Women Radiologists Find Their Voice and Make It Heard

The lopsided male-to-female ratio among radiologists and radiology residents—around three men for every one woman—has remained stubbornly constant despite years-long efforts to narrow the gap. This reality is reinforced each time the American College of Radiology conducts its annual workforce survey.

And the imbalance is especially glaring given women’s much stronger presence in the overall U.S. physician workforce: around 36% as of spring 2019, according to Kaiser Family Foundation data.

However, the ways in which women are working to offset the equation and transform the profession—that’s another thing. Change is afoot, and headcounts only tell a small part of the story.

For perspective on how radiology is shifting along these lines—and what’s in store—RBJ sought perspective from six established and emerging female leaders:

▲ Elizabeth Kagan Arleo, MD, associate professor of radiology at Weill Cornell, editor-in-chief of Clinical Imaging and president of the American Association for Women Radiologists (AAWR).
▲ Katarzyna Macura, MD, PhD, professor of radiology, urology and oncology at Johns Hopkins and chair of the ACR’s commission for women and diversity.

Title IX Opened Many Doors But Didn’t Bust All Barriers▲ Geraldine McGinty, MD, MBA, assistant professor of radiology at Weill Cornell and chair of the ACR’s board of chancellors.
▲ Michele Retrouvey, MD, pediatric radiologist with Medical  Center Radiologists (Virginia Beach, Va.), assistant professor of radiology at Eastern Virginia Medical School and lead author of  “Women in Radiology: Creating a Global Mentorship Network Through Social Media” (JACR, January 2018).
▲ Carol Rumack, MD, professor of radiology and pediatrics at the University of Colorado School of Medicine and founding president of AAWR.
▲ Lucy Spalluto, MD, assistant professor of radiology and associate director of diversity, equity and inclusion in the radiology department at Vanderbilt.

Although the details varied, the responses were remarkably in concert with each other. Commonly voiced priorities ranged from the general—recruiting more women—to the specific, such as providing 12 weeks of paid family leave.

Here’s more of what we heard.

FAMILY-FRIENDLY FLEXIBILITY

When Macura was training, leaders of residency programs tended to discourage women physicians from becoming pregnant, she recalls. The main concern seemed to be that those team members would either struggle to maintain job performance or fail to finish the program.

Radiology’s friendliness toward family leave is still far from ideal, especially outside academia, she adds, but she’s pleased with the progress she’s seen since completing her residency in 2000.

“When I look at the Hopkins residency program these days, what I’m looking at is very diverse and rich in women’s participation,” Macura says. “Our residents—women and men—are married with children. And none of that affects their performance or their professional growth.”

Such progress on this front is encouraging, but much ground has yet to be gained, notes Arleo. She makes the case for 12 weeks of paid parental leave in a paper published in the March 2019 JACR, “Paid Parental Leave in Radiology: The Time Is Now—Challenges, Strategies and the Business Case for Implementation.”

Arleo reports considerable progress within academic radiology, citing a statement of support for 12-week leave in the same edition of JACR contributed by the Society of Chairs of Academic Radiology Departments.

How far the cause goes is “going to depend on the execution,” Arleo says, adding that the published papers above, and other activities, represent “a big step forward.”

What’s more, the push for more paid leave may hitch a ride on the coattails of the call for greater flex time. This has traction thanks to the widespread concern over physician burnout.

“Medical professionals who are happier, healthier and well-balanced are better able to care for patients,” Macura says. “We must create environments that emphasize the well-being of radiologists.”

Workplace flexibility is essential to advancing that aim, all sources seem to agree.

“I would really like to see us continue down that path to flexibility,” Retrouvey says. “If you have a flexible work environment, especially early in your career, that’s really the Holy Grail.”

Katarzyna Macura, MD, PhD, Johns Hopkins Medicine
Katarzyna Macura, MD, PhD,
   Johns Hopkins Medicine

WHO’S IN YOUR MED SCHOOL?

The lack of leave—or for that matter, lactation rooms—doesn’t necessarily deter women from pursuing radiology because it’s a problem across specialties, according to the sources interviewed for this article. Nevertheless, taking aim at the problem within radiology could improve recruitment while setting an example for other specialties.

If radiologists were consistently taking 12 weeks of parental leave, word about it would get around and become an important differentiator, says Arleo. “I see it as positive branding, which is important for recruitment, retention and morale,” she says. “Most importantly, it’s the right thing to do.”

When it comes to attracting women to the specialty, simple efforts to increase its visibility in medical schools can go a long way, the experts agree. First- and second-year female students who have initial encounters with women radiologists are, unsurprisingly, likely to at least consider the specialty. Yet many medical students don’t have a radiology rotation until their third or fourth year.

“We need to communicate our passion for what we do and make sure we talk to medical students early,” Mc-Ginty says. Arleo agrees, noting that some schools involve radiologists in teaching first-year anatomy. She runs the radiology component of first-year anatomy at Cornell.

Another possible reason fewer women choose radiology is the misperception that the specialty offers little or no patient contact. “I recognize the stereotype of radiologists being antisocial and sitting in the dark,” Arleo says. “However, that’s just not how radiology is practiced in 2019, especially in highly patient-facing subspecialties such as breast imaging, pediatric radiology and interventional radiology.”

Another way radiology is practiced today is with transparency in residency programs’ selection processes, one goal of which is to ward off perceptions of bias. “We aren’t simply looking at a board score to determine whether someone will be a good candidate for our program,” Spalluto says. “We make sure applications are reviewed in a very holistic manner.”

SUNLIGHT AND CLARITY

Transparency, in fact, plays well in just about every aspect of recruitment, retention and job satisfaction. “Salary
transparency, call transparency, promotional criteria transparency—these are all things we can do to ensure that women have equal opportunities,” Spalluto says.

Transparent rules are especially important in career-development programs, Macura says. “I think traditionally
some of these opportunities were not openly advertised and were preferentially distributed,” she adds.

Spalluto established Vanderbilt’s Women in Radiology program to support a more equitable culture in her department and beyond. “The long-term goal of the program is to change the culture of our department,” she explains, “to one that meets the needs of women and encourages women to be leaders within the department and beyond.”

Shorter-term aims supporting that vision include creating more faculty-development opportunities.

Of course, cultivating leadership skills in women radiologists is one thing. Ensuring them a seat in rooms where consequential decisions get made is quite another.

Which is to say that women rads continue to be underrepresented in leadership roles.

LEADERS MADE, NOT BORN

This fact has been well documented, including in a 2018 paper senior-authored by Macura and published in RadioGraphics (“Addressing Needs of Women Radiologists: Opportunities for Practice Leaders to Facilitate
Change”).

Meanwhile a study published in the January 2019 American Journal of Roentgenology showed that women occupy just 14 percent of leadership roles in academic nuke-med departments (“Gender Differences in Leadership Positions Among Academic Nuclear Medicine Specialists in Canada and the United States”).

A third recent entry in the literature identified a gender gap in the literature itself—“Underrepresentation of Women
on Radiology Editorial Boards” (JACR, Jan. 2019). And that’s just a sampling.

The good news is that, while the backward-looking numbers are discouraging, fresh anecdotal evidence suggests
the tide may be turning.

Among the most notable developments are McGinty’s election as the first woman chair of the ACR board of chancellors and the 2019 appointments of Ruth Carlos, MD, as editor-in-chief of JACR and president of the American Roentgen Ray Society.

Academic Radiology Leadership: Where Are the Women?These advancements are significant, but “there still need to be more women in leadership,” Rumack says. Her recommendation: Nominate more women to leadership positions at least within practices and departments.

It’s all about building a leadership pipeline, McGinty says. She emphasizes the importance of being thoughtful about committee appointments “so we’re getting the right expertise and being very thoughtful about diversity—not just gender and ethnicity, but also in terms of practice type.”

This also applies to panels at meetings, she says, and ties back to recruitment. If medical students don’t see panelists and speakers they can closely relate to, they may feel radiology is not a welcoming field.

“The more women speak at scientific meetings, the more it becomes the norm, and the more it becomes expected,”
Arleo says. She adds that the ACR is developing a project to increase the number of presenters, inspired by the U.K. program SheNote Speaker (online at SheNote-Speaker.org).

WANTED: MENTORS (AND MENTEES)

Mentorship and networking, like leadership, turn out to be recurring themes when speaking with leading women radiologists. For example, Macura credits much of her early success to the support and mentoring she received from the AAWR, which she joined as a first-year resident.

“I learned from other women what I needed to do to create a path for myself,” she says. “When I encountered potential barriers, I always focused on finding alternatives: If not this way, then that way.”

Today she encourages the young women she mentors to do the same.

Mentors and sponsors are as important as ever, all agree, but some of those relationships look different than they did just a few years ago. This is thanks in large part to the reach of social media.

In the 2018 JACR paper on using social media to create a global mentorship network, Retrouvey and co-authors
make the case that, although the research shows mentorship is a key element for career success, developing those relationships with other women may be challenging, given how few women are in the field. Here’s where social media can come in. 

“Twitter is proving to be an effective way to improve access to mentorship by promoting a culture of inclusivity and creating a community to empower female radiologists,” the authors write.

On Twitter, Retrouvey tells RBJ, “your horizons really open up.” The platform fosters community, mentorship, friendship and even research collaborations. It can be a powerful recruitment tool too, providing that much-needed exposure and visibility.                                                                                                                                                       

And then there’s the awareness boost that’s inherent in the medium. “Your universe often stops at what you can see,” Retrouvey says. “Some of us are in very supportive practices where things are going great.” Connecting across social media with those in less supportive environments provides an antidote to complacency, she adds.

And, of course, there’s no place like online for unceasing advocacy. “Social media is a way to get your rallying cry out there,” Retrouvey points out. “You can say, ‘Look, there’s something going on and we need our voices heard.’”

THE LITTLE THINGS ADD UP

Research continues to show the value of diversity beyond simply being the right thing to do. High-performing teams are diverse both intellectually and demographically, according to research from Deloitte. (See Deloitte Review, January 2018, “The Diversity and Inclusion Revolution: Eight Powerful Truths,” free online.)

Family LeaveOn the academic side, experts have shown how gender diversity in research endeavors can drive scientific discovery (Nielsen et al., “Making Gender Diversity Work for Scientific Discovery,” Nature Human Behaviour, September 2018).

Few question that an organization and all its members benefit when diversity is prioritized. But women may benefit in certain specific ways.

“We offered childcare at our [ACR annual] meeting last year for the first time,” McGinty says. It may seem like a small thing, she says, but some who in prior years may have stayed home can now attend, participate and develop professionally. “I’d like to think we’ll continue to build on that.” (ACR 2019 is indeed offering childcare options.)

Retrouvey says the historic lack of women-friendly accommodations was likely not intentional, much less malicious. “They just didn’t think about it,” she says. “If you haven’t been faced with those issues, it’s not something you are going to think about.”

There’s more. “I have a 7-month old and my husband definitely doesn’t encounter the same problems I do,” Retrouvey adds. “Even though he is very hands-on, his nipples just don’t work.”   

BEST YET TO COME

Attitudes toward women have changed over the decades. The establishment of the ACR Commission on Women and Diversity several years ago was a “great start,” Rumack says.

The barriers have become less structural, but that doesn’t mean they’re absent or any less real, says Mc-Ginty. Why is this? She’s not sure she has the answer. “I think I probably prefer to focus now on how we remove any remaining barriers, whether structural or tacit.”

She does know that it’s taken longer than it should have for a woman to lead the American College of Radiology. “I may be the first woman in that role,” she says, “but I am by no means the first woman who could have done it.”

As articulated by just a few of the leading lights among women in radiology, one constant is likely to remain as women’s visibility continues climbing.

McGinty surely speaks for most: “I really love being a radiologist.”