Opinion Viewpoint

Given that more than 3000 of our teenaged patients are murdered by guns each year, when one teen shoots another (as is the case in almost half of teen homicides8) we should join her in asking this question. We must keep this gun issue from fading from national attention. Since the killing of 20 children at Sandy Hook Elementary School in Newtown, Connecticut, on December 14, 2012, our nation has engaged in a long-overdue conversation about the role of guns in our society. Thirty-nine states passed new gun laws in the year following the shootings in Newtown—but in 24 of those states, gun laws were made less restrictive.9 Health care and public health professionals can move gun reform forward by reaching out to grassroots groups and sharing our viewpoint at recruitment events and comARTICLE INFORMATION Published Online: December 8, 2014. doi:10.1001/jamapediatrics.2014.2851. ConflictofInterestDisclosures:DrHemenwayreceives some support for firearms research from the Joyce Foundation. No other disclosures were reported. REFERENCES 1. Dowd MD, Sege RD; Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423. 2. Centers for Disease Control and Prevention. 10 Leading Causes of Injury Deaths by Age Group Highlighting Unintentional Injury Deaths, United

munity panels. We have found such groups to be very welcoming, as our voice adds to the rich chorus of gun violence survivors, family members, concerned parents, mayors, faith leaders, and others who characterize the gun reform movement. Health care and public health professionals can also offer valuable testimony to lawmakers at public hearings or in private meetings. Soon, the second anniversary of the horrific Sandy Hook Elementary School massacre will come and go. Media attention may continue to drift away from it. Yet, until major reforms are made to our state and federal laws, gun violence will continue to be the second biggest killer of American teens and a major cause of disability, fear, anxiety, and despair. This is a public health problem worthy of our attention and action.

States–2011. http://www.cdc.gov/injury/wisqars/pdf /leading_causes_of_injury_deaths_highlighting _unintentional_injury_2011-a.pdf. Accessed October 9, 2014. 3. Levitt SD, Dubner SJ. Freakonomics: A Rogue Economist Explores the Hidden Side of Everything. New York, NY: William Morrow; 2005. 4. Children’s Defense Fund. Protect Children Not Guns. http://www.childrensdefense.org/child -research-data-publications/data/protect-children -not-guns-2013.pdf. Accessed October 9, 2014. 5. Weil DS, Knox RC. Effects of limiting handgun purchases on interstate transfer of firearms. JAMA. 1996;275(22):1759-1761.

Boston, MA: does overestimation of peer gun carrying matter? J Adolesc. 2011;34(5):997-1003. 7. Operation LIPSTICK. Where did the gun come from? http://www.operationlipstick.org/where-did -the-gun-come-from/. Accessed October 9, 2014. 8. Centers for Disease Control and Prevention. National Violent Death Reporting System, 2003-2006. http://www.cdc.gov /violenceprevention/nvdrs/. Accessed October 7, 2014. 9. Law Center to Prevent Gun Violence. Search Gun Laws by State. http://smartgunlaws.org /search-gun-law-by-state/. Accessed August 12, 2014.

6. Hemenway D, Vriniotis M, Johnson RM, Miller M, Azrael D. Gun carrying by high school students in

AMERICAN PEDIATRIC SOCIETY VIEWPOINT

Catherine DeAngelis, MD, MPH Johns Hopkins University School of Medicine, Baltimore, Maryland; and Editor in Chief Emerita, JAMA.

Corresponding Author: Catherine DeAngelis, MD, MPH, Johns Hopkins University School of Medicine, 3704 N Charles St, Unit 105, Baltimore, MD 21218 ([email protected]).

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Women in Pediatrics When we were sick during our childhood, most of us were cared for by our mothers; this nurturing characteristic of women plays an important role in pediatrics. That is not to say that some men are not nurturing—we all are better for knowing them. The first woman physician was Merit (how is that for a fitting name?) Ptah, who lived in Egypt around 2700 BC. It is likely that she cared for children in her practice. However, it was much later that the first woman in the United States earned her medical degree from the Geneva MedicalCollegein1849.1 ElizabethBlackwellthenstudiedatchildren’shospitalsinLondon,Paris,andScotland,andlaterreturned to the United States, where she helped start the NewYorkInfirmaryforWomenandChildren.In1872,Mary PutnamJacobi,wifeofAbrahamJacobi,startedachildren’s wardattheNewYorkInfirmaryandwasthefirstwomanto become a member of the Academy of Medicine.1 It was not until 1850 that Women’s Medical College of Pennsylvania, the first medical school for women, was founded. That was 85 years after The University of Pennsylvania School of Medicine—the first medical school in the United States—was founded, but for the first century or so onlymenwereaccepted.Only4%ofmedicalschoolgradu-

ates in 1905 were women; in 1965, women comprised 8% ofgraduates,andby1985,thefigurehadincreasedto31%. Since 2003, approximately 48% of medical school graduates have been women. So for the past decade, women have been graduating from medical schools at about the same rate as men.2 While women were not generally accepted in medicine, their role in pediatrics was more acceptable to men, who essentially controlled medicine. Perhaps this was because pediatrics was considered a “soft” specialty (whatever that means). I remember an incident when I was the pediatric residency director at Johns Hopkins in the 1980s that makes this point. One of the female residents asked if I would meet with her mother, who was unhappy that she had chosen the specialty of pediatrics. When I met the mother, she acknowledged being disappointed because she had expected her daughter to have chosen a field where she would care for “really sick” patients. Rather than changing her mind with words, I took her on a tour of the Children’s Medical and Surgical Center, including the intensive care units. Later, while sharing tea in my office, she began to cry and told me she never knew pediatricians cared for such sick children. I explained that,

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Table. AMSPDC Women Pediatric Department Chairs Name, Affiliation Judy Aschner, MD, Albert Einstein College of Medicine

Name, Affiliation Beverly Neyland, MD, University of Nevada School of Medicine

Alice D. Ackerman, MD, Virginia Tech Carilion School of Medicine

Teresa Quattrin, MD, University of Buffalo State University of New York School of Medicine

Xylina Bean, MD, Meharry Medical College

J. Usha Raj, MD, University of Illinois College of Medicine

Yvonne Blasini, MD, Ponce School of Medicine and Health Sciences

Ann Reed, MD, Mayo Medical School

Valerie P. Castle, MD, University of Michigan Medical School

C. Joan Richardson, MD, University of Texas Medical Branch

Archana Chatterjee, MD, Sanford School of Medicine, The University of South Dakota Loretta Cordova de Ortega, MD, University of New Mexico School of Medicine Sherin Devaskar, MD, UCLA (University of California, Los Angeles) David Geffen School of Medicine Allison Eddy, MD, University of British Columbia

Cheryl Rockman-Greenberg, MD, FRCPC, FCCMG, University of Manitoba Rita M. Ryan, MD, Medical University of South Carolina College of Medicine Lisa Satlin, MD, Mount Sinai School of Medicine Judith L. Schaechter, MD, University of Miami Leonard M. Miller School of Medicine

Patricia J. Emmanuel, MD, University of South Florida College of Medicine

Nina F. Schor, MD, PhD, University of Rochester School of Medicine and Dentistry

Donna M. Ferriero, MD, University of California, San Francisco, School of Medicine Susan Gilmour, MD, MSc, FRCPC, University of Alberta

Robin H. Steinhorn, MD, University of California, Davis, School of Medicine

Ildy M. Katona, MD, University of Calgary

Yasmin Tyler-Hill, MD, Morehouse School of Medicine

Mary Lee, MD, University of Massachusetts Medical School

Cathy Vardy, MD, FRCPC, Memorial University Newfoundland

Barbara J. Stoll, MD, Emory University School of Medicine

Catherine Scott Manno, MD, New York University School of Medicine

Ellen R. Wald, MD, University of Wisconsin School of Medicine and Public Health

Margaret McGovern, MD, PhD, School of Medicine at Stony Brook University

Patricia Whitley-Williams, MD, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson

Abbreviation: AMSPDC, Association of Medical School Pediatric Department Chairs.

while it was not as sexy, we also did much to prevent serious illnesses and suffering in children. She left feeling very proud of her daughter. Women have often historically chosen pediatrics as their primary specialty. Since its inception in 1933, the American Board of Pediatrics has certified 108 879 pediatricians, of whom 51% have been women. Interestingly, 84% of certifications revoked by the American Board of Pediatrics involved men.3 One might wonder what, if anything, that says about those male pediatricians. No matter, because the total number of revocations is so small (only 304 of 108 879) that it speaks very well for pediatricians. Currently, 30% of all active physicians in the United States are women, but 58% of the 55 509 pediatricians and 50% of the 3844 internal medicine pediatricians are women. The only other specialty that comes close is obstetrics and gynecology, in which 47% of the 40 377 members are women.2 The trend continues: 72% of current pediatric residents and fellows are women, second only to the smaller field (in numbers, not stature) of obstetrics and gynecology at 81%.2 Women pediatricians have received leadership roles, awards, or acknowledgments less often than would be expected proportionally to their contributions and numbers. For example, very few pediatricians know of Mary Putnam Jacobi, while almost all know Abraham Jacobi, if only by name. Of the 151 members of the Association of Medical School Pediatric Department Chairs, only 32 (21%) are women, including 28 of 138 in the United States and 4 of 13 in Canada (Table). Only 1 of the 13 women medical school deans, Nancy Andrews, is a pediatrician. ARTICLE INFORMATION

Correction: This article was corrected on February 2, 2015, for a typographical error.

Published Online: December 22, 2014. doi:10.1001/jamapediatrics.2014.2917. Conflict of Interest Disclosures: None reported. Disclaimer: Dr DeAngelis is the former editor of JAMA but was not involved in the editorial review or the decision to accept the manuscript for publication.

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The Joseph St Geme Award is voted on by all the major pediatric organizations. It started in 1988, with Samuel Katz being the first recipient, but only 4 of the 27 awards (15%) have been presented to women. However, 3 of the past 10 have been awarded to women: Carol Berkowitz, Gail McGuinness, and Renee Jenkins. The Howland Award, provided by the American Pediatric Society, began in 1952, with Edwards Park being the first recipient. This award has been given to 65 pediatricians, but only 8 (12%) have been presented to women. However, 3 of the past 10 recipients have been women: Mary Ellen Avery, Elizabeth McAnarney, and Rebecca Buckley. So women pediatricians can look to the future with great hope for recognition and leadership roles. Some argue that women pediatricians work fewer hours per week than male pediatricians and take off months or years for child bearing and caring and therefore do not contribute as much as men. However, it can also be argued that men have more serious illnesses in later life and live an average of 2 to 3 years less than women. Therefore, the overall total work hours might not be all that different. In any case, until men can bear children (not likely to happen), this is a moot point. In fact, if women stopped bearing children, there soon would be no need for pediatricians or, in fact, physicians. Women pediatricians have always and will continue to play a significant and important role in pediatrics. We can look to the future with confidence that advances will be made to the health and wellbeing of children, and women will contribute substantially. So it is onward to the future of pediatrics.

REFERENCES 1. Pediatrics: Pediatric Milestones: History of Pediatrics. About Health website. http://pediatrics .about.com/od/becomingapediatrician/a /pediatrics.htm. Accessed October 13, 2014.

2. Physician Specialty Data Book. Association of American Medical Colleges website. https://members .aamc.org/eweb/upload/12-039%20Specialty %20Databook_final2.pdf. Accessed October 13, 2014. 3. Workforce Databook. The American Board of Pediatrics website. https://www.abp.org/content /workforce-databook. Accessed December 16, 2014.

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