"Showing any vulnerability is a sign of weakness."
Victor Torres / Stocksy
Recent research suggests that in many ways, it still sucks to be a female doctor. The study, published this month in the medical journal JAMA, included 359 emergency medicine residents (medical school graduates who are training in their specialized fields). The researchers found that the female doctors received lower evaluation scores from their professors than their male colleagues.
"We are concerned that the disparity we discovered in evaluations may point to an implicit bias," co-lead author Daniel O'Connor, a student at the University of Pennsylvania Perelman School of Medicine, said in a press release. "Our finding, that female residents in emergency medicine receive lower scores than males across all sub-competencies really implicates bias rather than a deficit in specific skills or knowledge."
The gap emerged during the second year of residency, and by the end of the third year of training, the evaluation scores suggested that male residents had more medical knowledge than female residents. Of even greater concern: There was no disparity between the evaluator's ratings based on the gender of the evaluator; female and male faculty members were just as likely to give women lower scores. By the end of the residency program, these scores placed women three to four months behind their male peers.
As a psychologist who teaches medical students during their third-year rotations, these results made me wonder what's happening in residency programs that could be adversely affecting women. Is it lack of support, representation, or something else entirely? I reached out to ten physicians (all men) in charge of residencies at top hospitals around the country hoping that they could shed some light on the latest findings.
But no one agreed to talk to me. Instead, I received these messages: "I'm sorry but our residency director chooses to pass on commenting on this study," or "I'm not the correct person to address this topic" (even though in that latter case, the doctor I contacted was in charge of the surgical residency).
This silence highlights a dynamic that's prevalent in the culture of medicine: the fear of being punished for speaking up. Even if a physician in a leadership position recognizes that bias occurs, politics often play a role in whether or not they say anything about the inequality they witness. Unfortunately, many women, even those in top positions, may worry that their careers will suffer if they disclose the sexism that takes place in the medical field.
While there are more women going to medical school than ever, male doctors still dominate medicine. (In fact, the press release about this very study doesn't include any quotes from women.) A 2016 Compensation Report from MedScape shows that men continue to earn almost 20 percent more than their female colleagues in primary care, and over 30 percent more in specialized fields of medicine. Worse, 75 percent of female doctors have reported experiencing gender bias at work. This discrimination affects doctors emotionally as well as negatively affects their careers and relationships.
Ritu (who asked that I only use her first name) is a chief surgical resident at a university hospital on the east coast. During her five years of training, she's witnessed a significant amount of gender bias. She's seen her male colleagues dismiss their female patients' medical concerns by labeling them as "hormonal." She's heard them make disparaging comments about their female peers, too. "I often feel like I have to erase any evidence that I am a woman," she says.
This means that she never lets her male colleagues see her have an emotional reaction to anything at work, and that she's had to develop a thick skin to protect herself from their hurtful micro- and sometimes macro-aggressions. She also didn't feel she could take much time for maternity leave after her baby was born. "The American College of Surgeons wants residents to take a maximum of six weeks off every year during the training period—four weeks vacation and two weeks disability if needed," she says.
Ritu says that if she had taken six weeks of leave, she would have had to extend her residency training by putting in extra time. Because of this, she only took four weeks to recover from childbirth and bond with her newborn. When she returned to work, her surgery schedule was so intense that she wasn't even able to pump breast milk regularly. Even though she was alarmed by the treatment she had received, she never said a word, since "showing any vulnerability is a sign of weakness."
Sometimes creating a sense of community can help these doctors feel more supported, but these communities can be difficult to establish. As a psychologist in training, I used to work for a top medical school where I led a support group for female medical students of color. Even though the group was small, these women relied on each other throughout their medical school careers. For several years, they talked about the unique challenges of being a woman in a male-dominated profession, and they strategized about how to advocate for themselves as they navigated the hierarchy of medicine.
Female physicians, including residents and attendings, need this type of emotional support, as well as mentorship guidance about how to apply for and achieve leadership roles in their specialities. Unfortunately, research shows that many medical schools don't offer this type of direction for their female faculty members.
A study published in Women's Health Issues interviewed 44 senior leaders at 24 medical schools about their views of gender equality and the advancement of women at their institutions. Forty percent of the medical schools didn't have any special programs for recruiting, promoting and supporting women in medicine. Many of the schools did, however, offer family support such as child care and spousal hiring programs.
Do these results suggest that there's an implicit belief that women should receive support for feminine roles like "childrearing," but that they aren't worthy of having the same type of guidance to help them advance in their careers?
Nearly half of the leaders who were interviewed in this study didn't believe that gender equality mentorship programs were necessary, which might help to explain why female physicians are often overlooked for promotions.
Hala Sabry, an emergency room physician, says that gender bias is rampant in medicine, in her experience. Even though she's an attending physician, she still faces a lot of pushback from her male colleagues. "I've been called a bitch for being assertive and doing my job," she says. "This would never happen to the male doctors. They would never get labeled as 'difficult' for giving direction to the nurses or taking charge of a crisis, like a Code Blue [when a patient stops breathing and needs to be resuscitated]."
Being a mother in medicine is also pretty much an occupational hazard, Sabry points out. As a mother, she's been passed over for promotions because her male peers assumed that she didn't have the time for a leadership position. "This discrimination also happens to women with older children and to women who don't have families yet, but aspire to start them one day," she says.
And the male doctors aren't the only ones making female physicians feel like it's like 1930.
Sabry says it's not uncommon for her patients to think that she's a nurse even though her badge is clearly labeled "doctor." "On more than one occasion, I've entered an exam room, and the patient has asked me when the doctor is arriving," she says. This can cause women to feel devalued and erased. If this happens a lot, they may even begin to silence themselves, because they don't believe that what they have to say will be heard.
Contrary to what patients may believe, recent research shows that female physicians provide a higher level of care than the males: Patients treated by women are less likely to die than those treated by men at the same hospital. So yeah, maybe we do want to see some changes in the system that could sustain and retain our women doctors in training.
Sabry is working hard to break the gender gap in medicine. Last year, she advocated that National Women Physicians Day recognize the work of Elizabeth Blackwell, the first woman to earn an MD. She also founded the Physicians Mom Group, a national organization aimed to support doctors who are also mothers. Broadening the way in which medical schools address discrimination and bias is even more important given these latest findings.