Women in medicine: A front line perspective

Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws behind you, but you don’t want to get branded a trouble maker and risk subtle (or not-so-subtle) discrimination.

Now imagine you are sitting in the doctors’ lounge, and a senior physician says that sending women to medical school is a bit of a waste. The people sitting around the table make decisions every day about who to accept and reject to medical schools and residency programs, who to hire, who to promote, but hey, it’s just a group of guys having a cup of coffee. How would you react?

In the early 1960′s, about 5% of medical American medical students were women. Now about half are. Women are first authors on more medical papers than ever, yet fill only about 11% of department chairs, and fill about 15% of full professorship positions.

What’s behind this?

There is literature studying the trends in academic and clinical medicine. I’ll point you to this reference in the New England Journal of Medicine as a starting point, but I’d like to give you a front-line perspective.

Something I hear every week is that women are likely to take time off for kids, and to work part-time, and that this somehow renders them less valuable. I’m not sure how this reasoning works. After all, doctors treat people of all ages, genders, and ethnicities, and doctors of different backgrounds often have different experiences and skills to bring to the table.

But I can see how some of these ideas are perpetuated. Slots in medical schools, residencies, and fellowships are quite limited, and it costs much more to create a doctor than tuition could ever cover. Some take a false utilitarian view that because it costs so much to create a doctor, only those who can give back the most in time and money should be trained.

Residencies are limited in both the number of residents they can take, and in how many hours these residents can work. When one becomes pregnant, it can burden the entire program (or so it’s perceived).

Well, this is the real world, and in the real world, half of us are women, and women are the ones who bear children. Also, the prime years for physician training are prime child-bearing years. Get used to it. If we think women have at least as much to offer as physicians as men, we better get used to the fact that they have “lady parts” and that this has real effects. Are we to limit the contributions women are allowed to make because a short period of their lives may or may not involve child-bearing?

In clinical medicine (as opposed to academic medicine), there seem to be many more opportunities to work part-time than in the past. The less you work, the less you get paid, but the pay is still pretty good. But academia is still about productivity, and gaps are not acceptable.

As a society and a profession, we have to decide to take the role of women seriously. If we demean women’s role in our profession, we may be more likely to demean our female patients and family members. And it’s just wrong.As a society and a profession, we have to decide to take the role of women seriously.

Things are getting better, but we still have a long way to go.

“PalMD” is an internal medicine physician who blogs at White Coat Underground.

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  • http://twitter.com/SeattleMamaDoc WendySueSwanson MD

    Great post. Love the fire and the wisdom in this post.

  • Sgent

    Just for purposes of this discussion, I think the Jama article blogged about on KevinMD a few weeks ago at
    http://jama.jamanetwork.com/article.aspx?articleid=1182859 is on point.

  • http://twitter.com/mamabearmurmurs mamabearmurmurs

    I am still shocked about the gender discrimination and sexual harassment present in 2012. I finished fellow ship in 2009 and started my first attending position on July 1st. One year later, I had been asked to leave the doctor’s lounge, because “nurses aren’t allowed in here, even on the weekend!” I explained that I had graduated from medical school seven years prior, and the only response was, “well I don’t know you.” No apology. Six months after that I had to ask a group of six doctors to stop loudly critiquing the sexual appeal of their patient’s breasts in the doctors lounge. Security asked me to leave the doctors parking lot about 2 years into my new position, because “you know nurses can’t park here.” And these are just the blatant episodes. When I discuss these obvious problems, or more subtle slights, with my division chair he says I’m just being too sensitive.

    • Dawit Gebrekidan

      How about this- when I’m on the wards wearing scrubs, I must wear my white coat. If I’m dressed in shirt and slacks no need for the white coat. Why you ask? Well, if I’m wearing scrubs and no white coat I am mistaken for housekeeping, patient transport, X-ray tech, RN. Not once has anyone thought that I could be a doctor. The reason- I suspect- is because I’m black. I have been asked to take out the garbage, I have been criticized for being late to transport a patient although I just arrived from the OR to the PACU with a pt who had undergone surgery. The problem is people’s stereotypes are like a bad herpes infection. You can’t get rid of it.

      As Dike says- just my two cents

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for posting this PalMD – medicine is indeed one of the last bastions of flagrant good old boy conversations and mentalities. You will see it on display most egregiously in the doctor’s lounge when there are no women around. Over and over I have heard the refrain you quote, “Why do we even waste time training women … they are just going to go part time and have babies anyway?”

    AND I have never understood it — except that the male doctor saying that is probably toast and a part of him really wishes he could figure out a way to work part time and spend more time with his family. Then the testosterone poisoning and his residency conditioning kicks in and he feels it would compromise his MD Manhood in some way to practice anything other than full time .. or let anyone else “get away with it.”

    Having a life, spending quality time with your family, practicing part time, valuing empathy and relationships … all of these (and much more) are being brought to the battlefield mentality of our medical conditioning primarily by women. You will meet resistance AND the changes you are bringing will benefit everyone. Healthy providers practice quality medicine. AND no one is saying the good old boys have to slow down here … they can still work their 120 hour weeks and keep complaining … we don’t have to listen though.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • HealthCareProf

    To mama bear murmers:
    Are you serious? What part of the country are you working in that is so backwards that they still have doctor lounges and a mentality that nurses and other employees are lower beings? I don’t deny that subtle discrimination exists to this day.
    These old bow tie wearing , outdated doctors that populate “doctors only” lounges need to just retire already. Shouldn’t they be off seeing patients instead of sitting around complaining about what is a “waste”. One could probably hire a part time doctor who
    could do twice the work of these overpaid bigots. Fortunately the academic institutions I have worked for, have mostly done away with doctor lounges.