When my mother was training to become an OB/GYN, a mere twenty-five percent of her program was composed of women. Worse, women made up only twenty-two percent of her 1982 graduating medical school class. My mother experienced overt sexism and sexual harassment throughout her training. I am glad to say that when I graduate medical school in 2019, my female classmates and I will represent over fifty percent of our class. While I personally have not been subjected to overt sexism, I have certainly experienced it covertly. Over the last 100 years, a lot of progress towards professional and societal equality has been made. But not enough.
Speaking to my female classmates, I repeatedly hear my voice and experiences echoed back to me. How many times will I be mistaken for a nurse today? How many patients will call me sweetheart? How many attending physicians will advise me about my reproductive plans? How many ways will my career be shaped by my gender?
While I believe that medicine is my calling, I often wonder how my career choice will impact the rest of my life. Looking to the future, I strive to be an excellent physician, involved in academic medicine, and have a family of my own. The demands of these goals are often overwhelming and leave minimal room for anything else. But this is true regardless of gender.
In order to achieve career and personal success, women often face increased expectations in both worlds. In the professional realm, there is an underlying feeling that women have to work harder than their male colleagues to be seen as equals. In family life, society has perpetuated the notion that women are responsible for the majority of domestic work and household management. But let’s put stereotypes aside and look at the data. One study found that female physicians spent 8.5 more hours per week than male physicians on domestic activities including household and childrearing duties [1].
Recent evidence shows that patients cared for by female physicians have improved outcomes; one study showed decreased mortality and readmission rates [2]. Even though women may have better outcomes, they are compensated less than their male counterparts. On average, they make $33,000 per year less in primary care, and $82,000 per year less in specialties [3].
Some explanations for the wage gap point to the fact that female physicians are more likely to work part time and be primary care providers. These physicians, such as family practitioners, internists, and pediatricians, while critical to our healthcare system, are paid less than sub-specialists. However, one study that controlled for hours worked, specialty, age, and other factors, showed female physicians still made $22,347 per year less than their male counterparts [4]. Conventional arguments, then, fail to explain where this large wage gap comes from.
Another illustration of inequity is the lack of women in leadership positions within medicine. Men make up 66.5% of the physician faculty of medical schools. The proportion of women in academic medicine has not increased since the 1980’s; and after controlling for age, experience, specialty, and measures of research productivity, women were less likely to be full professors [5]. Even after controlling for physician age, years of experience, specialty, faculty rank, several measures of research productivity, and payments by Medicare, women made approximately $20,000 less per year in academic medicine. Additionally, female full professors had a comparable salary to male associate professors [6].
These data represent only a fragment of the gender inequity in medicine. Gender bias can negatively influence evaluations in medical school and residency [7, 8], and is associated with the slower promotion of women in academic medicine that cannot be explained by productivity [9]. As a future female physician, I sense the constant expectation of excellence but also perceive the sexist reality that my contributions will not be as valued as my male counterparts’ contributions. I am fortunate to be surrounded by strong female role models and am able to see progress when I reflect on my mother’s experiences. But it is not enough.
I must acknowledge that I have focused on gender inequity, but it is important to recognize that there are many other peoples who experience discrimination in medicine. This discussion has concentrated on physicians, and not on the disparities that patients experience. Whatever solutions we create must address all injustices; those based on gender, race, ethnicity, religion, socioeconomic status, sexual orientation and identity, and others we have not yet readily identified. I look forward to continuing the conversation to alleviate these barriers and promote equity.
- Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers.Annals of internal medicine. 2014;160(5):344-353. doi:10.7326/M13-0974.
- Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians.JAMA Intern Med.
- Peckman C. Medscape Female Physician Compensation Report 2016. Medscape Web site. https://www.medscape.com/features/slideshow/compensation/2016/female-physician. Published May 25, 2016. Accessed 2/8, 2018.
- McMurray JE, Linzer M, Konrad TR, et al. The Work Lives of Women Physicians: Results from the Physician Work Life Study. Journal of General Internal Medicine. 2000;15(6):372-380. doi:10.1111/j.1525-1497.2000.im9908009.x.
- Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014.JAMA. 2015;314(11):1149-1158.
- Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salary in U.S. public medical schools.JAMA internal medicine. 2016;176(9):1294-1304. doi:10.1001/jamainternmed.2016.3284.
- Choo EK. Damned if you do, damned if you don't: Bias in evaluations of female resident physicians.J Grad Med Educ. 2017;9(5):586-587.
- Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ. Differences in words used to describe racial and gender groups in medical student performance evaluations.PLoS One. 2017;12(8):e0181659.
- Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine. glass ceiling or sticky floor?JAMA. 1995;273(13):1022-1025.
Laura Hamant is a member of the University of Arizona, College of Medicine-Phoenix class of 2019. She is an Arizona native, hailing from Tucson. She received her undergraduate education at the University of California, San Diego and completed a B.S. in Cognitive Science with minors in Biology and Dance. Her hobbies include ballet, cooking, and baking.