I met recently via Zoom with a group of female medical residents taking a rare break in their hectic schedules. As we discussed how their experiences compared with my own as a new doctor 35 years ago, I was surprised and alarmed. My young colleagues related to how overworked and overwhelmed I’d felt; how I developed a dangerous pregnancy complication because I was too afraid to ask for any reduction in my hours on duty; how a man in my program informed me that I’d been chosen to be a chief resident as a “token woman”; how I’d feared any display of weakness or emotion on my part would mark me as unworthy. Three decades after my residency, in 2021, as we mark the bicentenary of the birth of Elizabeth Blackwell, the first female graduate of an American medical school, have we really made so little progress?
For the thousands of new female physicians starting internships this month, there’s good and bad news. The good news is that there are more women in medicine than ever before. According to the Association of American Medical Colleges, in 2017, for the first time, more women than men entered medical school, and since 2019 women have slightly outnumbered men overall. In specialties such as obstetrics and gynecology and pediatrics, more than two-thirds of current residents are women. Even in traditionally male-dominated fields such as orthopedic surgery, the percentage of female trainees is growing.
The bad news is that these numbers aren’t translating into leadership positions. Medical school professors, hospital presidents and department chairs, and CEOs of health care systems are still mostly men by large margins. Women who are members of minority groups are even less likely to occupy these prestigious posts. And it’s not that women haven’t had time to catch up. As one discouraged young female physician asked recently on Twitter:
“In 1993 42% of entering med students were women. I was 8 years old. We’ve said this 1000 times but I still wonder where all those years went and where are those women now — why aren’t they my bosses!”
In 1993 42% of entering med students were women. I was 8 years old. We’ve said this 1000 times but I still wonder where all those years went and where are those women now - why aren’t they my bosses!— Allison Ruff (@AlliLRuff) April 9, 2021
Why indeed? Two studies in recent years suggest that patients treated by female physicians may have better outcomes than those treated by men. One showed that the patients of female physicians are more likely to survive heart attacks and another demonstrated that they’re less likely to die or be readmitted within 30 days after hospitalization. According to a 2018 survey, nearly a third of Americans of both genders, and nearly half of women, prefer a female physician, while barely a quarter of men prefer a male doctor. It would appear that women in medicine are thriving — but we’re not.
Female physicians earn, on average, 20 percent less than our male colleagues; receive lower levels of funding for medical research; are exposed with appalling frequency to verbal and physical harassment and abuse in the workplace; are more likely to report feeling burned out; and are at higher risk of dying by suicide than either male physicians or women generally. The COVID-19 pandemic has exacerbated these inequalities. At a time when colorful banners proclaim health care workers heroes, female physicians feel more beleaguered than ever.
If more women entering medicine isn’t creating more equity, what will? Promoting more women to positions of leadership would help, though that effort has to be accompanied by policies addressing harassment, child care, family leave, physician mental health, and the pay gap between male and female physicians. Even the most ambitious and intensively mentored woman won’t rise in the ranks of medicine if she’s harassed, burned out, underpaid, and unsupported at home.
For women physicians to achieve equality, we need not only new policies, but also a new story.
Traditional gender stereotypes remain deeply entrenched in medicine. Social media has been surprisingly effective in helping dismantle them. One Twitter hashtag, #lookslikeasurgeon, gained traction when a New Yorker cover drawing showing four women performing an operation was reenacted by female surgeons around the world. Last year, after an article in a medical journal criticized female surgical residents for “unprofessional” behavior such as posting photographs of themselves in swimwear on their personal social media accounts, a powerful protest campaign swept the Internet. Thousands of female (and some male) physicians posted photos of themselves in bathing suits with the hashtag #medbikini, causing the article’s authors to retract it. One #medbikini Instagram post featured a physician in a red bikini administering emergency first aid. She had jumped up from her beach blanket to rescue a swimmer who had been struck by a boat.
The residents I met with have asked me back for another session in the future. I’m flattered but, honestly, I’d rather my younger colleagues viewed me as a dinosaur, my accounts of sexism in medicine as irrelevant to them as ether.
Dr. Suzanne Koven is a primary care doctor and the inaugural writer-in-residence at Massachusetts General Hospital. She is the author of “Letter to a Young Female Physician.”