19 workers to basic scientists to faculty members, she says. They all echo my frustration, but especially those with young kids.

As the pandemic upends so much in health care and society experts worry that COVID-19 could have dramatic effects on the careers of women in medicine.

Even before the pandemic, women physicians were earning 75 cents for every dollar their male counterparts made. Women also lag in leadership positions, comprising 25% of medical school professors and 18% of deans. And the ranks of women faculty of color have grown just 1 percentage point over the past decade. The research landscape is uneven as well, with women representing 41% of authors, a 2019 article reported.

Now, increased child care responsibilities, diminished opportunities for research and professional development, harassment in online settings, and hiring and promotional issues have women worried that their careers may take a hit for years to come.

Ive been incredibly frustrated, and my sentiments are repeated by almost every woman I speak to, from front-line COVID-19 workers to basic scientists to faculty members.

Heather Christensen, PhDUniversity of Cincinnati College of Medicine professor of medicine

While the full impact wont be known for months, women in medicine are already sounding the alarm. More than 20 women physicians and scientists recently warned that the pandemic could lead to a hemorrhaging of women from academia. In a recent survey, 46% of women medical students said they worry about COVID-19s effect on their careers, versus 36% of men. And a National Academies of Sciences, Engineering, and Medicine (NASEM) webinar noted that many academic jobs lost during the pandemic have been contract, nontenure-track positions jobs often held by women.

Gender inequities brought on by the pandemic must get addressed and soon, experts say. Its not just a social justice issue, argues Amy S. Gottlieb, MD, an associate dean at the University of Massachusetts Medical School-Baystate and the chair-elect of the AAMCs Group on Women in Medicine and Science steering committee. To thrive as a profession, we need to harness the talents of our entire workforce.

Theoretically, the pandemic could offer women physicians increased professional opportunities. Women have been at the forefront of efforts to track down much-needed personal protective equipment, for instance. Mostly, however, experts point to causes for concern.

Child care tops the list. Even before the pandemic, women physician-researchers did more parenting and domestic work than men in similar positions, totaling 8.5 additional hours per week.

Now women are doing even more at home, says Kimberly Templeton, MD, University of Kansas Medical Center professor and past president of the American Medical Womens Association. I worry that they will dramatically reduce their work hours or leave medicine entirely.

But experts also worry that COVID-19 threatens promotion prospects for women with no child care concerns. Thats in part because women get tapped more often to do less-valued tasks, such as writing patient education materials.

Then theres the concern that women have been stymied in publishing, which is so crucial to landing tenure. In fact, the portion of women lead authors in 2020 on COVID-19-related papers was 23% lower than their representation among lead authors in 2019.

It seemed like I kept hitting dead ends, and the men were getting the support. They often have large networks and a lot of resources.

Cynthia Derdeyn, PhDEmory Vaccine Center researcher and professor

Women in academic medicine bear a bigger load of teaching and patient care, notes Reshma Jagsi, MD, DPhil, senior author of the study and a professor at the University of Michigan Medical School. So the transition to virtual care and virtual teaching has created all these demands that are disproportionately falling to women, making it harder to publish.

Cynthia Derdeyn, PhD, had high hopes of contributing to COVID-19 research. After all, she runs a lab at Emory University that researches vaccines and infectious diseases. But, she says, it seemed like I kept hitting dead ends, and the men were getting the support. They often have large networks and a lot of resources.

Experts also fear that women are being hit hard in the online world, where the pandemic has driven so much work.

Women more than men tend to rely on nonverbal communication, and thats hard to do virtually, says Templeton. I worry about women being acknowledged and fully participating in virtual meetings, where its tough to read the room.

Templeton has particular concerns about women of color. She points to a recent webinar for women residency applicants, where many questions came from African American participants wondering how to wear their hair during virtual interviews. Its frustrating that with all that students are facing this year, they also have to worry about unconscious biases related to their appearance, she says.

In addition, women are losing out on vital networking opportunities as conferences move online, notes Eve Higginbotham, MD, vice dean for inclusion and diversity at the Perelman School of Medicine at the University of Pennsylvania. Women really need those sidebar conversations they get at in-person meetings, she says.

But most worrisome to Jagsi is the harassment that can harm women in the online world.

Since the pandemic in particular, weve seen a move toward using Twitter for communication, which leads to responses not just from the professional community, but from the public, she says. Twitter has opened up a number of my female colleagues to requests for dates, vulgar remarks, and really aggressive comments.

If you want your research papers to get noticed and cited, youd better have a Twitter presence, she says. But its the wild, wild west of what people will say to you.

Twitter has opened up a number of my female colleagues to requests for dates, vulgar remarks, and really aggressive comments.

Reshma Jagsi, MDUniversity of Michigan Medical School professor

Experts are working to address the ways the pandemic threatens progress for women in medicine. Here are some of their suggestions.

Step up for parents

Given increased and often unequal responsibilities at home, institutions need to provide women with flexible schedules and robust child care supports, experts argue.

Medical schools and teaching hospitals are trying to help. Indeed, 62% of institutions that provided child care before the pandemic expanded such services after it hit, according to a recent AAMC webinar.

Institutions that dont provide direct child care are assisting in other ways. The University of Florida College of Medicine connects staff and students to nearby nanny agencies, for example, and has negotiated discounts with local child care facilities.

At the University of California, San Francisco, leaders joined with the YMCA to create daylong learning camps in August. So far, some 100 children have attended, mostly from families of health care providers.

Shift promotion processes

To counter potential gender imbalances, institutions must rethink how they reward academic and organizational effort. Gottlieb encourages women to list pandemic-related service work on their CV and performance evaluations, for example.

But perhaps the biggest question is how to handle tenure clocks as COVID-19 hobbles credential-building work. Already, many institutions allow staff to request an extra year before coming up for tenure. Others have taken a much bolder approach: automatically stopping the clock for all candidates (with the option to opt out). Thats the case at Florida State University College of Medicine and Emory University School of Medicine, for example.

Templeton applauds the move. Women often have difficulty requesting something they need, she says. We may think that its just our personal issue, so we dont want to bother anybody. We too often dont feel empowered to speak up.

Actively level the playing field

Last month, leaders in internal medicine published suggestions for protecting women from the fallout of COVID-19. Among their recommendations was to proactively help women advance their careers.

Templeton points to one recent example: Women Orthopedic surgeons created a series of in-depth webinars for women medical students focusing on how best to handle virtual interviews for residency slots.

Also crucial this year is helping junior faculty build their careers through such supports as sponsoring them to present virtually at national conferences, Gottlieb says. At Michigan Medicine, for example, leaders have continued to fund conference registrations and professional society membership despite pandemic-related budgetary pressures.

You cant be what you cant see. So, if women leave medicine or they dont get promoted to leadership positions, Im afraid were at risk of losing future generations of women physicians.

Kimberly Templeton, MDUniversity of Kansas Medical Center professor

When leadership positions do open up, Gottlieb urges decision-makers to focus on equity, such as publicizing opportunities in places where diverse candidates will see them. Lets also make sure interview committees include women and individuals who are underrepresented in medicine, she says.

Higginbotham emphasizes another aspect of equitable hiring and promotion: training those in charge to avoid unconscious biases. At Penn Medicine, she notes, all 5,000 leaders have already received such training.

Pay attention

Finding solutions starts with identifying problems, so leaders advise monitoring how women in medicine are faring. Already, NASEM is exploring COVID-19s impact on women in medicine and science, looking at five domains, including their mental health.

In terms of medical schools and teaching hospitals, options include reaching out to women to assess their concerns. At Rosalind Franklin University of Medicine and Science, for example, the office of diversity arranged monthly calls for women faculty of color to discuss shared COVID-19-related issues and brainstorm possible solutions.

Gottlieb also urges closely monitoring areas where women tend to lag, like compensation. At the Medical College of Wisconsin, despite a hold on salary increases, leaders are continuing to monitor compensation to ensure equity down the road. Such attention is essential, Gottlieb notes, given that women physicians have one of the largest gender pay gaps in the entire U.S. labor market.

As they peer into the future, observers worry about the long-term fallout for women from COVID-19-related obstacles.

You cant be what you cant see, says Templeton. So, if women leave medicine or they dont get promoted to leadership positions, Im afraid were at risk of losing future generations of women physicians.

Meanwhile, Jagsi hopes that this years negative impact could actually lead to a positive turning point.

A year ago, we created a curve depicting womens progress as department chairs and deans. Based on that, we drew a forecast, which shows that if we dont change the curve, it will be 50 years before we reach parity. And now, because of COVID, it looks like the curve will actually change for the worse.

Maybe that fact will be so worrisome that people will unite to push the curve toward equity more quickly, Jagsi says. Thats my hope.

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How COVID-19 threatens the careers of women in medicine - AAMC