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The Path Forward: How to Use Metrics to Promote Equitable Work Environments


Catherine Cansino, MD, MPH

Co-author Catherine Cansino, MD, MPH
Family planning specialist

Promoting equitable work environments, like clinical practice, requires data gathering and tracking. This paper explores ways in which institutions and professional organizations can use metrics and related tools to understand and address the structural disparities generating inequities experienced by women and BIPOC physicians.

Relevant metrics track entry into the field, advancement and leadership roles, and workforce retention; the availability of support (such as training programs, administrative backup, funding, and mentorship); the distribution of tasks, demands, awards, and opportunities; and key practices around hiring, family leave, and compensation, among other factors. Organization change involves looking beyond explicitly discriminatory ideas and actions (“first-generation bias”) to actions and ideas that appear neutral but maintain or entrench the status quo (“second-generation bias”), such as leadership expectations that are incompatible with women’s family responsibilities. Metrics must cover work-life integration (the “second shift”) and diversity and equity work (the “third shift”), which fall unevenly on women and BIPOC physicians. They must also cover well-being, since women physicians experience higher rates of burnout than their male colleagues.

Metrics are essential but not sufficient. Systems change cannot happen without benchmarks and improvement targets. The paper introduces tested frameworks for improving organizational representation, including models and concepts from the American Academy of Physiatrists; the National Academies of Sciences, Engineering and Medicine; the National Institutes of Health; universities; and academic publishing. It draws, in addition, from effective approaches in business and law (for example, the Mansfield Rule, which drives affirmative consideration of diverse candidates for leadership roles in law practices).

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Source: Women in Medicine journal supplement, Pediatrics, the journal of the American Academy of Pediatrics, September 2021.