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A Perspective on Out-of-Pocket Spending.

Sex Bias—Beyond Pay Inequity To the Editor The Original Investigation by Jena and colleagues1 concerning sex differences in physician salaries published in a recent issue of JAMA Internal Medicine is objective documentation of the ongoing sex bias in academic medicine. In a survey of National Institutes of Health career development awardees, Jagsi and colleagues2 reported that almost onethird of women report sexual harassment and almost twothirds of women report sex bias in professional advancement. These analyses document , with promises of confidentiality, the outcomes and places of sex bias. However, we need to move beyond the reporting of statistics to share the emotional stresses and the subsequent loss of women’s aspirations for influential leadership, which either fade or are obstructed. More than ever, we need transformative leaders of both sexes to meet the challenges of health care. Among all academic medical centers, there is absolutely no dearth of appointed diversity leaders, training modules, and goals to decrease sex biases. There are mission statements that establish the purpose to transform the academic culture to be more inclusive and diverse. Women faculty leadership forums often host seminars on how to negotiate for salary equity and how to manage conflict. However, if we accept the recent publications in JAMA Internal Medicine1 and JAMA2 as evaluations of the success of these programs, we must conclude our current efforts are not effective. Change will not occur with more diversity goals or only women “leaning in.” We must work collectively across both sexes to sensitize and personalize the effects of such continued biases. Men should reflect on their behaviors and recognize in themselves the biases they may harbor. Collectively, male leaders need to transform their behaviors so that women will have optimal opportunities to share their gifts for the betterment of health care. The necessary change will begin when all men start owning their role in the change we aspire to see in the world. I am grateful for male colleagues who encouraged me in my early career, who mentored me and were instrumental in my career development, and who supported me to openly challenge and contribute to clinical research. These men and other men with similar values and integrity must serve as role models and mentors for the next generation of male leaders in our mission of creating a culture where all sexes and genders contribute and thrive.