Newsletter April 2022: Strategies for improving gender equity

Joana Berger Estilita & Marko Zdravkovic

Over the last 10 years, much data concerning gender equity in anaesthesia and intensive care have been published (1,2). Mostly, these data show numerical differences between men and women in leadership positions and in research. This is usually measured as the number of women authors, the number of women as first or the leading author, the number of women on editorial boards, in panels, as speakers at conferences etc. The numbers clearly reveal the gap between men and women, even when weighted per employment ratio in our field. Importantly, it seems that this gap has been stable for decades.

Equity vs equality

Although often confused and used interchangeably, equality and equity have different meanings. The definition of equality entails the state or quality of being equal, correspondence in quantity, degree value, rank or ability. Equity, on the other hand, assures that each individual or group has the same resources and chances (3). The World Health Organization defines equity as “the absence of avoidable or remediable differences among groups of people” (4). In other words, social equity distinguishes the different circumstances of each person and adapts their resources to achieve the same outcome. The route to achieving equity will not be accomplished through treating everyone equally, but according to their circumstances.

Why does gender disparity occur?

Unfortunately, there is little experimental data on gender equity in medicine. However, experimental studies from the business sector show no perceptible differences in the behaviour of men and women. In a recent study with behaviour tracking (5), women had the same number of contacts as men, they spent as much time with senior leadership, and they allocated their time similarly to men in the same role. That is, men and women had indistinguishable work patterns in the amount of time they spent online, in concentrated work, and in face-to-face conversation. Additionally, in performance evaluations, men and women received statistically identical scores. This held true for women at each level of seniority. However, women were not advancing in their careers and men were.

Eliminating the current gender inequality and inequity in medicine is challenging but will enhance working conditions for all physicians, resulting in a more reliable working team (6). Additionally, patients’ outcomes may also be better (6). Unfortunately, there is little research about practical approaches to diminish these problems. There are three main aspects worth mentioning that may increase gender equity and equality in the workplace (3,7):

  1. To raise awareness of the gender gap.
  2. To identify the reasons that prevent women and ethnic minorities from having the opportunity to advance on their career or academic tracks.
  3. To address these barriers objectively (almost goal-oriented) in a gender-neutral/non-discriminative approach.

To put such aspects in practice, we should first explore the potential barriers women have in reaching their career goals. In a recent review, we pointed out four main theories on where the gender gap originates from: the pollution theory, unconscious gender bias, motherhood penalty, and impostor syndrome (6). Based on an analysis of thousands of responses on perceived barriers among anaesthesiologists, we qualitatively divided those into four themes or sources, for ease of understanding: personal barriers, departmental barriers, institutional/governmental barriers and societal barriers (3). All these barriers can be acted upon and should be targeted individually, according to each context.

As we were analysing the gender inequality/inequity data in anaesthesia and intensive care we thought of the Pareto principle in this context too. The Pareto principle states that about 20% of the causes lead to 80% of the consequences (8). Which would these vital few be in our case? If we were able to pinpoint these key causes and act on them swiftly and thoroughly, the progress in gender equity and equality would be substantially accelerated. For that, we would also need a widespread buy-in of the stakeholder, the key decision-making champions. At the departmental and institutional level, these are obviously the heads of the departments and directors/presidents who could be the key partners in this process.

Which strategies do stakeholders need to implement?

The strategies suggested by anaesthesiologists were also grouped in the same four themes (3). For example, on a personal level, we can adopt zero tolerance to discrimination, we can change our personal beliefs, advocate for the need for change and reject taking advantage of gender alone to attain career goals. On the departmental level, we can aid in adopting meritocracy, support recruitment of qualified women, create a family-friendly work environment, have an efficient mobbing reporting system in place, mentorship for women and equal funding opportunities (3). Other helpful measures include the institution of local guidelines against harassment, with severe consequences for perpetrators, gender-neutral language in written documentation and the objective and transparent selection process for leadership (3). Selection juries should be unaware of the gender of candidates by hiding the names from applications. These juries should also be balanced, including women and men in approximately the same number. On an institutional level, we should be able to secure funding for adequate staffing, involve national societies and support the stronger implementation of existing gender-neutrality/equity rules (3). On a societal level, which would obviously take a longer time, we should support better education for women, equal household chore distribution, in medicine specifically, more women professors, more women in conference panels, and increase the visibility of women in medicine (3).


The literature lacks strong evidence of measures leading to gender equity in anaesthesia and intensive care. However, by studying perceived barriers and suggestions for improvements, one can gain insight into what men and women perceive to be needed in our profession to move gender equity further. To be fully equitable, we cannot assume that gender discrimination towards women is greater than towards men in each individual institution or country; it is possible that this is reversed in some circumstances. Yet, globally, the gap is still favouring men over women in our profession and we certainly need a global urge to reward ability over any other discriminatory factors (be it race, gender, ethnic background, etc).



  1. Flexman AM, Shillcutt SK, Davies S, et al. Anaesthesia. 2021 Apr;76 Suppl 4:32-38. doi: 10.1111/anae.15361
  2. Zdravkovic M, Neskovic V, Berger-Estilita J Journal of Gender Studies 2021; 30: 868, DOI: 10.1080/09589236.2021.1969225
  3. Zdravkovic M, Osinova D, Brull SJ, et al. Br J Anaesth. 2020;124:e160-e170. doi: 10.1016/j.bja.2019.12.022
  4. WHO, Equity, Available from, https://www.who.int/westernpacific/healthtopics/ equity. Accessed 23 December 2021
  5. Turban S., Freeman,, Ben Waber, B. A Available from, https://hbr.org/2017/10/a-study-used-sensors-to-show-that-men-and-women-are-treated-differently-at-work, Accessed 15th March 2022
  6. Noronha B, Fuchs A, Zdravkovic M et al. Trends in Anaesthesia and Critical Care, 2022, https://doi.org/10.1016/j.tacc.2022.02.004
  7. Matot I, De Hert S, Cohen B, Koch T. Br J Anaesth. 2020;124:e171-e177. doi: 10.1016/j.bja.2020.01.005
  8. Duszyński, M. Pareto Principle & the 80/20 Rule (Updated for 2021). Available from, https://resumelab.com/career-advice/pareto-principle?utm_source=google&utm_medium=sem&utm_campaign=6540517835&utm_term=%2Bpareto%20%2Bprinciple&network=g&device=c&adposition=&adgroupid=104311758447&placement=&gclid=CjwKCAjw8sCRBhA6EiwA6_IF4VbMWab7ZP1A5qMupJ2IWJQrImuT5svYxRNnnv46OHG-ePwl_BMSiBoCScoQAvD_BwE


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