SGEM Xtra: From EBM to FBM – Gender Equity in the House of Medicine

Date: October 7th, 2021 This is an SGEM Xtra episode. I had the honour of co-presenting at the Renaissance School of Medicine, Stony Brook University, Department of Emergency Medicine Grand Rounds. The title of the talk "From EBM to FBM - Gender Equity in the House of Medicine. You may be wondering: why is a middle aged, white, heterosexual, cis gender, male, atheist, nerd co-presenting on gender equity in the house of medicine? "And isn’t it ironic, don't you think? A little too ironic. And, yeah, I really do think".  According to Sir Patrick Steward (Captain Jean-Luc Picard from Star Trek), “People won’t listen to you or take you seriously unless you’re an old white man, and since I’m an old white man I’m going to use that to help the people who need it” My co-presenter was Dr. Suchismita Datta. She is an Assistant Professor in the Department of Emergency Medicine and GME Diversity Leader for the NYU Long Island School of Medicine. The presentation is available to listen to on iTunes and GooglePlay and all the slides can be downloaded using this LINK. Three Objectives Recognize gender inequity in medicine Identify gender inequities in each of the three pillars of of evidence-based medicine (EBM) Understand how gender inequities can impact the cardiovascular care of women Dr. Datta's Journey Dr. Datta Dr. Datta shares her personal journey from medical school to attending physician and discusses the challenges she faced along the way. She and her husband Neil met at medical school. They both matched to the same emergency medicine (EM) program. After graduation they began working at a high-volume, high-acuity critical access hospital.  After a few years they moved back to New York. Dr. Datta describes her unpaid and paid maternity leave, difficulties in pumping breast milk while on shift and the pay gap she experienced. Gender Inequities Using the EBM Model There are three pillars of EBM. The literature should inform care, guide care but it should not dictate care.  Clinicians must also use their good clinical judgment in applying the literature. We also need to ask patients about what they value and prefer. This can be summarized into a Venn diagram capturing the Dr. Sackett's definition of EBM. The Medical Literature: Who gets most of the grant money in medicine? Men Who rises to the top academic positions at universities? Men Who rises to the top academic positions in medicine? Men Who rises to the top academic positions in Emergency Medicine? Men Who is most likely to be the first author on a medical publication? Men Who is most likely the first author on a emergency medicine publication? Men Who is most likely to be the first author on a Pediatric Emergency Medicine (PEM) Paper? Men Who are often excluded from being subjects in medical research? Women The Clinicians: Who historically has been the clinician in the room? Men Who is most likely to rises to top leadership positions within the hospital structure? Men Who gets paid more in medicine? Men Who gets paid more in academic medicine? Men Who gets paid more in academic Emergency medicine? Men Who is more likely to be introduced with their professional title at grand rounds? Men Who get's paid more in Ontario, Canada? Men What can be done about the gender pay gap? CMAJ 2020 The Patients: Who traditionally was more likely to access health care? Women Who is typically responsible for most family health care needs? Women Who has been systemically under-treated when it comes to painful conditions? Women Who are provided less care for life threatening illnesses like STEMIs? Women   Cardiovascular Disease in Women Gender biases and inequities can seriously impact our clinical management. Cardiovascular disease in women is understudied, women are underrepresented in clinical trials,