According to the Association of American Medical Colleges (AAMC), 2017 was the first year that more women enrolled in U.S. medical schools than men. The association reported that women comprised 50.7 percent of 21,338 enrollees in 2017, compared to 49.8 percent of 19,254 enrollees in 2016. This data point is particularly noteworthy when you put it in historical context. In 1965, only about one in 10 U.S. medical school enrollees was a woman. A hundred years before that, few medical schools admitted women at all. The latest enrollment numbers from the AAMC reflect the inroads that women have made in the field of medicine over the past century and a half. However, while significant progress has been made, women continue to face gender barriers and disparities while training and working as doctors. For example, female physicians are paid 26 percent less on average than their male peers, according to one recent analysis. Women are also underrepresented in faculty and leadership positions at U.S. medical schools, relative to their numbers in the student body and the general population. They comprised 39 percent of full-time faculty, 32 percent of people promoted to full professor, and 16 percent of departmental chairs in 2015. Similarly, women are less likely to be chosen as speakers in grand rounds, a form of continuing education that helps doctors stay up to date on clinical care and new research information. Nonetheless, research indicates women do just as well as male doctors in terms of patient outcomes, and they communicate better with their patients. Similar patient outcomes Despite the barriers that many women physicians face, studies suggest that female doctors achieve patient outcomes that are as good or better on average than those of their male peers. In 2013, researchers in the Journal of the American Board of Family Medicine reported that patients of female physicians had comparable mortality rates to patients of male physicians. The authors also found no statistically significant differences in prescription drug expenditures, office visits, or hospital use between patients of female and male doctors. More recent research suggests that on average, female doctors may even have a slight edge in some areas. Last spring, Yusuke Tsugawa and colleagues reported the results of a cross-sectional study on hospitalized Medicare beneficiaries aged 65 years and older. They found that patients treated by female doctors had slightly lower mortality and readmission rates than patients treated by male doctors. When Christopher J. D. Wallis and colleagues compared postoperative outcomes in patients aged 18 years and older in Canada, they found similar results. Patients of female surgeons had slightly lower rates of 30-day mortality than patients of male surgeons. In these two studies, the differences in average mortality rates between patients of female and male doctors were small but statistically significant. Patient-centered care According to Tsugawa, Wallis, and their co-authors, differences in average outcomes between patients of female and male doctors might reflect differences in practice patterns. For instance, several studies have found that female doctors are more likely to adhere to clinical guidelines and provide more frequent preventive care than their male counterparts. Research has also found that female doctors tend to use more patient-centered communication, which some studies have linked to better patient outcomes. “The work that my colleagues and I have done has demonstrated that there are very distinct gender-linked patterns of communication among male and female doctors,” Debra Roter, DrPH, a professor of health, behavior, and society at Johns Hopkins Bloomberg School of Public Health in Maryland, told Healthline. In multiple studies, Roter and her colleagues have analyzed audio recordings of medical visits to assess gender-linked conversational differences in physicians and patients. Debra Roter They’ve also conducted a meta-analysis of studies on the topic. According to their findings, female physicians typically conduct longer patient visits than male physicians. They tend to ask more questions to elicit patients’ opinions and check for mutual understanding. They tend to ask more questions and provide more counseling on psychosocial issues related to lifestyle, daily living activities, social relationships, coping strategies, and stress. “They’re also more emotionally responsive,” Roter said. “They’re more likely to express empathy, legitimation, concern, and reassurance when patients express the need for that, and they’re also much more positive in the words that they use and the voice tone that they use.” In turn, patients tend to respond to female and male doctors in different ways. “Both male and female patients talk more overall when with female physicians,” Roter explained, “and the next thing is especially important — they disclose more information that has medical relevance about their psychosocial [experiences], lifestyle, coping, and adjustment, but also about their biomedical condition, giving more information about problems they might be having with their medications, or the recommendations for tests, or anything like that.” “Getting that information is critically important and female doctors seem to get more of that,” she said. Female physicians are also more likely to engage family members who accompany patients. That might be particularly important for older patients, such as those studied by Tsugawa and colleagues, who are more likely than younger adults to be accompanied by a family member. While these average differences are statistically significantly, Roter was careful to note: “That doesn’t mean that all women doctors are better than all men doctors. The overlap in the normal curves is much greater than the non-overlap.” Discrimination and other challenges In the 19th century, many opponents of medical education for women suggested that women were too irrational or delicate to perform the work of doctors. Critics also said that the role of physician was incompatible with women’s caregiving responsibilities as wives and mothers. While gender norms have started to shift, discriminatory attitudes and the unequal distribution of domestic labor continue to pose challenges to women who train and work as doctors. Compared to male peers, female doctors tend to spend more hours per week on parenting and domestic labor, and report higher levels of conflict between work and family obligations. Dr. Jessica Rubin “I think this is magnified by the fact that there’s so much training in medicine, so women often are having children at some point early in their careers, or even during their training, and that places particular burdens on them as caregivers at pivotal times for advancement,” Dr. Jessica Rubin, MPH, a gastroenterology fellow at the University of California, San Francisco (UCSF), told Healthline. For many women in the field, the pressure to balance work and family obligations may affect the specialties they pursue, the hours they work, and how their colleagues perceive them. In a recent survey of physician mothers, two-thirds reported experiencing gender discrimination and one-third reported experiencing maternal discrimination on the job. Compared to men in academic medicine, women report facing higher levels of both gender bias and sexual harassment in the field. “Unfortunately, I think you will be hard pressed to find a female physician who has not encountered some form of gender bias, discrimination, or harassment,” Dr. Ersilia DeFilippis, an internal medicine resident at Brigham and Women’s Hospital in Massachusetts, told Healthline. Dr. Ersilia DeFilippis “Sources of bias can include not only our colleagues and other healthcare providers, but often patients and their families. As a medical student, I was kissed by a patient, who similarly made inappropriate comments toward me,” DeFilippis said, referencing an encounter that she described in greater detail in an essay published last month in JAMA Internal Medicine. “Some of these experiences are referred to by some as forms of benevolent sexism, namely that women are complimented based on stereotypes, rather than insulting them,” she continued. “For example, a woman is not promoted or asked to participate in a committee because she just had a new child, and leadership assumes that she will not have the time.” DeFilippis also described situations in which patients call women physicians “honey” or “sweetie” rather than “doctor,” a gendered informality that may subvert their status in the field. This tendency to address women doctors in more informal and familiar terms also appears in interactions among colleagues. “There’s many fewer women speakers at grand rounds at academic medical centers than there are men, and even when there is a female grand round speaker, she’s more likely to be introduced by her first name rather than ‘doctor,’” Dr. Anna Parks, an internal medicine chief resident at UCSF, told Healthline. “I think those kinds of things have insidious effects,” she added. What changes are needed Average differences between female and male doctors may not be large enough to justify choosing one physician over another based on their sex or gender. But the demonstrated competence of women doctors does call into question the justness of paying them less on average and appointing them to fewer positions of leadership than men. “[T]hese findings, that female internists provide higher quality care for hospitalized patients, yet are promoted, supported, and paid less than male peers in the academic setting, should push us to create systems that promote equity in start-up packages, career advancement, and remuneration for all physicians,” Parks wrote with one of her colleagues, Dr. Rita Redberg, MSc, in an editorial response to Tsugawa and colleagues’ study. Dr. Anna ParksTo help address the disproportionate burden that women physicians bear for childrearing, Parks and Rubin told Healthline that “family-friendly policies” are important. For example, allowing physicians to work flexible hours and from home when they’re not providing scheduled patient care might help them balance competing obligations. Mandatory paid parental leave might also help alleviate some of the pressure on physicians who are parents, and promote wider cultural changes in caregiving norms. “I think one of the key ideas about mandatory paid leave, to make it effective, is to have it mandatory for both men and women, so it becomes expected that everyone takes it and not only women,” Parks said. In addition to these strategies, Park suggested that establishing clear hiring guidelines, promotion guidelines, and salary transparency might help address disparities in hiring, promotion, and pay. Training women on the skills needed to effectively negotiate higher salaries and “be seen as desirable leaders in their institutions” might also help address persistent gender gaps, Rubin said. According to DeFilippis, training and other support resources also have a role to play in helping women manage day-to-day instances of bias, discrimination, and harassment. “Institutions have zero tolerance policies for sexual harassment. However, the implicit or unconscious bias can be harder to target,” DeFilippis said. “At my institution, we are creating a toolkit to provide resources to our female residents regarding how to address bias in the workplace,” she continued. “Oftentimes, we do not have the right words to say in the moment when we are witnessing or experiencing bias. Having ‘go-to’ statements that can be adapted to the situation and yet remain professional could be small but powerful tools.” Over time, these types of interventions might lead to wider shifts in gender norms and the ways that women in medicine are perceived and treated. “A lot of it has to do with training and policies that hopefully, down the line, will lead to culture change, because I think that’s fundamentally what has to happen,” Park said. “Changing a culture and society is difficult,” Rubin added, “so I think that, while that’s the ultimate goal, some of the other potential solutions we mentioned are small steps that can help with minimizing discrimination and minimizing barriers that women face in the meantime.” Source
