Women in Radiology: How the Specialty Can Bridge the Gap

When it comes to women in medicine, the numbers can be confounding. In 2012, women made up nearly 50 percent of medical school applicants, but they accounted for only 34 percent of practicing physicians. And, the statistics for women in radiology drop even lower - roughly 24 percent of all providers are female.

So why are so few female medical school graduates choosing radiology? And, what can be done to change this reality? How can the specialty be more supportive for its female practitioners?

Radiology finds itself in a frustrating cycle, according to Howard Forman, MD, a diagnostic radiology, economics, and public health professor at Yale University School of Medicine. Unless the specialty finds a way to fix these perceived problems, there could be an ultimate impact on patient care.

“If you don’t have women in the specialty, then you don’t have role models for medical students to look to or to aspire to be like. They don’t have those mentors, and that alone creates a bit of a limitation,” said Forman, who led an expert panel discussion on this topic sponsored by the American Roentgen Ray Society in January 2012. “And, if you don’t have women in radiology, then you’re losing the perspective of women in terms of both research and teaching, as well as the perspective of the patient as a woman.”

It’s time, he said, to open a conversation and ask the tough questions about why more women don’t choose radiology as their specialty.

The Perceived Problems with Radiology

[[{"type":"media","view_mode":"media_crop","fid":"13717","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3185538340541","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"544","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 337px; width: 225px; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]Historically, industry leaders have pointed to women’s roles within the family and their child care responsibilities as significant factors that routinely suppress the number of women in medicine, including radiology. Practicing physicians often work long hours in high-stress roles, and in many cases women have opted instead to seek a greater work/life balance.

But there are specific reasons why female students and practitioners say they shy away from a radiology career.

Surveys of female medical students - predominantly women of child-bearing years - revealed it’s the assumed long-term radiation risk, rather than their own family responsibilities, that pushes them away. In addition, women reported they believe radiology has too little patient contact, that the specialty is too highly competitive, and that it requires too many years of additional training. A recent study from Western University in Canada also concluded the idea of working in dark reading rooms isn’t attractive to women.

While these issues might steer some women away from radiology, they are largely misconceptions about the field, said Elizabeth Oates, MD, president of the American Association for Women Radiologists.

“We don’t know the full reason why people have this erroneous view of radiology, but probably one of the biggest reasons is that women - and men - aren’t introduced to the field early in their medical school years,” she said. “Students simply aren’t aware of radiology as a field, what it encompasses, and what it is that we do. It’s a pervasive issue.”

[[{"type":"media","view_mode":"media_crop","fid":"13689","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_371066065052","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"542","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px; height: 206px; width: 275px;","title":" ","typeof":"foaf:Image"}}]]But the medical students wary of pursuing radiology aren’t alone. The women who do enter the field often face difficulties, as well, said Julia Fielding, MD, abdominal imaging division chief at the University of North Carolina at Chapel Hill School of Medicine. Fielding also chairs the newly-formed American College of Radiology’s Commission for Women, a group charged with researching and identifying ways to attract and retain more women in the profession.

“A lot of women in radiology feel isolated from their male colleagues,” she said. “But, a lot of the errors men make aren’t errors of commission. Instead, they’re errors of omission - maybe everyone goes out Tuesdays after work for beers, but they don’t even think to ask you.”

The intent, she said, isn’t to actively exclude women. However, many female providers might be uncomfortable joining into a group activity without an explicit invitation. This isolation can have consequences beyond the work social scene. Women are more likely to be passed over for leadership roles or promotion if they aren’t seen as truly being part of the office culture, Fielding said. The result to-date has been a dearth of women as radiology chairs or heads of national associations.

What Radiology Can Do For Practitioners

Much of the responsibility for making radiology more attractive to women rests on department and practice leaders, Oates said.  If changes come from the top down, the specialty’s culture is more likely to change.

The most important thing senior radiologists can do is give female medical students accurate information to dispel the many myths that currently surround the specialty. For example, practitioners are exposed to radiation, but not to the levels many women fear. When conducting studies, providers are protected by lead aprons, lead glasses, thyroid shields, and many other coverings.

It’s also imperative to introduce students to radiology much earlier during their medical school career. A growing number of medical schools are now incorporating radiology into the basic science curriculum of the first two years of training rather than introducing it only as an elective during the fourth year, Oates said.

“[[{"type":"media","view_mode":"media_crop","fid":"12343","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9009811603621","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"476","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 152px; width: 150px; float: right; margin: 5px;","title":"M. Elizabeth Oates, MD, president of the American Association for Women Radiologists. ","typeof":"foaf:Image"}}]]The key is to get female students exposed and into the radiology environment early as observers,” she said. “But we have to avoid having students just sit next to a radiologist in a darkened reading room. Perhaps engaging women providers in breast imaging would be a good way to provide role models for female first-year students.”

It could also a positive move, she said, if school administrators helped identify students who might benefit from having a female radiologist as an advisor.

Radiology leaders must also work hard to counteract the belief that radiologist have little-to-no patient contact, Fielding said. In fact, many female patients request women practitioners, particularly with breast imaging. Although radiologists, as a whole, have fewer direct patient interactions, they do work with patients and have significant contact with other doctors.

“I always tell students and younger providers that they might not always have patient contact, but they have contract with their fellow doctors every day,” she said. “Radiologists have enormous patient impact. It’s almost impossible to get out of the hospital without some type of test, and in a lot of cases, it makes a big difference for the patient.”

There are more tangible ways to grow the number of female radiology leaders, as well. Approving and subsidizing additional education courses can be an effective way to foster career growth among women providers, Fielding said. For example, practice or department leaders can support a colleague through an accounting course if she is interested in pursuing a finance management position within the group.

According to Etta Pisano, MD, vice president for medical affairs and dean of the College of Medicine at the Medical University of South Carolina, sometimes the best way for radiology leaders to support women is to simply listen to their wants and needs. Administrators must be accommodating.

“Those of us in leadership positions must be attentive to what employees are saying to us about what they need to be successful and happy at work,” said Pisano, who is also a radiology professor. “Often, we set meetings outside of work-time boundaries, and that’s going to be very hard for anyone with a family. We need to focus on doing work during the work day.”

What Providers Can Do For Themselves

Although practice and department leadership can make changes that make radiology more welcoming for women, it’s incumbent upon women practitioners to take steps to improve their own situations, Fielding said. One of the most important things a female provider can do, she said, is to identify and engage mentors.

“Women must realize that they need to find mentors both inside and outside their departments,” she said. “You should have one for the work-life balance, how to write grants, and how to seek promotions.”

Being proactive in forging new workplace relationships doesn’t always come easily to many women, Fielding said, because they aren’t accustomed to asking for help, opting instead to navigate work situations alone. To move ahead, women must be willing to step outside their comfort zone. For radiologists new to a group, simply asking a senior colleague to lunch to discuss how the practice plan works can provide a plethora of information and help establish a mentor-mentee partnership.

In addition, women can take more initiative in how they socialize at work, Fielding said. Rather than waiting for an invitation to an outside-of-work get-together, she suggested women actively express an interest in a long-standing practice volunteer activity or sport. Learning to play tennis or golf could also be strategies to winning more face-time with practice leaders outside of the office.

In that vein, she said, women can increase their involvement and recognition wit[[{"type":"media","view_mode":"media_crop","fid":"13720","attributes":{"alt":"Etta Pisano, MD","class":"media-image media-image-right","id":"media_crop_2509918306082","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"546","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 203px; width: 150px; margin: 5px; float: right;","title":"Etta Pisano, MD, of the Medical University of South Carolina","typeof":"foaf:Image"}}]]hin an organization by volunteering to serve on committees, such as the credentials or finance committees. Fielding recommended serving on no more than two committees and only signing up for those that significantly impact practice or department operations. Assuming these roles can highlight women’s communication and negotiation skills, as well as provide routine access to senior colleagues and grow their reputations as representatives of radiology.

The ACR’s Role

Growing the number of female radiologists and supporting the women already in the profession are paramount to successful patient care. Consequently, the ACR’s Commission for Women took its first steps in early May into addressing the issues facing women.

The group already has assumed an outward focus.

“Women might be just 25 percent of total radiologists, but they make the healthcare decisions in 80 percent of families,” Fielding said. “More women need to be at the table, and many of us have realized that we don’t only want to work on women’s health issues. We want to enhance women’s power in the healthcare system.”

The ultimate goal, she said, is to increase the volume of the female voice within healthcare. Commission members are less concerned about women’s salaries and more concerned about the positions women will hold in an organization. This is particularly important, she said, as the Affordable Care Act takes effect over the next decade. Throughout the implementation, it will be important to incorporate the female perspective when addressing areas of concern.

Ultimately, the commission is expected to produce a data-driven report, highlighting where women currently work in radiology and the impact they’re already making. With that information, the Commission and other radiology leaders will be able to outline further tactics for increasing the specialty’s female population.

Despite all the current issues the specialty faces or the future challenges it will grapple with, though, radiology already offers a great deal to its female practitioners, Pisano said.

“There are plusses and minuses to every job, but women in radiology have it pretty well compared to other professions,” Pisano said. “They’re well paid. You get a good salary for the time you put in, and that extra money can go toward hiring help for your family. Not everyone has that need, but everyone wants balance in some way, and radiology offers that flexibility. It’s just a great job.”

FORUM: Check out the SIIM Women's Forum