The medical profession is predominately led by men and operates in accordance with masculine norms, values, and expectations. As a result, although half of all U.S. medical school students are women, only 16% of deans, 18% of department chairs, and 25% of full professors in those schools are women (Paturel, 2019). Women are only 18% of hospital CEOs, 10% of senior authors on peer-reviewed medical papers, and 7% of editors-in-chief at prestigious medical journals (Mangurian, et al, 2018).
And, of course, there is the issue of pay. Not only are women physicians paid less than their male counterparts, but that pay gap is widening. While some of this gap is accounted for by choice of specialty and hours worked, 39% of the total gap is unexplained by objective factors (Lo Sasso, et al, 2020).
The most effective strategies for combatting women’s systematic discrimination in the medical profession is to directly confront the affinity and gender biases (Kramer & Harris, 2019) that underlie this discrimination.
Affinity bias is people’s natural preference to associate with, advance the interests of, and coach and mentor people who are like them. This means that the men currently at the top of the medical profession instinctively—and generally unconsciously—favor other men when allocating career-enhancing opportunities. This favoritism is compounded by gender bias—the stereotype-driven assumption (also generally unconscious) that men are superior to women at leadership and challenging career-related tasks.
The adverse consequences of these biases for women physicians’ careers are starkly revealed in a 2019 Merritt Hawkins survey (2019).
Key takeaways from the 2019 Merritt Hawkins survey
- 74% of women physicians believe they are paid less than comparably situated men.
- 76% of those women have personally experienced gender discrimination.
- 75% of those women who experienced gender discrimination have also experienced offensive or inappropriate comments from fellow physicians.
- 79% of all women physicians believe that gender discrimination is a serious or somewhat serious problem in medicine.
- 73% of women physicians report feeling a diminished sense of career motivation and satisfaction because of gender discrimination.
This pattern of discrimination against female physicians is reflected in the lack of respect they are often shown. For example, half of the time when female physicians are introduced by men, they are not identified as “doctor.” On the other hand, women almost always introduce both female and male physicians as “doctor” (Files, et al, 2017). Blatant recent examples of this disrespect were frequently on display in Donald Trump’s introductions of Dr. Deborah Birx and Dr. Anthony Fauci at the coronavirus task force briefings. Trump frequently introduced Birx as “Deborah” but Fauci as “Dr. Fauci.”
Another manifestation of the disrespect often shown female physicians is that more than 50% of the women faculty in teaching hospitals has experienced sexual harassment — a far higher percentage than the comparable percentage for female faculty in science or engineering departments (Johnson, et al, 2018).
The lack of respect frequently shown to women physicians is perfectly captured in a story recounted by a female surgeon in Physician’s Weekly (Salles, 2019). She writes, “When a male anesthetist walked into a surgeon’s lounge that happened to have several women in it at the time, he said, ‘Look at this! It looks like a goddamned Tupperware party in here.’”
There are concrete steps that can be taken to deal with the affinity and gender biases underlying the discrimination and lack of respect women physicians so often experience. For example, the stereotype driven nature of gender bias results in women physicians often being seen as either too communal — nice, kind, and sweet — to be effective leaders or too agentic — dominant, forceful, and assertive — to be likable. We call this too soft, too hard, rarely just right phenomenon, the “Goldilocks Dilemma.” Women, however, can escape the Goldilocks Dilemma by combining both communal and agentic qualities so they are perceived as forceful and caring; dominate, and welcoming; competent and empathetic (Kramer & Harris, 2016).
Women physicians also need to understand that the medical profession, like all other professions, is not a meritocracy. While providing high-quality medical care is a necessary condition for fulfilling their primary responsibility as physicians, it is not sufficient to assure career advancement. Advancement depends on women continually raising their hands, looking for opportunities to take on ever more important responsibilities, and not being shy about owning their own accomplishments.
In addition to individual efforts to overcome affinity and gender biases, women physicians need to recognize the importance of collaborative efforts. Strong female-dominated networks — such as the Women in Medicine Summit — are essential to female physicians’ successful and satisfied professional lives. And, seeking the active support, mentorship, and sponsorship of senior male physicians is also important. To increase the likelihood of such support, women should genuinely acknowledge their senior colleagues’ accomplishments, express their desire to learn leadership skills from them, and display a willingness to accommodate themselves to their colleagues’ schedules.
Finally, organizations must change their policies and practices to ensure more inclusive, bias free, and respectful medical workplaces (Kramer & Harris, 2019). These policies and practices must explicitly foster transparency, flexibility, and gender-neutral processes for assignments, evaluations, compensation, and promotions. Achieving these goals will depend in large part on organizations implementing objective metrics to track the results of policy changes.
The medical profession has a long way to go before it will achieve gender neutrality. If it starts now, it can get there in the foreseeable future.
ANDIE KRAMER, JD
AL HARRIS, LL.B.
Ms. Kramer and Mr. Harris write, speak, conduct workshops, and advise organizations about how to achieve truly diverse and inclusive workplaces. They are the authors of It’s Not You, It’s the Workplace: Women’s Conflict at Work and the Bias that Built It and Breaking Through Bias: Communication Techniques for Women to Succeed at Work. Join the discussion at www.AndieandAl.com.
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Files, J.A., Mayer, A.P., Ko, M.G., Friedrich, P., Jenkins, M., Bryan, M.J. Vegunta, S., et al. (2017). Speaker introductions at Internal Medicine Grand Rounds: Forms of address reveal gender bias. Journal of Women’s Health, 26(5). https://doi.org/10.1089/jwh.2016.6044.
Johnson, P.A., Widnall, S.E. & Benya, F.F. (Eds.) (2018) Sexual harassment in academic science, engineering, and medicine.” National Academies of Science, Engineering, and Medicine. The National Academies of Sciences, Engineering, Medicine. https://www.nationalacademies.org/our-work/sexual-harassment-in-academia.
Kramer, A.S. & Harris, A.B. (2016 May 04). The goldilocks dilemma: Why career advancement is so much harder for women than men and what women can do to change that. Change This. http://changethis.com/manifesto/show/141.01.BreakingThroughBias
Kramer, A.S. & Harris, A.B. (2019) It’s Not You, It’s the Workplace (ch.4). Nicholas Brealey.
Kramer, A.S. & Harris, A.B. (2019 August 27). This is what it takes to get more women leaders in the workplace. Fast Company. https://www.fastcompany.com/90395955/how-to-increase-female-leadership
Lo Sasso, A. T., Armstrong, D., et al. (2020 February 20) Is the gender starting pay gap for physicians getting wider? MedPage Today. https://www.medpagetoday.org/publichealthpolicy/generalprofessionalissues/84696?vpass=1.
Mangurian, C., Linos, E., Sarkar, U., Rodriguez, C. & Jagsi, R. (2018 November 07) What's holding women in medicine back from leadership. Harvard Business Review. https://hbr.org/2018/06/whats-holding-women-in-medicine-back-from-leadership.
Merritt Hawkins. (2019 December 09). 2019 Survey of Women in Medicine. Merritt Hawkins. https://www.merritthawkins.com/trends-and-insights/article/surveys/2019-survey-of-women-in-medicine/.
Paturel, A. (2019 June 11) Where are all the women Deans? Association of American Medical Colleges. https://www.aamc.org/news-insights/where-are-all-women-deans.
Salles, A. (2019 July 23). Gender bias narratives in medicine. Physician's Weekly. https://www.physiciansweekly.com/gender-bias-narratives-in-medicine/.