Like many other women, I am no stranger to sexism in medicine.
One memorable instance occurred over the phone. "Hello,” I said. "I'm Dr. Kristen Fuller." I didn't expect his response: "Oh. I've been picturing Dr. Fuller as a strong, male doctor.”
Another time, after speaking with a patient for over an hour about his diagnosis and prognosis, he asked to “speak with a physician.”
"I have had patients tell me that they prefer a male physician because they feel they could 'trust them more.'"
— Kristen Fuller, MD
Each time, I've had to reflect on how this expressed bias affected me, consciously and subconsciously. And I've wondered what I'd want a medical student (male or female) to learn from these situations, had one been in the room with me.
Deep roots of gender bias in medicine
In 1849, Elizabeth Blackwell became the first woman in the US to be granted a medical degree after being turned away by multiple medical schools. Physician friends suggested she disguise herself as a man to gain admission to medical school in France—which she refused to do.
Blackwell ultimately attended Geneva Medical College in Western New York after the male students were asked whether she should be granted admission and agreed to admit her, assuming the matter was a prank.
Here are some additional facts about gender bias in medicine:
In 2017, women comprised the majority of first-year medical students for the first time in history, and in 2019, for the first time, there were more women than men enrolled in US medical schools (50.5%).
Although times are changing and things are improving for women in medicine, they still only make up slightly over a third of the profession and a slim margin of sub-specialties, faculty, and leadership positions.
Women are a minority in specialties such as orthopedic surgery (5.8%), urology (9.5%), pulmonary disease (12.3%), and surgical specialties from general surgery (22%).
Patriarchy’s ripple effects on women
The effects of patriarchy in medicine on women include harassment, the gender wage gap, and gender segregation in specialties and medical leadership, among others.
The 2022 Medscape Physician Compensation Report found that female primary care doctors earn 25% less than their male counterparts for doing the same work—$57,000 less a year, on average. The specialty pay gender gap between the sexes is even larger, with females earning 31% less than their male counterparts, or $95,000 less annually.
Women physicians have higher divorce rates compared with their male counterparts, as working longer hours for them means higher probability of divorce, according to a study published in the BMJ, whereas for male doctors, working longer actually decreases divorce risk.
"In US surveys, female physicians on average report making greater professional adjustments than male physicians to accommodate for household responsibilities such as child rearing," the authors wrote. "Greater trade-offs between professional obligations and family life may contribute to lower quality of relationships and higher prevalence of divorce among female physicians."
Besides experiencing more work-family conflicts than male physicians, women physicians have higher rates of burnout and depression, and demonstrate high levels of imposter syndrome (in which you question your abilities and feel like a fraud). Perhaps these feelings of self-doubt are responses to the obstacles that we, as women, face in our medical careers.
We are less likely to hold leadership positions, less likely to be granted awards, and less likely to be first authors of perspective-style articles. We are more commonly introduced by our first names at public speaking events, rather than as “doctor.” Ultimately, we are more likely to quit medicine because we are not supported.
This unequal treatment of women physicians who have equal levels of education often reinforces the perceptions that women are of lower status or level of expertise.
"We are isolated, exhausted, under-represented, and unheard."
— Kristen Fuller, MD
Women are a minority in medicine, and anytime someone is a minority, they are not heard and, to some degree, isolated because they feel they do not belong. A primary reason for this under-representation is the lack of quality mentorship for women physicians.
Combatting gender bias in medicine
Supporting the well-being of women in healthcare—through such means as equal pay, accounting for career advancement during childbearing years, accommodations for maternity leave, and opportunities to improve job satisfaction, performance growth, and retention—must happen now.
Medicine needs strong women mentors who can initiate honest discussions with their female mentees about the unconscious biases and workforce inequalities they may face.
We want female medical students and residents to feel ready for the challenges they will face, and know that they are supported and not alone.
It’s important for women physicians to speak openly and candidly about their experiences in medicine (both good and ugly) and share them with their colleagues through various mediums such as social media and medical journals. We also need to increase and improve networking and communication among women physicians across all specialties and in different healthcare professions.
Until there are solutions to change a system that was built without regard for women in the workforce, gender inequalities will continue to hurt our healthcare system, and we will continue to fail in hiring and retaining female doctors.
"Change requires building on the work of individuals and institutions nationwide, consolidating the numerous efforts to share resources and metrics, establishing a national baseline for parity, and holding leadership accountable,” wrote Shikha Jain, MD, FACP, on Wolters Kluwers’ Expert Insights page.
"These gender imbalances must be rectified at a systemic and global level."
— Shikha Jain, MD, FACP
"Not only is it crucial for fairness in the workplace, but these inequities also directly impact the healthcare workforce and the care provided to patients," Jain wrote.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.