By Sharla Hooper
Women physicians were interested in our survey! Our survey garnered a two-thirds majority of women respondents. Thank you to all the physicians who took the time to thoughtfully consider the presence of women in medicine leadership, and the biases encountered.
Women leadership in training & current environment
American Association of Medical Colleges (AAMC) data shows that in 1966, women accounted for 9.3% of the population matriculating from medical school; by 1990, that percentage had jumped to 38.5, and as of 2014 was 47.2.
Over half of our respondents, 57.1%, reported having “few” women physician leaders in their training. While our survey did not collect ages of respondents, it is likely that our younger physicians are experiencing the outcome of a shift in the presence of women leaders in medicine; 24% of our respondents reported encountering an equal or majority of women physician leaders in their training.
While 57.8% of both male and female respondents feel that women are now proportionately represented in physician leadership, there was a striking difference in how male and female respondents perceived the gender pay gap. Of female respondents, 69% believe that a gender pay gap for women still exists; of male respondents, 41.5% believe a gender pay gap for women still exists. A 2016 Journal of the American Medical Association (JAMA) study of sex differences in physician salary at academic institutions found that women physicians were making about $51,000 less than their male colleagues. After multivariate adjustments (specialties, time worked, patient volume), the gap grew closer but still felt short by about $19,000 annually.
One of our respondents shared her personal experience of being offered $25,000 less than a male colleague: “I know exactly how much he made because I was his fellow when he was a first-year resident and we had maintained our friendship over the years. He started at that job straight out of fellowship with no prior experience. I was hired at the same job 1-2 years later when I had two fellowships under my belt and four years of practice! I was so mad, but instead of walking away, I negotiated for more money because I needed the job. Their final offer was still 10K short of what they offered him (he did not have to negotiate).”
Sixty-six percent of our respondents felt that women are proportionately represented in primary care, and 75.3% felt that women are not proportionately represented in specialty care. Again, this is confirmed by a recent study of residents. An AAMC 2015 Report on Residents identified the top specialties among 86,439 residents in the graduate medical education class of 2013-2014; women continue to make up a larger percentage of residents in Family Medicine (about 58 percent), Psychiatry (about 57 percent), Pediatrics (about 75 percent), and Obstetrics/Gynecology (about 85 percent).
Personal experiences of bias
Of the 154 respondents to our inquiry, “Do you feel you have experienced any bias or inequality due to your gender in your medical training or practice?”, 109 responded “yes.” We followed this with an opportunity to comment and share any observed inequalities in treatment, promotion, or responsibility due to gender.
The instances and observations described range from subtle to outright.
Several respondents shared that female physicians often experience being called by their first names by, well, everyone – while male colleagues are consistently referred to deferentially by their professional title of “Doctor.” From a woman physician in a self-identified administrator position: “It is small, but in a room of professionals, paraprofessional, staff, a male Dr is called Dr. A female Dr is often called by her first name…really is evident, has been for 24 yrs.” And from a hospital-employed woman physician: “I have also found women are far too often referred to by our first names by other non-physician staff–nurses, techs, patients, drug/device reps–whereas our male counterparts are almost always assumed to be “Dr. So-and-So” whether they are actually a physician or not. This has happened to me personally in meetings and via email regularly.”
There are generational differences reflected in the experiences of those who trained 30 years or more ago: “When I trained, women were either not accepted or rarely accepted into certain specialty training programs. When I started a solo practice in 1989, the ICU nurses said I had to get my orders co-signed by a male physician! I was also told the physician lounge was for males only!”
Some bias comes from a less discussed source: patient bias towards the physician. “I didn’t really experience anything in residency or fellowship from other physicians, but patients often thought I was a nurse and I had to explain that I was a doctor. Even today, some older male patients speak to me as if they have to explain medicine to me.”
Depending on setting/environment: “I have almost exclusively worked with men physicians. Only recently have women entered neurology practice in greater numbers. When I worked in a group there was no inequality. When I worked at the University there was definite inequality. Within physicians, we’re not valued, treated equally, or paid equally.”
Leadership growth limited to specialties with a higher percentage of female physicians: “I find growing numbers of women in leadership positions within my field (OBGYN) only, and even then, not in equal proportions. I also think that the lack of bias/inequality in my training is because of my chosen specialty.”
Motherhood in medicine
Several comments highlighted the conflict between training and family planning: “During interviews for residency, I specifically was asked if I was planning to become pregnant during those years (which I believe was not a permitted question), and was told that at that institution that males were preferred for this reason.” One respondent shared that she had a fellowship denied because she was pregnant.
A particularly extensive comment highlighted the differences in expectations of women physicians as mothers – and the biases perpetuated even by women physician leaders: “I have found women are not considered for extra-clinical opportunities (e.g. speaking engagements, trips) because organizers assume we are too busy with family commitments…Sadly, the concept of “work-life balance” is lost on many men and women, alike. In my personal experience, I have had several women in leadership positions opposed to things that could potentially make my work life easier. One of these women told us that because she personally struggled with finding good childcare previously in her career, she felt we were ‘getting off easy’ if we did not have the same struggles. Another woman in leadership said to me (after I had proposed coming back part-time for 6 months after maternity leave to get used to working with two little kids) that she didn’t support it because my colleagues may just get used to working without me; she went on to basically equate coming back after maternity leave to men coming back after having orthopedic surgery (shoulder/hip/knee repair) and that we shouldn’t discriminate against men by ‘favoring’ women with leave policies. This kind of mentality (from a woman, no less) greatly underestimates the stress and responsibility in addition to the profound physical changes a new mother feels after giving birth.”
One medical student offered the following thought: “It is not all negative, however. I know several really wonderful female physicians that I look up to and are great mentors. I feel supported by my school and in general most of the attendings and residents that I work with. But I do believe that there is still a lot of work to be done…”