Women and minorities face more barriers to getting ahead in their medical careers, both early in training and later on, researchers say.
In one study, Dr. Julie Boiko of the University of California, San Francisco and colleagues found that women are underrepresented among speakers at grand rounds, which are presentations delivered by esteemed doctors to medical teams at other institutions.
This was true for all but two of the medical specialties they examined during 2014.
"Speaker selections convey messages of 'this is what a leader looks like,' and women's visibility in prestigious academic venues may subconsciously affect women's desires to pursue academic medicine," Boiko's team warns in JAMA Internal Medicine.
A separate study in the same issue of the journal found that female doctors are judged to have less experienced when they finish training. Arjun Dayal of the University of Chicago Pritzker School of Medicine and colleagues analyzed 33,456 evaluations from 2013 to 2015 of 359 doctors-in-training, or residents, from 285 supervising doctors at eight U.S. emergency medicine programs.
Male and female doctors scored similarly during their first years of residency. But by the end of training, which typically lasted three years, male doctors were judged to have about a 13 percent higher attainment of important milestones than their female counterparts.
"We saw this across all the levels of competencies," said Dayal. Female physicians were receiving poorer evaluations whether they were diagnosing a patient or fulfilling physically demanding tasks.
The new study can't explain why women were evaluated lower than their male counterparts, but the senior author suggests it may be that women are judged more harshly as they take on leadership traits that are stereotypically male.
"This study simply adds to a variety of other studies published recently suggesting that female physicians face a negative consequence in their work - for a lack of a better explanation - because they're female," said Dr. Vineet Arora, who is also at the University of Chicago Pritzker School of Medicine.
A third study in the same journal found that medical students who belong to racial or ethnic minority groups have lower odds of being accepted into the prestigious Alpha Omega Alpha honor society.
Dr. Dowin Boatright from the Yale School of Medicine in New Haven, Connecticut and colleagues looked at data on 4,655 medical students who applied in 2013 to residency programs at their institution.
Students would typically indicate on their applications if they were members of Alpha Omega Alpha. "In terms of recognition, it is probably one of the most prestigious honors you can receive as a medical student," Boatright told Reuters Health.
Compared to white medical students, black students had 84 percent lower odds of being Alpha Omega Alpha members, the researchers found. Asian students had 48 percent lower odds, compared to white students.
"I think all these studies are showing that implicit bias exists in medical education, but people aren't looking at measures to track it," Boatright said.
Implicit bias consists of attitudes or stereotypes that affect people's "understanding, actions, and decisions in an unconscious manner," according to The Ohio State University's Kirwan Institute for the Study of Race and Ethnicity in Columbus.
In an editorial accompanying the new research, Dr. Molly Cooke of the University of California, San Francisco, recounts the story, from 2016, of a female African-American physician whose assistance was rejected when one of her fellow airplane passengers became ill. The flight crew didn't believe her when she said she was a doctor.
"What happened to Tamika Cross on Delta flight DL945 in October was terrible," wrote Cooke. "However, it is not exclusively the fault of the nonmedical world."
"We must insist that our profession and the processes that our trainees encounter along the way treat them fairly and reflect the diversity of the patients we serve," she said.