Women in medicine: Gender, mentors and role models

We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession anywhere in the world.

The fault line is in the family and life balancing act women must do to survive in the workplace.  To be clear this is true for men too. Women are more likely to face challenges when long work hours, travel and the business of professional networking keep them away from families.

Furthermore, the profession of medicine requires a commitment to patient care, education and research, but the climb to the top has additional milestones. While many put in extra time and sweat their persistence still places them outside the closed doors of  hospital board rooms, department chair offers, academic medicine positions or physician-leader roles.  Data and research are scant on measures for progress.  I always look at the pictures on the walls in medical center hallways and conference rooms, it’s rare to see anyone who resembles me in those pictures. I do see women moving through up the ranks who are awesome role models.

For the last 10 years medical school classes have held equal portions of men and women, but those who teach medical students and lead institutions are predominately men.  Recent research published by Dr. Borges and others indicate that “women physicians choose their careers because of the perceived quality of life, earnings potential, and organizational reward. They are less likely than men to identify role models for professional–personal balance.”

Women do need to seek out role models early in their careers, but it’s not enough. More significant is the understanding that if there’s no institutional, top-down approach to addressing the complexity of these issues, meritocracy alone will not break down barriers nor will change occur.

Dr. Karen Sibert’s recent op-ed in the New York Times inspires my blog post along with other offline discussions, including the talk with Michele Martin on NPR’s Tell Me More, which aimed to further the conversation about part-time career choices women are making in the face of doctor shortages, decreasing health care budgets and a moral obligation. Dr. Sibert and others make it clear about the sacrifices for both men and women when it comes with a commitment to patient care, but Dr. Au and others make the case for our right to choose, wisely and carefully.

I follow the career paths by reading the literature as well as over the years some of the books written by women in medicine, here are just a few from my bookshelf:

Treatment Kind and Fair: Letters to a Young Doctor by Perri Klass

Zenzele: A Letter for My Daughter by J. Nozipo Maraire

Final Exam: A Surgeon’s  Reflections on Mortality by Pauline Chen

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Katrina S. Firlik

Medicine in Translation: Journeys with My Patients by Danielle Ofri

Almost Home: Stories of Hope and the Human Spirit in the Neonatal ICU by Christine Gleason

The Country Doctor Revisited: A Twenty-First Century Reader edited by Therese Zink

Stories of Illness and Healing: Women Write Their Bodies edited by Marsha Hurst and Sayantani DasGupta

On a historical note Dr. Virginia Apgar’s story is endearing as she was set on becoming a surgeon, but gender discrimination led her to a career in anesthesiology after training she went on to head a new division of anesthesiology where she developed the Apgar score. As the medical school’s first female division head, she built a residency program and, in 1949, became the first woman appointed to a full professorship at the Columbia University College of Physician & Surgeons.  No, I’m not interested in a career anesthesiology, I am looking for opportunities where innovative ideas are supported regardless of gender, race or ethnicity.

A few pointers, I’ve heard from those listed above and elsewhere:

  • Relationships and family matter, try to avoid undermining your anchors to move ahead, you may find short-term success and long-term misery with the loss of your family and friends and a more demanding job.
  • Don’t turn your head or look way when you see real harm done to women especially if it’s you in the hot seat, choose battles worth fighting.
  • Read and review the policy handbook at your institution. Knowledge is power.
  • Honor and respect women physician-leaders in their roles and get to know their stories.
  • Tell your own stories so that others might know of your success and/or be warned of your pitfalls.
  • “Lift as you climb” so that you enable collective success in the profession.
  • The road is long so make good friends for the distance.

U.S. Surgeon General Regina Benjamin, Secretary of Health and Human Services, Gov. Kathleen Sebelius and First Lady Michelle Obama are at the helm efforts to improve health and health care in America and these women are all phenomenal. We should continue our look up stream and push for policies and practices that allow for a more balanced profession for men and women, which in my view enables better patient care and improves quality of life for both patient and physician. There should debate, divergent points of view as well as common ground to stay focused on more progress.

Katherine Ellington is a medical student who blogs at World House Medicine.

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  • Kristin

    “Choose battles worth fighting.”

    I have to wonder. Which battles are those? Does it matter if I get called “sweetie” at work? I feel like it does–I feel like it’s a reflection of a lack of respect. Nobody called my male coworkers at that institution “sweetie.” On the other hand, if I make a fuss about it, will people take me less seriously when I bring up other issues, like bias in the promotion process?

    I feel like there are many battles that get glossed over as unimportant or unwinnable. I think letting that sort of thing go contributes to the culture of discrimination. I think if it’s enough to irritate you, it’s enough to discourage other potential entrants to the field, and it’s worth saying something about. Not saying much, maybe, just “Fine, babycakes,” with a heavy dose of obvious sarcasm, but still engaging in a confrontation, however minor.

  • http://briarcroft.wordpress.com Emily Gibson

    I’ve been employed as a “part time” family physician for 30+ years and in addition have had administrative duties supervising a clinic of over thirty employees for 2/3 of that time. My work week has always averaged 50-60 hours while I’ve been paid at a rate of 75% of a full time position. I have always seen more patients in clinic than my “full time” colleagues because I work efficiently and waste little time.

    I preferred the part time employment so I would have the flexibility to be available during the day while raising our three children. Now that they have grown, my employed position is 90% of full time (which is all the budget can bear) and my work week has expanded accordingly.

    By no stretch of the imagination can this be called part time doctoring, but it is very much part time compensation. Much of my work is accomplished very early in the morning before dawn, or very late at night, often from home. I think the state that partially subsidized my medical education in the late 70′s and continues to employ me has gotten a very good pay back from this “part-time” woman physician, while I’ve had the flexibility to be part of my children’s childhood, volunteering in their schools, being part of my church’s activities and working as needed where no other physician (particularly male physicians) wanted to work because of the low compensation: drug detox centers, low income clinics, family planning clinics, child sexual abuse forensic evaluations. I have felt privileged to be able to provide my skills where they have been badly needed rather than put my energy into the climb up the ranks to the board rooms.

    Dr. Sibert’s analysis in her Op-ed piece is flawed because she does not truly understand what “part time” means to the average primary care physician whose patients have direct access to physician consultation 24/7, something few other subspecialties provide.

    Those of us women physicians who have been in the trenches for decades, doing what it takes to make sure patients get care when and where they need it, resent the implication that we have not fulfilled the “promise” of our medical education simply because we have been willing to be paid “part time” for long hours of work.

    Try walking in our shoes–if you can keep up!

  • http://onsurg.com/about Chris Porter MD

    Part-time surgeon here. I support the mature priorities of the the next generation of doctors, female and male. Let’s close the gender gap and the generation gap.

    I agree with the importance of mentorship. I’ve created a page of resources and inspirational figures for female surgeons at http://onsurg.com/women-in-surgery. I also wrote a response to Dr Sibert’s piece http://porteronsurg.blogspot.com/2011/06/part-time-doctor.html.

    I hope to develop a mentoring program at OnSurg with time.

  • http://www.expeditingtheinevitable.com Linda Brodsky MD

    Important topic. Let me offer a new perspective.

    As a still active full time surgeon (pedi ENT), full time mother (3 grown kids taking more time than ever),former tenured full professor (retired from university not by choice) and survivor of gender discrimination litigation against my hospital and university, the way to ending the gender battles in medicine are found at http://www.expeditingtheinevitable.com where we help women physicians and the healthcare workplace close the gap. The healthcare workplace and the evolving healthcare workforce need to co-adapt.
    50% of our medical students and 30% of our doctors are women. It’s time the healthcare workplace was re-engineered. Flexible structures and culture shifts will result in better patient outcomes with happier, more productive physicians, both men and women. It’s possible, it’s happening, and we just have to expedite what is going to be inevitable.
    The health of our patients will be best served by making sure each one of us is fully, flexibly and fairly integrated into a more modern, up to date, healthcare work place.

  • http://www.drdialogue.com Juliet K. Mavromatis, MD

    Great piece. I’m glad that you’re thinking about this as a medical student. I’ve recently also written a response to Dr. Sibert’s editorial at DrDialogue: http://www.drdialogue.com/2011/07/part-time-women-in-medicine-are-they.html
    My career in general internal medicine closely mirrors the experience of Dr. Gibson above. To this day, I am still rubbed the wrong way each time I see the photos of the predominantly white male physicians that line the walls of my academic institution. I would encourage women, as they enter relationships, to discuss these issues at length with their partners. Work-life balance does not evolve naturally, but requires careful planning, especially in dual physician couples. But in the words of Sheryl Sandberg, Facebook COO at the Barnard commencement, women should still remember: “we will never close the achievement gap until we close the ambition gap. But if all young women start to lean in, we can close the ambition gap right here, right now, if every single one of you leans in. Leadership belongs to those who take it. Leadership starts with you.”

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