The cruel cocktail of sexism, pay inequity, and burnout has led to a critical shortage of female physicians. And it could be putting us all at risk.
When a group of female medical students entered Pennsylvania Hospital’s surgical amphitheater to attend their first clinical lecture in 1869, pandemonium broke loose. Male students rushed into the upper tiers, climbed up on the seats, and began hooting, hissing, and hollering. They spat tobacco, spitballs, insults, and epithets at the unsuspecting women. Yes, men were so scared of women invading what they perceived as their profession, they threw horrible, violent hissy fits.
While things have improved since then, many women entering medicine today still face rampant discrimination, harassment, and bullying simply for being women. A whopping 76 percent of women physicians report experiencing gender discrimination. In the Harvard Business Review, two Johns Hopkins professors declared that discrimination against women in the medical field “constitutes a potential threat to patient safety and public health.” Why? Because women are better doctors.
“They don’t talk to me like I’m a colleague, they talk to me like I’m a nurse,” said cardiologist Dr. Carla Parkes*. “I can’t tell you how many times I’ve sent a patient to have a heart catheterization done by one of my colleagues and he’ll just cancel it. He won’t even call me, he’ll just talk to the patient and say, ‘She’s wrong and you don’t need to have this procedure done.’ It’s so frustrating.”
Of the two practices she’s worked in during the five years she’s been practicing, Parkes has never had a female colleague. Only 12 percent of board-certified cardiologists are women.
As for patients, Parkes says she’ll often spend an hour with them going over their diagnosis and treatment, only to have them say: “So do we wait here in the room for the doctor to come?” Parkes spoke with DAME on condition of anonymity; fearful that speaking out would lead to workplace retaliation or increased discriminatory treatment. Though her experience is painfully common, she was the only physician we found willing to go on record.
“I have certainly considered leaving medicine,” Parkes said. “When you aren’t respected by your colleagues and you’re not respected by your patients and not respected by the nurses, it kind of makes it tough to get up and go to work every day.”
A University of Michigan study found that almost 40 percent of women physicians go part-time or leave medicine altogether within six years of completing their residencies. That stinks for the women who worked so hard—and spent so much money—on training for a career they were passionate about. But it also stinks for patients.
Patients seen by women have better outcomes than those seen by men. A study of 1.5 million Medicare patients admitted to the hospital found those treated by women were significantly less likely to die or be readmitted within the next 30 days. Patients operated on by female surgeons are also less likely to die within the next 30 days.
Women physicians are more likely to follow clinical guidelines and provide preventive care. They conduct longer patient visits, ask more questions, and are more likely to confirm patient understanding, solicit patient opinions, and provide counseling on issues like relationships and stress. When doctors make time to dig a little deeper with patients, they can unearth things others may have missed.
Women docs are especially important for women patients. Women largely prefer being cared for by women physicians, not because they know what it’s like to be a woman, but because they believe them to be better communicators. Women are much more likely to survive heart attacks if they are treated by women doctors. (Men patients fare better, too.) What’s more, women patients receive better care from men physicians if they have more women colleagues. And the more women patients they tend, the better men get at treating them. Which is quite unfortunate if you happen to be among his first few patients.
“Perpetuating work environments, hierarchies, or mentoring structures that disadvantage women may mean that patients cannot get the care with which they’re most comfortable,” doctors Lisa Rosenstein and Anupam Jena explain in the New England Journal of Medicine.
Improving treatment outcomes for women is of vital importance since they are routinely dismissed and misdiagnosed. The specter of hysteria rears its ugly head to declare women’s problems are all in their mind: heart attacks diagnosed as panic attacks, sedatives prescribed instead of pain meds. On average, women are diagnosed four years later than men. And with a massive primary care physician shortage looming, things are only going to get worse. Continuity in primary care leads to better health outcomes.
But it’s not just outright sexism that’s driving women doctors to quit.
One of the biggest reported issues is lack of work-life balance: 78 percent of women docs who quit or went part-time cited family as the reason for the change. For doctors with kids, 31 percent of women reported not working full-time versus 5 percent of men. That’s a massive red flag that the private healthcare model is not amenable to working women. It’s also a harbinger of inequity.
“The emergence of this gap so early in physicians’ careers may contribute to later gender inequities in compensation and promotion,” the researchers concluded. “Until policies and a culture allowing women and men to be both parents and physicians are created, women are less likely to be retained and to advance.”
Gender pay gaps and disparities in leadership positions in medicine are huge. Among newly graduated residents, men’s starting salaries are roughly $17,000 higher than women’s. In primary care, men earn $36,000 more than women. Among specialists, the difference is $95,000. And 66 percent of women in academic medicine report being overlooked for advancement opportunities just for being women.
The gender pay gap helps reinforce patriarchal gender roles among heterosexual couples. When children or an aging family member enters the picture, women think: “Well it makes sense for me to cut my hours since I make less money.” Fewer women employees mean fewer women leaders.
For the first time, women make up the majority of U.S. medical students enrolled: 51 percent. This seems like an especially enormous accomplishment when you consider Harvard Medical School didn’t admit women until 1945. Where hope starts to fade is comparing the numbers of practicing doctors: only 36 percent are women. Worse still are the leadership roles: women account for a meager 25 percent of full professors, 18 percent of department chairs, 16 percent of medical school deans, and 13 percent of healthcare CEOs.
Institutional bias sees women guided into appropriately feminine specialties, which typically pay less, and the specialties that allow for more flexible schedules or part-time work can also be lower paying. Among the specialties with the highest percentage of women, only dermatology ranks in the top 10 highest-paying specialties. Given the discrimination Parkes experienced, it’s no wonder women might prefer to stick with the specialties that have more women.
Some women see part-time opportunities as a win, a solution allowing them to meet both their professional goals and their familial commitments. But others don’t want to reduce their hours, thus lowering their pay. They want better daycare options, more flexible scheduling solutions, longer family leave, guarantees of a job when they come back. They want their partners to take on a larger share of the domestic tasks at home, to be the one to go part-time.
“I think that making medicine in general a little bit more feasible for women would also help,” Parkes said. “For example, I wanted to do part-time, but they made it so there’s really no way to do that.” She says several of the women in her med school class dropped out before graduating. And many of the women she graduated with have also since left medicine.
The Time’s Up organization launched a healthcare arm in March 2019 in an effort to tackle the discrimination, harassment, and inequity eating away at the profession. No one expects improvement overnight, but apparently we can have rapid deterioration: A survey of women physicians showed between 2018 and 2019, things actually got significantly worse.
Women being pushed out of medicine stinks for literally everyone.
“Mistreatment, underpayment, and exclusion, among many affronts faced daily by female physicians, have negative consequences for patient outcomes, patient experiences, health care accessibility and organization, and scientific progress,” Rosenstein and Jena assert. How many life-saving treatments and innovations have we lost to discrimination?
Though medicine may seem destined to be an interminable boys club, it doesn’t have to be that way. Medical practice can be made more feasible for women. And it’s not even that hard.
In the U.K., where medicine is socialized, 45 percent of National Health Service doctors are women. There is no gender pay gap in general practice medicine. Employees may request flexible work arrangements, such as setting their own start and end times, working set shifts, only working on school days, and spreading total annual work hours unevenly throughout the year. Employees receive 8 weeks of maternity leave at full pay, 18 weeks at half pay, and a further 26 weeks unpaid. Their job will be waiting for them when they return.
Women doctors in the U.S. don’t even take the length of maternity leave they recommend to patients. A survey of U.S. family medicine residency programs found the average maternity leave was 5.3 weeks for faculty and 4.5 weeks for residents. Profit-driven employers make employees feel guilty for taking the time off they deserve, that their body needs. By taking maternity leave and leaving them in the lurch, you’ve proven that a woman of reproductive age shouldn’t have been hired in the first place.
“I didn’t really grasp the kind of differences there are for men and women when I was in [school],” Parkes says of her time at the Mayo Clinic School of Medicine. “And I think the reason is because there are so many female pioneers of medicine there; a handful of the first female cardiologists are the ones that trained me. I was surrounded by these super strong women that supported me and really taught me how to stand up for myself.”
Women leaders can serve as role models and mentors, and they can also push their institutions toward creating more family-friendly policies and cultivating a workplace where discrimination and bullying are not tolerated.
“I think that’s huge, having women leaders who change the culture. If there were a few women who were very strong that would help change things,” Parkes said.
It comes as no surprise that women doctors suffer from burnout at significantly higher rates than their male counterparts. “In the face of physician shortages and long waiting times for doctors’ appointments in many U.S. regions, it’s imperative that we think carefully about how the gender dynamics of medicine contribute to burnout,” warn Rosenstein and Jena.
Yes, medicine can be a high-pressure job, but then add on a daily barrage of sexist microaggressions and working twice as hard to prove you’re worthy of promotion, all while earning less than your male associates for that pleasure, and then coming home to a house full of undone chores and family members you don’t get to spend enough time with. And if you’re a woman of color, you’re likely also dealing with workplace racism. Parkes says it begins to feel like a “lose/lose/lose” situation. Burnout isn’t a strong enough word.
“I love medicine. I love my patients. I love taking care of people. I love cardiology. But it really sucks, practicing medicine as a woman,” said Parkes. “I have sacrificed my entire life to medicine. I don’t have kids. And here I’m almost 40 years old, I look back I don’t know that I could say it was worth it because of how females are treated.”
*not her real name.
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