A comparative analysis of two major cross-sectional surveys indicates that while demographic representation of women in Brazilian rheumatology is increasing, significant structural barriers to gender equity remain. The study, published in Advances in Rheumatology, evaluated longitudinal trends in career advancement, the work-family interface, and workplace safety among members of the Brazilian Society of Rheumatology (SBR). By comparing data from the Reuma Equity survey conducted in 2022 and the Brazilian subset of the global Coalition for Health and Gender Equity (CHANGE) survey in 2024, the researchers identified persistent disparities alongside specific evolving trends in professional practice. The findings suggest that a demographic shift toward a female majority in the medical workforce does not automatically guarantee equitable career advancement or workplace safety.
The study design involved a comparative cross-sectional analysis of two self-administered, web-based surveys. The first, the Reuma Equity Project, was conducted in 2022 among SBR members, yielding 459 valid responses, of which 67.1% were from women. The second survey was the Brazilian portion of the CHANGE study, a global initiative involving rheumatologists and allied health professionals in 105 countries. In Brazil, the CHANGE questionnaire was distributed to SBR rheumatologists in August and September 2024, resulting in 301 valid responses, with 74.4% identifying as women. The surveys covered academic sociodemographic data, work performance, gender discrimination, bullying, sexual harassment, and career progression. Statistical analyses included Pearson’s chi-square, Fisher’s exact, and Mann–Whitney tests, with a significance level set at p ≤ 0.05.
One of the most persistent findings across both time points was the disproportionate burden of domestic responsibilities borne by female rheumatologists. In both 2022 and 2024, women were significantly more likely to report being solely or predominantly responsible for household chores compared to men. The odds ratio for this association remained stable at 2.8 in both years, with p-values less than 0.001. Additionally, female rheumatologists were twice as likely to be the legal guardians of minors under 18. This domestic inequity appears to translate directly into professional barriers, as women reported significantly higher rates of refusing career progression for family-related reasons. The odds of women refusing career advancement for these reasons increased from 2.1 in 2022 to 3.2 in 2024, indicating a widening gap over the two-year period.
Leadership visibility in national rheumatology events also showed persistent gender disparities. Men were consistently more likely to occupy high-visibility roles such as moderators, presidents, or organizers at national congresses. In 2022, men had 2.3 times the odds of holding these positions compared to women, a disparity that persisted in 2024 with odds of 2.1. However, no statistically significant difference was found regarding the likelihood of men or women serving as speakers at these events. This suggests that while women may be equally present in speaking roles, they remain underrepresented in organizational and presiding capacities. The study noted that academic graduation levels, academic functions, and leadership positions within institutions showed no statistical difference between genders, highlighting that the disparity is concentrated in external, high-visibility professional events.
Workplace safety and discrimination remained significant concerns for female participants. Reported rates of verbal sexual harassment were significantly higher among women in both surveys, although the magnitude of the disparity decreased over time. In 2022, the odds of women reporting verbal sexual harassment were 4.2 times higher than men, whereas in 2024, this odds ratio decreased to 2.6. In 2024, women also reported significantly higher rates of bullying, with no men reporting frequent or constant victimization. Overall scores for gender discrimination in professional practice were significantly higher for women in both periods. These findings suggest that harassment and discrimination are systemic issues affecting women in the field, regardless of their training level or seniority.
Despite these persistent barriers, the study identified encouraging shifts in clinical practice metrics. In 2022, significant gender-based differences were observed in medical visit fees and duration. Women were more likely to charge lower fees for medical visits, with 69.2% of women reporting lower fees compared to 57.6% of men. Conversely, 78.2% of women reported having longer medical visits compared to 69.5% of men. By 2024, these differences were no longer statistically significant, with p-values of 1.000 for fees and 0.318 for duration. This normalization of clinical practice metrics may indicate a growing alignment in professional valuation and practice standards across genders, possibly driven by increased awareness of equitable remuneration and professional standards within the rheumatology community.
The study also examined perceptions of gender equity interventions, revealing a shift in attitudes among male participants. In the 2022 Reuma Equity survey, all 17 items regarding interventions to promote gender equity showed significantly higher support from women than men. In contrast, in the 2024 CHANGE survey, only 9 of the 29 items demonstrated significant gender differences, while the remaining 20 showed no significant difference between men’s and women’s responses. Items with significant differences in 2024 included support for gender-balanced leadership, media campaigns highlighting female leadership, and flexible working hours. The increased agreement from men on most proposals suggests a possible increase in awareness and involvement among male rheumatologists in the pursuit of greater gender equity.
The authors noted that the Brazilian medical landscape is undergoing rapid feminization, with women becoming the majority of physicians in 2025. However, the data confirms that this demographic shift alone does not guarantee gender equity. The persistent domestic burden and the increased likelihood of women refusing career progression for family reasons align with the concept of the motherhood penalty, where caregiving duties restrict professional advancement. The study highlights that while women are highly productive at the start of their careers, systemic barriers may prevent them from reaching the highest career positions, as evidenced by their underrepresentation in senior authorship and editorial roles in academic journals.
Limitations of the study include the voluntary nature of participation in self-administered questionnaires, which may introduce selection bias. Participants with greater involvement in gender equity issues may have been more likely to respond, and the responses reflect personal perceptions rather than objective measures. The cross-sectional design and differences between the two questionnaires limited the ability to perform robust statistical comparisons between the two time points and precluded causal inference. The authors emphasize that the findings provide a longitudinal perspective on the evolving landscape of gender equity, highlighting both the progress made and the structural barriers that remain.
The study suggests that increased visibility and discussion of gender equity within Brazilian rheumatology may contribute to the observed improvements in professional indicators and male attitudes.
The study utilized specific statistical methods to quantify associations between gender and various professional and personal outcomes. Researchers employed Pearson’s chi-square and Fisher’s exact tests for qualitative characteristics, while the Mann–Whitney test was used for quantitative comparisons due to violations of normality and homoscedasticity assumptions. Associations were quantified using odds ratios with 95% confidence intervals, and significance levels were corrected using the Bonferroni method to account for multiple comparisons. The medical visit fees reported in the surveys were converted from Brazilian reais to US dollars using an exchange rate of 1 USD = R$ 5.48, which was in effect during the study period. This standardized conversion allowed for consistent financial comparisons across the two survey time points, although participants working exclusively in the public sector were excluded from these specific financial analyses.
Demographic data from both surveys indicated that the majority of participants resided in the Southeast region of Brazil. In the 2022 Reuma Equity survey, 459 participants represented 21.7% of Brazilian Society of Rheumatology members. The age distribution showed that most participants were under 51 years old, with women significantly more likely to fall into the younger age brackets. Specifically, 19.7% of the 2022 cohort was between 22 and 36 years, and 43.8% were between 37 and 51 years. The 2024 CHANGE survey included 301 valid Brazilian respondents, with a similar age profile where 23.6% were between 22 and 36 years and 44.5% were between 37 and 51 years. Three participants who identified as transgender women, non-binary, or preferred not to say were excluded from the Brazilian statistical analysis due to low representativeness, ensuring the primary analysis focused on binary gender categories.
Professional self-confidence assessments revealed shifting patterns between the two survey years. In 2022, women reported higher levels of agreement in five out of eight measures of resourcefulness and preparedness compared to men. By 2024, this trend reversed, with a significant gender difference observed in only one of the eight measures, which favored men. This change in self-reported confidence metrics occurred alongside the normalization of clinical practice indicators, such as visit fees and duration. The 2024 survey also introduced specific evaluations of bullying, which were not present in the 2022 questionnaire. Women reported significantly higher rates of bullying in 2024, with no men reporting frequent or constant victimization, highlighting a distinct aspect of workplace adversity that was only captured in the later study.
The global context of the CHANGE survey provided a broader framework for the Brazilian data. The survey was conducted between January 2023 and May 2024 across 105 countries and translated into eight languages, including English, Spanish, Japanese, Portuguese, Thai, Traditional Chinese, Simplified Chinese, and French. The Brazilian subset was distributed specifically to SBR rheumatologists in August and September 2024. The global study included 1,945 participants, with the Brazilian respondents comprising 15.6% of the total sample. This international scope allowed the researchers to situate the Brazilian findings within a larger global initiative focused on health and gender equity, although the primary analysis remained focused on the temporal changes within the Brazilian rheumatology community.
Subject of Research: Gender equity trends in Brazilian rheumatology
Article Title: Advances and barriers in gender equity within Brazilian rheumatology: a two-year follow-up study
Article References: Souza, M. P. G. U., Xavier, R. M., Monticielo, O., Gupta, L., Ovseiko, P., Guimarães, M. F., Wright, G., Coates, L., Agarwal, V., Souza, V. A. D., & Kakehasi, A. M. (2026). Advances and barriers in gender equity within Brazilian rheumatology: a two-year follow-up study. Advances in Rheumatology, 66(1), Article 58. https://doi.org/10.1186/s42358-026-00566-8
Image Credits: AI Generated
DOI: 10.1186/s42358-026-00566-8
Keywords: gender equity, rheumatology, Brazil, workplace discrimination, career advancement, medical workforce, cross-sectional study, work-family interface, Advances, barriers, gender, equity
News Source: Anthony Perry. (November 10, 2026). Brazilian Rheumatology Study Reveals Persistent Gender Equity Barriers. Scienmag.
