Medicine should be heralded as the star pupil of modern feminism- at least that's what a recent New York Times article would have you believe. Female physicians expressed outrage on Twitter and decried the idea that medicine is a family-friendly profession. Medicine is an ancient profession and women couldn't join its ranks until very recent times. In 1849, Dr. Elizabeth Blackwell was the first woman to graduate from a United States medical school. She was admitted to Geneva Medical College in New York when the faculty tried to call her bluff and asked the all-male medical student body to vote on her admission; she accepted the spot to their shocked disbelief. We've experienced the rapid improvement of gender equity in medical school admissions, and in 2017 more women enrolled into medical school than men- 50.7% were women compared with 49.8% men. Yet, touting the high representation of female physicians in medical school as "success" ignores the gender inequity these physicians are working to fix on a daily basis. Social media has provided physicians with the unprecedented means to connect virtually. This connectivity has facilitated grassroots movements led by physician activists, such as #ThisIsMyLane, the campaign by physicians working against gun violence and reject the NRA's message to doctors: "Stay in your lane," i.e. to not weigh in on the gun debate. In his New Yorker article, Dr. Eric Topol considers why many of these physician activists are female, stating: Perhaps dealing with long-standing gender inequities in medicine has helped these doctors cultivate a willingness to stand up.” Exactly. The productive consensus-building via social media has been particularly impactful for women physicians. What started as informal connections between physicians online has galvanized the gender-equity movement in medicine. This vehicle for change has brought increased awareness to gender inequity and unconscious biases that contribute to the glass ceiling for female physicians. So when female physicians read the above-mentioned article touting medicine as a family friendly profession, female physicians rejected this claim vehemently. Dr Arghavan Salles tweeted: Very frustrating that she painted such a cheery picture of work for women in medicine. Compared to other workers, we are lucky to have options. But if the only way to have a family is to choose to be underemployed that doesn’t really sound “family-friendly” to me." And herein lies the issue for female physicians: "good enough" isn't good enough, and they'll work to improve the gender inequity in medicine until it truly no longer exists. Here's my short list of what needs to be improved: Fair compensation. The pay gap for women physicians has been documented across many specialties and is independent of full-time or part-time work. This must be rectified. Dr Reshma Jagsi from the University of Michigan shared with me: We have strong reason to believe that gender differences in physician compensation cannot be explained by differences in hours worked, or a host of other factors that have been proposed as justifying differences observed." Dr Jagsi’s research on this topic revealed that male physicians were compensated $13,399 more than their female peers, even after taking into account differences in specialty, academic productivity, academic rank, work hours, research time, and leadership positions. Similarly, the Medscape Female Physician Compensation Report 2019 found that among physicians who are 55-69 years old (who are commonly past child-bearing and child-rearing) the income difference between male and female physicians is 30%. Equal representation in all specialties. Female physician trainees should have high representation in all medical specialties, and we need to challenge the assumption that gender disparity in some specialties (like surgery) is due to women's true preferences. The idea that candidates are better suited to some positions vs others is strongly influenced by gender and race, as illustrated by researchers who sent fake resumes to professors and asked them to rate them for compentence, hireability and likeability. All resumes were identical except for the candidate’s names, which were altered to manipulate race and gender. They found that professors rated male applicants higher than female candidates, despite their resumes being identical. Men were rated as more hireable, and women were rated as more likeable than men. They also found that White and Asian candidates were rated as more hireable and more competent than Latinx and Black applicants. This research highlights that gender and race influences our perceptions of suitability in an unconscious manner. Regarding why some specialties appear have higher representation of female doctors, Dr. Ariella Marshall, MD said: The idea that the number of hours in a specialty that is responsible for attracting women versus the men to the specialty is a prime example of correlation without causation. In fact, specialties dominated by men are likely to attract more men because of increased access to mentors and sponsors, career development opportunities, and support for like-minded individuals. Medicine is rife with sexual harassment – most often committed by men towards women – and both harassment itself as well as the “bro culture” and lack of female mentors and role models is likely responsible for a good percentage of career decisions that women make about what field to enter, rather than the hours the specialty requires.” We should strive for equity in all fields of medicine and at all leadership levels. This can only be accomplished by a top-down, deliberate approach from medical leadership. A great example is when Dr. Francis Collins, director of the National Institutes of Health, published a statement “Time to End the Manel Tradition.” He challenged male physicians to join him and stop participating in panel discussions that only include males, i.e. “manels.” Family-friendly policies. Let's not accept the existence of some family-friendly part time jobs in medicine as the definition of success, as "good enough." It's time to institute policies that are truly supportive of physicians who want to parent. An imperative first step is for the Accreditation Council for Graduate Medical Education to create an official parental leave policy for medical trainees. None currently exists, which sends the message to trainees- don't get pregnant, or your training will be in jeopardy. Other policies that should be implemented include: affordable childcare, fertility support, and flexible work schedules in all specialties. When will our progress towards improving the gender disparities in medicine be good enough? When it becomes a cause we no longer have to champion. Source
