WITH LOOMING physician shortages across the U.S., it makes sense to address extra career barriers common to half of the medical workforce – women physicians. Equal pay, respectful treatment, greater visibility and meaningful support for family responsibilities could go a long way to help. Below, three female physicians talk about progress made and how more still needs to be done. [See: 17 Ways Heart Health Varies in Women and Men.]
Dr. Erin O'Brien is an assistant professor in the department of otorhinolaryngology (ear, nose and throat) at the Mayo Clinic in Rochester, Minnesota, where she specializes in sinus surgery. In 2007, she was the first resident in her training program to have a baby. Only allowed to miss six weeks of any academic year, and with her upcoming fellowship – optional, additional specialty training after a residency – arranged and about to begin, O'Brien somehow stayed on schedule. Six weeks after having a cesarean section, she was back on her feet in the operating room.
As a new mother managing breast-feeding, O'Brien coped with the logistics of pumping between operating room cases, in the narrow time frame already allotted to writing patients' notes and filling out postoperative orders. "There were times when we had a long case and I would just say, 'I have to go pump right now,'" she says. Women physicians in similar situations strive to do the best they can, she adds.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
O'Brien is the diversity leader for her department. She talks to female residents about patterns of microaggression – a little-known concept during her own training. A sense of having their medical orders questioned and challenged more frequently – by staff members from other physicians to nurses to operating room technicians – and of being addressed more casually and less respectfully than male peers, is common. "When the residents talk to each other, they realize they do seem to get more pushback, but don't seem to get the same level of respect in some cases," she says.
Speaking up to other health care team members is fraught. "It's challenging because they're really in a position without authority," O'Brien says. "The power differential can be difficult." Subtle slights and continual challenges to a professional's knowledge and authority can add up. "Unfortunately, if it keeps happening to some of the female residents, it erodes their confidence after five years of this," O'Brien says.
Awareness among colleagues is essential. "We rely on a lot of interactions with other physicians and other people on the care team," O'Brien says. "And if [microaggression] is part of the relationship, patients aren't going to get the best care they can. The female physician can't advocate for that patient if there's not buy-in and respect to that physician."
Salary and Other Disparities When hospital administrators insist on paying male physicians more money – even when female physicians have more experience, credentials and training – maybe it's a reflex, like the knee-hammer test.
Time and time again, women physicians receive smaller salaries and lower signing bonuses than men, says Dr. Roberta Gebhard, president-elect of the American Medical Women's Association and co-chair of AMWA's gender equity task force.
In her task force role, Gebhard hears from women physicians, including full professors, who mentor male medical students only to learn they're already earning much more straight out of their residency programs. She's suffered from blatant pay inequities in her own career.
Pay gaps between newly trained male and female physicians aren't only persisting – they're growing, according to an analysis by the Center for Health Workforce Studies using data from the annual New York Resident Exit Survey.
On average, male physicians' starting income was some $26,000 more than females' in 2016. This gap was less than $10,000 in 2005, then up to nearly $12,000 by 2010. Gender wage gaps also showed up by specialty. Women dermatologists earned nearly $80,000 less, cardiologists earned about $64,000 less and emergency medicine physicians about $35,000 less than their early-career male counterparts.
Results from the Doximity 2018 Physician Compensation Report were no better. According to data from 65,000 physicians from more than 40 specialties, the national gender pay gap grew wider in 2017, with female doctors earning 28 percent less, or about $105,000 less, than their male counterparts.
Gebhard advises women residents and medical students to learn as much as they can about negotiating. Finding a mentor is also important, she says, especially someone willing to speak up on their behalf and recommend them for hiring, promotion or pay raises.
In her personal life, Gebhard is a member of the sandwich generation – juggling responsibilities such as raising children and supporting an ailing parent with her career. Even with her strong family network, it can be difficult.
Not surprisingly, a 2014 survey of nearly 1,500 high-achieving, academic physicians revealed that women spend more time on parenting and domestic responsibilities than men. Among those with children, women spent 8.5 more weekly hours on activities around the home.
Medical 'Manels' and Name Games Women physicians are all too accustomed to having the title "Doctor" left out when introduced by colleagues or addressed by staff members and patients. They're more likely than male physicians to be called by first name only at medical conferences and in clinical settings.
Dr. Sharonne Hayes, founder of the Women's Heart Clinic at the Mayo Clinic, is Mayo's director of diversity and inclusion. She's the senior author of a May 2017 study in the Journal of Women's Health that analyzed speaker introductions at internal medicine grand rounds. Women physicians introduced by men were less likely to be addressed by their professional titles, archived videos showed. Women physicians, however, addressed both men and women by their titles.
"I've had one woman not raise her hand when I asked this question: Have you ever been called by your first name when all the men were either called by or introduced as Dr. So-and-So?" Hayes says. "I've asked that to rooms and rooms of women."
Giving a speech or participating in a professional panel at a medical conference can boost a doctor's visibility. However, invitations go disproportionately to male physicians, although some conferences are striving to become more inclusive.
A recent study probed the speaker gender gap at five annual critical care conferences held from 2010 through 2016. Male speakers outnumbered female speakers at every conference, every year, according to findings published March 28 in the journal Critical Care Medicine.
Despite having similar expertise and qualifications, female neurologists were less likely to be invited to speak at medical conferences than male neurologists, according to an April 2017 study in the journal Nature Immunology. However, speaking up helped, researchers found. Conference organizers revised their preliminary list of speakers to be more inclusive after becoming aware of the issue and being provided with a list of accomplished female neurologists.
After seeing one manel, or male-dominated panel, after another at an annual cardiology conference, Hayes was pleased by a recent change. "Two years ago, the meeting director was a senior woman who actually very deliberately asked for diverse panels," she says. Seeing women get up on the big stage caught everyone's attention, she notes.
Making a more-inclusive program takes effort, Hayes says: "You don't go to the usual suspects. You don't go to the people who look like you. You ask a wider network. And you're going to end up with a much better conference."
[See: 11 Things Seniors Should Look for in a Health Provider.]
Earlier in her career, Hayes put aside publishing and scholarly work to raise two children with her husband, also a cardiologist. She forged ahead clinically but decided she was OK with being "only" an associate professor, even as others continued to climb the academic ladder. "If we're being judged on the same metrics – productivity, writing papers, seeing patients; whatever the metric is in our practice – as the men who are not taking time off to procreate, it is an immediate disadvantage," Hayes says. Some organizations are trying to mitigate such obstacles, she notes, by offering options like stop-the-clock tenure to support family life.
As her children grew more independent, Hayes says, she became an academic late bloomer. She is now a full professor of medicine and publishes prolifically. However, she's concerned about equal progress and opportunities for other women. To accommodate different paths, she says, the structure of medicine needs to change.
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