Barriers to Promotion: A Survey Study Investigating Obstacles to Women's Advancement in Radiation Oncology

Purpose: Even though women comprise most matriculating medical students in the United States, women radiation oncologists, especially racial minorities, hold a small proportion of tenured academic positions and leadership roles. We conducted a survey of practicing radiation oncologists to identify structural and perceived barriers for women’s career advancement by gender, age, practice type and position.

Methodology: An anonymous survey was disseminated between February and May of 2023 via email and social media platforms to American College of Radiation Oncology (ACRO) members. The survey composed of demographic questions (age, race, practice setting, gender, child-rearing status) and a validated 5-point Likert scale survey (1: strongly disagree to 5: strongly agree) to evaluate the elements preventing women’s academic success. Briefly, respondents rated statements in these domains: (a) equal access, (b) work-life balance, (c) gender bias, and (d) leadership support. Statistical analyses were performed using custom scripts in R studio.

Results: A total of 1112 individuals completed the survey, and 99.5% (N=1107) non-duplicate responses were included for analysis. A majority (77.1%) self-identified as female, and 69.1% of participants have children. More than half (54.2%) of participants were age 30-39. Most respondents (75.9%) are Caucasian with remaining being 10.7% Black/African American, 5.6%Hispanic/Latino, and 3.3% Asian. A minority (28.1%) of participants are employed at academic medical centers, while 71.9% practice in non-academic hospital, managed care or private practice settings.

Overall, respondents have favorable perceptions in domains of bias, access, balance and support. Among all participants, 48.1% agreed that women had less protected time as compared to male colleagues for research and non-clinical contributions. Asian women responded less favorably to questions in leadership support and gender bias domains with greater concerns about feeling comfortable bringing up such concerns. Among those with children, 45.2% agreed that “attending to personal needs, such as taking time off for sick children, is frowned upon”, while over 50% agree that long workhours are required for success, success is less likely workload needs to be reduced for family reasons, and female physicians who reduce their workload are expected to take on extra responsibilities. Interestingly, though no significant difference in responses were observed based on gender, for 2 of these 3 there was a non-significant trend toward less favorable responses from women than men.

Conclusions: In our survey of practicing radiation oncologists, obstacles in domains of equal access and work-life balance remain major challenges that women physicians face. Further research is needed to inform policy changes and interventions to create a more equitable pathway for women's advancement in radiation oncology.

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