Women's Participation in the Medical Profession: Insights from Experiences in Japan, Scandinavia, Russia, and Eastern Europe

Although much literature has focused on the status of female physicians in the United States, limited English-language studies have examined the role of women in the medical profession elsewhere in the world. This article synthesizes evidence regarding the status of female physicians in three purposively selected regions outside the United States: Japan, Scandinavia, and Russia and Eastern Europe. These three regions markedly differ in the proportion of female physicians in the workforce, overall status of the medical profession, cultural views of gender roles, and workforce policies. Through a review of studies and articles published between 1992 and 2012 examining women's representation, status measures such as salary and leadership positions, and experiences of female physicians, the authors discuss potential relationships between the representation of female physicians, their status in medicine, and the overall status of the profession. The findings suggest that even when women constitute a high proportion of the physician workforce, they may continue to be underrepresented in positions of leadership and prestige. Evolving workforce policies, environments, and cultural views of gender roles appear to play a critical role in mediating the relationship between women's participation in the medical profession and their ability to rise to positions of influence within it. These insights are informative for the ongoing debates over the impact of the demographic shifts in the composition of the medical workforce in the United States.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140127/1/jwh.2014.4736.pd

Progress and controversies: Radiation therapy for invasive breast cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106667/1/caac21209.pd

Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146289/1/cncr31532_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146289/2/cncr31532.pd

Malpractice Suits and Physician Apologies in Cancer Care

Conside the following case: The patient is a 44-year-old woman who presents for radiation treatment of an isolated locoregional recurrence of breat cancer in her chest wall, 3 years after undergoing masectomy. At the time of diagnosis, she had T2N2M0 disease, with four of 15 lymph nodes involved with tumor. She received a masectomy with negative margins and appropriate chemotherapy, but none of her physicians talked to her about postmasectomy radiation therapy, which would clearly have been indicated to reduce her risk of locoregional failure and would have been expected to improve her likelihood of survival. She asks the radiation oncologist who sees her whether this recurrence could have been prevented, and she notes that when she was diagnosed with the recurrence, a nurse asked her why she had not received radiation before. She states that she is thinking of retaining an attorney. The radiation oncologist says, Dwelling on what could have been isn\u27t productive - let\u27s just focus on how we can fight this cancer now. This case reveals some of the dilemmas oncologists face when treating patients who have suffered from substandard medical care. It also highlights some of the shortcomings of the existing tort systm, both in addressing the legitimate claims of the patient who has been harmed by negligent care and in promoting quality improvement. In this article, we survey the US medical malpractice system and assess the effectiveness of tort law at achieving its goals. We then consider how physicians and health care organizations could better assist negligently harmed patients and simultaneously reduce future mistakes. Specifically, we describe how the hypothetical case presented might have been handled if if had occurred at our own institution, which has adopted a noevl approach to promote transparency and remedy through disclosure and apology by negligent providers to injured patients. This program was designed to compensate patients swiftly and fairly when there is evidence of harm caused by unreasonable care, as well as to decrease future errors through continuous quality improvement and an open exchange with injured patients about medical mistakes

Fertility and Childbearing Among American Female Physicians

Background: Female physicians may experience unique challenges regarding fertility and family planning. We sought to determine childbearing patterns and decision-making among American female physicians. Materials and Methods: In 2012?2013, we surveyed a random sample of 600 female physicians who graduated medical school between 1995 and 2000. Primary outcome measures included fertility and childbearing history, reflections regarding decision-making, perceptions of workplace support, and estimations of childbearing potential. Results: Response rate was 54.5% (327/600). A majority (82.0%) of the sample were parents, 77.4% had biological children with an average of 2.3 children. Average age at medical school graduation was 27.5 years, at completion of training (completion of medical school, residency, and/or fellowship) was 31.6 years, and at first pregnancy was 30.4 years. Nearly one quarter (24.1%) of respondents who had attempted conception were diagnosed with infertility, with an average age at diagnosis of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve. When asked what they would do differently in retrospect, most respondents (56.8%) would do nothing differently regarding fertility/conception/childbearing, 28.6% would have attempted conception earlier, 17.1% would have gone into a different specialty, and 7.0% would have used cryopreservation to extend fertility. Fewer of those whose first pregnancy was in medical school perceived substantial workplace support (68.2%) than those whose first pregnancies followed training (88.6%). Conclusions: A substantial proportion of female physicians have faced infertility or have regrets about family planning decisions and career decision-making. Combining a medical career with motherhood continues to pose challenges, meriting further investigation and targeted support.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140144/1/jwh.2015.5638.pd

Frequency, nature, effects, and correlates of conflicts of interest in published clinical cancer research

BACKGROUND: Relationships between clinical researchers and industry are becoming increasingly complex. The frequency and impact of conflicts of interest in the full range of high-impact, published clinical cancer research is unknown. METHODS: The authors reviewed cancer research published in 8 journals in 2006 to determine frequency of self-reported conflicts of interest, source of study funding, and other characteristics. They assessed associations between the likelihood of conflicts of interest and other characteristics by using chi-squared testing. They also compared the likelihood of positive outcome in randomized trials with and without conflicts of interest by chi-squared testing. RESULTS: The authors identified 1534 original oncology studies; 29% had conflicts of interest (including industrial funding) and 17% declared industrial funding. Conflicts of interest varied by discipline ( P < .001), continental origin ( P < .001), and sex ( P < .001) of the corresponding author and were most likely in articles with corresponding authors from departments of medical oncology (45%), those from North America (33%), and those with male first and senior authors (37%). Frequency of conflicts also varied considerably depending upon disease site studied. Studies with industrial funding were more likely to focus on treatment (62% vs 36%; P < .001), and randomized trials that assessed survival were more likely to report positive survival outcomes when a conflict of interest was present ( P = .04). CONCLUSIONS: Conflicts of interest characterize a substantial minority of clinical cancer research published in high-impact journals. Therefore, attempts to disentangle the cancer research effort from industry merit further attention, and journals should embrace both rigorous standards of disclosure and heightened scrutiny when conflicts exist. Cancer 2009. © 2009 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63065/1/24315_ftp.pd

Preventing the tower from toppling for women in surgery

In a rich qualitative analysis of interviews with women who left surgical training in Australia, Rhea Liang and colleagues report in The Lancet their study that applied insights from feminist and social theories to illuminate how various factors interact to disadvantage women. They persuasively argue that various stresses accumulate like a tower of stacked blocks. Eventually, an individual's tower can reach a height that it will topple in the absence of efforts to stabilise it; often the final toppling precipitator appears relatively minor. Their findings suggest that interventions seeking to improve retention and advancement of women in surgery must address the underlying multiple and constituent factors (blocks) rather than narrowly focus on the ultimate triggers. Ideally, such interventions should not overtly focus on women alone.The NIH, Doris Duke Charitable Foundation, Komen Foundation, Greenwall Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium and personal fees from Vizient and Amgen.http://www.thelancet.comhj2020Surger

Evidence-based sizing of non-inferiority trials using decision models

Abstract Background There are significant challenges to the successful conduct of non-inferiority trials because they require large numbers to demonstrate that an alternative intervention is “not too much worse” than the standard. In this paper, we present a novel strategy for designing non-inferiority trials using an approach for determining the appropriate non-inferiority margin (δ), which explicitly balances the benefits of interventions in the two arms of the study (e.g. lower recurrence rate or better survival) with the burden of interventions (e.g. toxicity, pain), and early and late-term morbidity. Methods We use a decision analytic approach to simulate a trial using a fixed value for the trial outcome of interest (e.g. cancer incidence or recurrence) under the standard intervention (pS) and systematically varying the incidence of the outcome in the alternative intervention (pA). The non-inferiority margin, pA – pS = δ, is reached when the lower event rate of the standard therapy counterbalances the higher event rate but improved morbidity burden of the alternative. We consider the appropriate non-inferiority margin as the tipping point at which the quality-adjusted life-years saved in the two arms are equal. Results Using the European Polyp Surveillance non-inferiority trial as an example, our decision analytic approach suggests an appropriate non-inferiority margin, defined here as the difference between the two study arms in the 10-year risk of being diagnosed with colorectal cancer, of 0.42% rather than the 0.50% used to design the trial. The size of the non-inferiority margin was smaller for higher assumed burden of colonoscopies. Conclusions The example demonstrates that applying our proposed method appears feasible in real-world settings and offers the benefits of more explicit and rigorous quantification of the various considerations relevant for determining a non-inferiority margin and associated trial sample size.https://deepblue.lib.umich.edu/bitstream/2027.42/146777/1/12874_2018_Article_643.pd