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There is a crisis in healthcare with respect to how its female physicians-the fastest growing and most prized talent pool-are being treated.
Women are half of all medical school entrants in the United States. They are a third of the profession and growing. Despite this, and evidence that they provide higher quality care than male physicians in some instances, their experiences as doctors are much different on average than their male counterparts, and not in a good way. They earn significantly less doing the same kind of work, often tens of thousands of dollars less.
Compared to male physicians, women physicians are more likely to get divorced. Working longer hours for them means higher chances for divorce, whereas for male doctors, working longer actually decreases divorce risk.
Women physicians may experience negative psychological states like depression and burnout more than their male counter parts. More of them compared to male doctors may engage in thoughts of suicide. They experience work-family conflict to a larger degree than men do, in part because they take on more of the home and parental duties. They have greater chances of being harassed at work and are often less likely to be promoted or move into leadership positions. They marry other doctors at a higher rate than their male colleagues, and in such dual career cases, are more likely to sacrifice aspects of their medical careers, work less, and earn less money.
These issues are more challenging to solve given that the profession is medicine. Why is that?
First, all physicians are at the top of the occupational food chain. They are paid very well in the relative sense, experience higher levels of autonomy in their work, and have working conditions far better than that of most occupations. The perception of doctors as a privileged profession may lessen the urgency by which those in and outside of it acknowledge the gender divide.
Second, this insensitivity to poorer treatment of its own members continues to be a normal part of the medical profession’s adverse alpha culture. Evidence of this culture is seen in how medical students and residents are often still treated. Women doctors pay their own price for being immersed in that culture.
Third, medicine is a profession built on power and control. Young physicians are reluctant to push back against an unfair system.
Finally, and more subtle is that female physicians often report high levels of job and career satisfaction despite the presence of these negative realities, as I discovered in a review myself and a colleague did several years ago. This implies a degree of compartmentalization that may allow some female doctors to navigate through hostile workplaces and yet still find rewards in the joy of clinical practice and other aspects of their work. I have witnessed this dynamic first-hand in women doctors that I have interviewed over the years, for example, as they talked about dealing with harassment from patients and other colleagues, and unfair treatment by employers. I remember one female physician who expressed a high degree of job satisfaction telling me that if she got mad about the gender bias she experienced on a consistent basis, she would end up being mad every minute of her workday.
Healthcare employers are a significant part of the problem where physician gender bias is concerned. Take the compensation disparities observed between male and female physicians. In 2004, several colleagues and I published a study of a new group of doctors called hospitalists. In that study, we found women hospitalists earning thousands of dollars less annually than male hospitalists, even after controlling for things like workload, type of job, and job tenure that might reasonably account for a pay difference. What was surprising about this finding was that it was occurring in a new medical specialty, one in great demand at the time. Other recent studies have supported this general finding among doctors across different specialties, including one that showed significant starting salary disparities between male and female physicians, illustrating showing that the problem begins at the start of a female physician’s work career.
At the time, we speculated that part of the gender pay disparity could be the result of employers playing a different negotiating game with female doctors. For example, they may offer lower compensation to women physicians by taking advantage of the greater concerns some of them have for gaining other benefits in their jobs. These other benefits may align better with their tendency to take on more of the spousal and parental roles in their households, benefits such as time off, flexible work schedules, and day care support for their children. Many women physicians believe, and survey data in some instances show, that they are at a disadvantage when negotiating contracts, that health care employers pay them less, that their performance gets evaluated using different criteria compared to men, and that there is gender discrimination in hiring and promotion evaluations.
The medical profession shares blame. In many instances, the negative realities women doctors end up experiencing start as early as medical school and residency training. In my research, I have spoken to many young female doctors who realize during their training and early career that despite having earned their way into the most competitive profession on Earth, they still will likely encounter a fair number of colleagues, employers, and customers that treat them like second-class citizens. For some, this realization starts at the very outset of their careers to drive negative perceptions of their chosen profession as well as producing higher rates of negative psychological states like depression. It also may immediately narrow the types of job and employment choices some women doctors believe are available to them, especially if they wish to marry or have children.
None of this gets fixed on its own, nor are there magic bullet solutions. At a minimum, women doctors would benefit from greater workplace protections and using whatever means possible to collectively bargain with their employers at a local level. There is strength in numbers. They also need many more champions and role models, especially later career mentors, who will whistle blow and take risks to push for change when injustices are apparent. Medicine is a strict hierarchy rooted in experience, and older female physicians can help if they are willing to lead the way for their younger colleagues. In addition, women physicians should seek solidarity where appropriate with male physicians, since there are many workplace issues that now affect both groups in similar ways that lessen career and job satisfaction.
There is a crisis in healthcare with respect to how its fastest growing and most prized talent pool is treated. Recognizing the scope of the crisis is an important first step. Solving it is what matters now.
Timothy Hoff, Ph.D., is professor of Management, Healthcare Systems, and Health Policy at Northeastern University in Boston, a Visiting Associate Fellow and Associate Scholar at Oxford University, and author of the 2017 book, Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health, published by Oxford University Press.