Being a girl in the IR gang: “We are not really learning from the past”

Paula Novelli
Paula Novelli

Paula Novelli, who is associate professor of interventional radiology (IR) at the University of Pittsburgh Medical Center (Pittsburgh, USA) put her own spin on a British Society of Interventional Radiology (BSIR) annual scientific meeting (2–4 November, Glasgow, UK) presentation titled ‘Women are more likely to work part-time’. The ‘myth-busting’ session as a whole saw speakers weigh in on how gendered perceptions and, in some cases, realities, can impact women interventional radiologists’ careers. Novelli in particular, bringing the perspective of ‘the only girl in the gang’—the gang being her IR team at Pittsburgh—left delegates with the salient message that “on all levels”, women are not overinvesting in education, despite the fact that, in the USA, “women practise fewer total hours than men due to significant household responsibilities.”

Novelli began her presentation remarking that, based on a 1970s survey of 97 male and 95 female doctors, 59% of the female respondents and 87% of the men had been working full-time from graduation, with 17% of the women not working due to taking on a traditional ‘female’ role instead. The prevailing thought at the time was that medical education of women in the USA was a poor investment due to the likelihood of women practising fewer hours over their professional lifetimes. Yet, despite these figures, Novelli conveyed that the findings demonstrated “women spent 90% as much time in medical work as did men, accounting for childbearing responsibilities.” This points to the idea of the “superwoman”, the presenter elaborated—female doctors may be working fewer overall hours, but they work with increased productivity.

More current than the previous data, Novelli then highlighted a British Medical Journal (BMJ) op-ed from 2008, which professed the opinion that women doctors were concentrated in “family-friendly” specialties, including paediatrics, psychiatry and family medicine. This was considered to be a “ticking timebomb” since women are more likely to work part-time, and this “feminisation” of these family-friendly specialties would mean that the specialties would disproportionately suffer the implications of part-time working and maternity leave, such as lack of continuity of care and resource use.

However, recent data on the state of women in academic medicine from the Association  of American Medical College (AAMC) Novelli countered, while “difficult to interpret” because of varying definitions of what percentage of full-time work part-time constitutes, suggests that among part-time doctors, there is an almost equal male-female split. The figures she cited were 50.1% of male part-time medical faculty, versus 49.9% women.

The “leaky pipeline” in IR

Bringing the focus to IR specifically, Novelli noted that radiology and surgery are “up there” when it comes to the specialties in which the aforementioned part-time doctors are concentrated, but that, as shown by the statistic, this is not due to a higher number of women faculty members in these specialties.

Yet, according to a Journal of the American Medical Association (JAMA)-published study of parental status among early-career physicians, the object of which was to determine which factors influence doctors’ decisions to work part-time or full-time, 75% of female participants said they were considering reducing their hours. Novelli underlined the importance of this “early gap” in hours practised between men and women, reaffirming the definite gender imbalance in this regard with anecdotal evidence: “I have never worked with another female IR [interventional radiologist] in my entire 18-year [IR career]”. The leaky pipeline will perpetuate the gender imbalance in medicine for the foreseeable future, Novelli posited.

The mental “toll” on women in IR

Novelli then brought burnout among interventional radiologists into the picture, flagged how, as found in a recent Society of Interventional Radiology (SIR) questionnaire, burnout was “significantly higher” than among diagnostic radiologists, and, pertinent to the current discussion, also among women over men. Similarly, Novelli added, another JAMA study assessing depression among doctors just post-medical school found that the rate was also higher among the female respondents.

A theory Novelli brought to explain this phenomenon was that, perhaps, women need to work harder: “I do believe that we need to work harder in any academic setting just to prove ourselves.” This “toll” medicine takes on women is multifactorial, the presenter furthered, stating that female doctors are more likely to be reported, have fewer advancement opportunities, and less likely to become full professors or academic leaders. “We are not really learning from the past,” Novelli lamented, explaining that since the seventies, there have been calls for women to receive more flexibility and respect to foster their advancement. “We need to eliminate biases and harassment,” was one of Novelli’s own calls regarding how to successfully support women in their medical careers.

Women are currently supported to some extent, Novelli acknowledged, mentioning the BSIR’s pamphlet that informs women of the scope for flexibility around training and provides guidance on radiation exposure for those of childbearing age who may be concerned about this aspect of an IR career.

Investment in women in medicine not misplaced

“Today, the total training cost per diagnostic radiology resident is US$99,000 a year on top of the half-a-million that they pay to become a physician academically,” was Novelli quantifying for the audience members the extent to which embarking on becoming a radiologist in the USA is a significant financial undertaking. Be this as it may, she opined that women are not “overinvesting” in their medical education, as their practices, even if they do not work full-time hours, provide the same level of patient care.

Novelli’s parting words were that “as the only girl in the gang” she has been “called into the principal’s office” many times—this refers back to how it is harder to be a woman in medicine, how the standards to which women are held are higher. “But I have been able to maintain the support of family and work/life responsibilities,” she celebrated. Novelli then admitted that she is “still waiting for her ‘Me Too’ moment and is “not sure” that her 16-year-old daughter should pursue a career in medicine as “there is still a lot of work to do.”

Subsequent discussion around the subject of Novelli’s presentation drew out the sentiment that her point about not necessarily encouraging her daughter to go into medicine was “[disheartening]”. This then raised the question of whether women could be the predominant source of negative comments dissuading fellow female doctors or trainees from pursuing IR. Mentorship was suggested as an antidote for women’s reticence about entering into a field which may have seemed, traditionally, not to be a good “fit” for women. “[The mentor need not] be a woman,” was Shilpi Pal’s (Ninewells Hospital, Dundee, UK) view—“[just] someone who has been in your shoes”.


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