• Resa E Lewiss, Julie K Silver, Carol A Bernstein, Angela M Mills, Barbara Overholser, and Nancy D Spector.
• Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
• J Womens Health (Larchmt). 2020 Feb 1; 29 (2): 187-192.

AbstractIn this perspective piece, we describe a multifactorial phenomenon whereby academic women physicians become invisible in the mid-career stage. Barriers, both small and large, cause a cumulative inequity effect, and women may leave academic medicine. Certainly, family and lifestyle choices play a role. And as we describe, so is a situation created where women become discouraged and disillusioned. We describe the growing evidence of subtle disparities, or micro-inequities, that cause women to be less visible and marginalized. Over time, early career women transition to mid-career with an accumulation of these micro-inequities. Women have more difficulty in building their academic portfolios and curriculum vitae-core components of academic promotion. They comprise greater than 50% of the health care workforce; yet, they are underrepresented in top leadership positions. For example, only 22% of full professors, 18% of department chairs, and 17% of medical school deans are women. Macro-inequities, which are observable and measurable, are also well documented. For example, women receive less compensation than men for the same job. We examine the contributing and causative processes and offer suggestions on how to promote equity among highly qualified mid-career women as they graduate from training and move beyond the early career stage.

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