# Improving Gender Equity for Women in Nephrology: A Global Perspective

Sabine Karam, Urmila Anandh, Aldjia Hocine, Michelle N Rheault, Benedicte Sautenet, Maryvonne Hourmant

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## To cite this version:

Sabine Karam, Urmila Anandh, Aldjia Hocine, Michelle N Rheault, Benedicte Sautenet, et al., Improving Gender Equity for Women in Nephrology: A Global Perspective. Kidney International Reports, 2024, 9 (3), pp.501-503. 10.1016/j.ekir.2024.01.036. hal-05324855

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# Improving Gender Equity for Women in Nephrology: A Global Perspective

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Sabine Karam<sup>1,2</sup>, Urmila Anandh<sup>3</sup>, Aldjia Hocine<sup>4,5</sup>, Michelle N. Rheault<sup>6</sup>, Benedicte Sautenet<sup>7,8</sup> and Maryvonne Hourmant<sup>9</sup>

<sup>1</sup>Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA; <sup>2</sup>Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; <sup>3</sup>Department of Nephrology, Amrita Hospitals, Faridabad, Delhi, National Capital Region, India; <sup>4</sup>Service de Néphrologie, Clinique du Landy, Saint-Ouen, France; <sup>5</sup>Service de Néphrologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France; <sup>6</sup>Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis, Minnesota, USA; <sup>7</sup>Service de Néphrologie et Immunologie Clinique, CHRU de Tours, Tours, France; <sup>8</sup>Faculté de Médecine, Université Francois Rabelais, Tours, France; and <sup>9</sup>Service de Néphrologie et Immunologie Clinique, University Hospital of Nantes, Nantes, France

Kidney Int Rep (2024) 9, 501–503; https://doi.org/10.1016/j.ekir.2024.01.036

© 2024 International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

## Introduction

Although the number of women pursuing a career in nephrology has been increasing worldwide, there remain barriers to career achievement. Today, thanks to women pioneers such as Drs Renee Habib, Marie-Claire Gubler, Sharon Anderson, Priscilla Kincaid-Smith, Saraladevi Naicker, and many others, gender is not a barrier to complete medical studies and elect nephrology as a specialty. In 2009, women represented just 33% of the nephrologists practicing in France; 14 years later, this number has increased to approximately 48%.¹ In the United States, approximately 25% of nephrologists are women and 36% of fellows are women, suggesting that numbers will continue

to improve over time.² However, gender equity remains elusive when it comes to fulfilling career goals for those who enter the field. The glass ceiling is not breaking yet, and women remain underrepresented in leadership positions, academic medicine, and at medical meetings worldwide.³,⁴ In the United States, just 6% of department chairs are women and just 9% of division chiefs are women.⁵ The fate of women physicians in one of the oldest and largest countries of the world is no different. In ancient India, medical practice was the domain of priests. Because this was a male-dominated profession, absence of the mention of female medical practitioners was the rule. This attitude did not change over the centuries and women medical professionals in India had to struggle to gain acceptance. The first woman nephrologist, Professor V.N. Acharya not only chose against all odds nephrology as a career but went on to become one of the

pioneers of the discipline by establishing one of the earliest nephrology programs in India. This editorial will illustrate the perspective of members of several scientific societies worldwide, notably the International Society of Nephrology, the French-speaking society of Nephrology (Société Francophone de Néphrologie, Dialyse et Transplantation), the Club des Jeunes Néphrologues in France, the Women in Nephrology (WIN) organization, and WIN-India, and highlight growing efforts worldwide that are trying to constructively address the issue of gender equity in nephrology.

## Challenges Faced by Women in Nephrology

Women in nephrology face many challenges, such as limited mentorship opportunities, gender bias when it comes to recognition and promotion, imposter syndrome, and the need for better work-life integration. A few of these issues have been confirmed in recent surveys distributed in the nephrology community. In a questionnaire sponsored and distributed by the Société Francophone de Néphrologie, Dialyse et Transplantation to the French speaking nephrology community with the help of Club des Jeunes Néphrologues and presented as an oral communication at the 2022 European Renal Association Congress,⁶ some of the identified obstacles to career advancement were “the lack of incentives by the civil society for women professional advancement” and “preference for a male professional whenever applying for a leadership position with equal qualifications.” In addition, “the absence of subsidized daycares,” “the lack of motivation to seek for a leadership

**Correspondence:** Sabine Karam, Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414, USA. E-mail: skaram@umn.edu
position from women themselves,”
and “the absence of or the insuf-
ficient duration of paternity leave”
were also deemed in this survey to
jeopardize career goals fulfillment
for women. A web-based survey of
its members by the Australian and
New Zealand Society of
Nephrology recorded the degree of
perceived inequity on a Likert
scale, ranging from 1 (none) to 5
(complete).⁷ Among the 134 re-
spondents, of whom 57% were
women, 88% perceived inequities
in the workforce and 75% felt that
gender was one of its drivers.
Qualitative analysis highlighted
limited opportunities for advance-
ment and lack of formal assistance
for those experiencing inequities.
Respondents called for policy
changes to ensure diverse repre-
sentation on committees and in
executive leadership positions.
Nonetheless, the most important
issue to solve for women nephrol-
ogists is likely motherhood and the
difficulties in balancing the re-
sponsibilities of parenting and
professional career. Globally, there
are big discrepancies in access to
parental leave and remuneration,
and worldwide maternity leave
varies between 0 and 40 weeks for
physicians.⁸ In the United States,
the Family and Medical Leave Act
allows for 12 weeks of maternity
leave, but this is unpaid.⁹ A lack of
systems-level guidelines for preg-
nancy and parental leave, incon-
sistent workplace accommodations
for pregnant and lactating physi-
cians, a lack of guidance and sup-
port for planning parental leaves,
and difficulties obtaining clinical
coverage for parental leave could
also play a significant role.⁶
Women physicians may delay
childbearing, be at increased risk
of adverse peripartum complica-
tions when they do become preg-
nant, and face subsequent
discrimination and lower earnings.
In that regard, 60% of the

respondents to the Société Franco-
phone de Néphrologie, Dialyse et
Transplantation survey deemed it
necessary to establish an adequate
support system at work such as
daycares and lactation rooms.⁶

Overview of the Different
Initiatives Geared at Achieving
Gender Equity in Nephrology

Several initiatives have been established independently worldwide with the goal of developing mentorship and career development opportunities for women in the field. The oldest initiative is undoubtedly WIN, an independent nonprofit organization founded in 1983 by Drs. Nancy Gary, Lois Katz, Sandra Levison, and Mabel Purkerson in the United States. For years, WIN provided a space for networking and community for women at the annual American Society of Nephrology conference as well as hosted a premeeting professional development course through 2014. Currently, WIN hosts a yearly professional development conference for nephrologists to provide leadership training particularly for early-career women. In addition, WIN nominates women for awards in nephrology, provides a speaker's bureau to allow for conference organizers to easily find a diverse list of speakers or panelists for any event, provides individualized mentoring for nephrologists and trainees, and advocates for family-friendly institutional and conference policies. WIN also provides a national leadership platform for its Executive Council members who have often moved on to other leadership positions in nephrology after their tenure with WIN. Finally, WIN promotes and shares content about achievements of women in nephrology via its social media channels to highlight their work and show women trainees the multiple career paths

in nephrology that are available to
them. Although there has been
recent movement toward improved
gender balance of the executive
council of the American Society of
Nephrology and other national
nephrology organizations, women
remain underrepresented in
research, both grant funding and
publications, and in academic
leadership. The WIN movement
has blossomed worldwide as its
Indian counterpart was started in
August 2021 with positive backing
from the original WIN, the Inter-
national Society of Nephrology
and prominent global women
leaders such as Professors Liz
Lightstone, Valerie Luyckx, and
Lisa Curtis.⁵¹ The organization has
since then conducted webinars,
quizzes, symposiums, case discus-
sions, and sent out newsletters.
The newly formed Indian society
also supported their counterparts
in Africa to establish the “Women
in Nephrology-Africa” movement,
which took wings at the 2023 Af-
rican Association of Nephrology
meeting in Cairo. Within the
Australian and New Zealand Soci-
ety of Nephrology, a gender equity
working group was set up in 2017,
and in 2020, the Equity, Diversity,
and Inclusivity committee was
formed within the same society to
address intersectional bias and
barriers to diverse workforce rep-
resentation for women and other
minority groups.⁷ In addition,
subsequent to the Société Franco-
phone de Néphrologie, Dialyse et
Transplantation survey and after
having noticed that women were
poorly represented in the leading
committees of the society, women
nephrologists from France and
other French-speaking countries
created in 2022 a commission
called FEMKY (for “FEMmes” i.e.,
women and KY for kidney). The
group adopted a plan of action
with 10 objectives (Table 1),
related to their professional and
<table><caption>**Table 1.** The 10 objectives of the FEMKY group</caption><tr><td>1.</td><td>Creation of a dedicated committee within the SFNDT (FEMKY)</td></tr><tr><td>2.</td><td>Increase the visibility and promotion of women through parity in commissions, congress invitations as speakers and moderators</td></tr><tr><td>3.</td><td>Create a network of women mentors</td></tr><tr><td>4.</td><td>Highlight female role models</td></tr><tr><td>5.</td><td>Organize self-confidence workshops for women nephrologists</td></tr><tr><td>6.</td><td>Information on daily sexist behaviors within the nephrology community, including trainees</td></tr><tr><td>7.</td><td>Introduce a gender equity chapter as part of the training curriculum of young nephrologists</td></tr><tr><td>8.</td><td>Set up a watch initiative over gender disparity</td></tr><tr><td>9.</td><td>Set up a help cell for women exposed to abuse or harassment at work</td></tr><tr><td>10.</td><td>Promote actions regarding private life (pregnancies, care of young children) that could help promotion of women and improve life-work balance</td></tr></table>

FEMKY, “FEMmes” that is, women and KY for kidney; SFNDT, Société Francophone de Néphrologie, Dialyse et Transplantation.

personal life, highlighting the need for solidarity, mentorship, and education. An important goal for FEMKY is to set up a support system for women exposed to abuse or harassment at work, a vital issue identified by this group from a recent survey.⁵² Most recently, the 60th congress of the European Renal Association saw the birth of a European advocacy group for WIN. Finally, another notable initiative is the occurrence in 2017 of a workshop by the Women in Transplantation Committee, a subcommittee of The Transplantation Society of Australia and New Zealand that instituted several tangible changes.⁵³ They include the reporting on an annual basis of the gender split of invited speakers and session chairs at the annual scientific meeting to the council of the society with the aim of gender equality and the establishment of a subsidized child-minding facility. The growth of all these initiatives and their work augur well for the equitable growth of nephrology worldwide.

## Conclusion

There remain significant disparities when it comes to women representation in leadership positions worldwide. It matters that the nephrology community

determines the precise factors and finds pragmatic solutions to a global problem. Some of the fruitful initiatives achieved so far have been the establishment of organizations dedicated to the promotion and recognition of women nephrologists through tailored mentorship programs and advocacy for equitable representation in councils and executive committees of scientific societies along with equal opportunities to present at national and international conferences. Nonetheless, major gaps persist when it comes to achieving a smooth transition to motherhood and integrating this major life-changing event in a woman's career without jeopardizing her aspirations. Improving and alleviating the struggles that many women go through to achieve their career goals will benefit all nephrologists through a more diverse, representative, efficient, and effective workforce leading to more scientific innovation. Ensuring that every trainee who chooses nephrology will be able to achieve her own path should be an everyday goal for our community.

## DISCLOSURE

All the authors declared no conflicting interests.

## SUPPLEMENTARY MATERIAL

### Supplementary File (PDF)

### Supplemental References.

## REFERENCES

1. Atlas de la démographie médicale en France. Ordre National Des Medecins Conseil National de L'Ordre. Accessed September 4, 2023. https://www.conseil-national.medecin.fr/sites/default/files/external-package/analyse_etude/b6i7b6/cnom_atlas_demographie_2023.pdf

2. The US adult nephrology workforce 2016 developments and trends. GWU Health Workforce Institute. Accessed December 22, 2023. https://data.asn-online.org/posts/workforce_2016/

3. Hart KL, Perlis RH. Trends in proportion of women as authors of medical journal articles, 2008–2018. JAMA Intern Med. 2019;179:1285–1287. https://doi.org/10.1001/jamainternmed.2019.0907

4. Malieckal DA, Ng JH, Shah HH, Hong S, Jhaveri KD. Trends in the proportions of women program chairs, moderators, and speakers at American Society of Nephrology kidney week 2011–2019. Clin J Am Soc Nephrol. 2020;15:265–266. https://doi.org/10.2215/CJN.08140719

5. Rotenstein LS. Fixing the gender imbalance in health care leadership. Harvard Bussiness Reviews. Published 2018. Accessed December 5, 2023. https://hbr.org/2018/10/fixing-the-gender-imbalance-in-health-care-leadership

6. Karam S, Hocine A, Hourmant M. FC009: women in Nephrology Leadership: a survey by the SFNDT. Nephrol Dial Transplant. 2022;37(suppl 3):gfac095.004. https://doi.org/10.1093/ndt/gfac095.004

7. Francis A, O'Sullivan KM, Patel P, et al. Equity and diversity in the nephrology workforce in Australia and New Zealand. Intern Med J. 2022;52:1900–1909. https://doi.org/10.1111/imj.15768

8. Casilla-Lennon M, Hanchuk S, Zheng S, et al. Pregnancy in physicians: a scoping review. Am J Surg. 2022;223:36–46. https://doi.org/10.1016/j.amjsurg.2021.07.011

9. O'Lone E, Webster AC. Barriers to the professional advancement of women in nephrology. Clin J Am Soc Nephrol. 2019;14:1399–1401. https://doi.org/10.2215/CJN.02720319