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As the number of women doctors grows, many are trying to square that promise with the systemic challenges they face.
Between ever-changing regulatory requirements, more time spent interacting with electronic health records systems than with patients, and a lack of work/life balance, physicians are burning out at an unprecedented rate. Yet there is hope that the next generation of women physicians can address many of the systemic issues that currently plague the field of medicine.
But the question remains: will they be given the opportunity to do so?
When Diane Birnbaumer, MD, FACEP, emeritus professor in the department of emergency medicine at Harbor-UCLA Medical Center, was training to be a physician more than 30 years ago, she did a clinical rotation in otolaryngology with an older, well-established male surgeon. When she finished the rotation, the surgeon complimented Birnbaumer on her abilities, but also told her he wasn’t going to give her a good evaluation.
“I immediately asked, ‘Why?’” she says. “He told me, ‘Women will ruin medicine. All you want to do is come into medicine and make it part-time. Women want other things. Medicine just isn’t your passion the same way it is for [male physicians].’”
It would be easy to say that such a conversation is a relic of a time long gone, when men dominated the field of medicine and women were fighting just for the opportunity to show what they might bring to the examining room. After all, today about one-third of practicing physicians are women. And most of those, like Birnbaumer, have worked hard to advance in their careers.
And more and more women are entering the field. Per the Association of American Medical Colleges, women today not only make up the majority of medical school applicants but are enrolling and graduating from medical school at a rate slightly higher than their male counterparts.
Despite those growing numbers, Roberta Gebhard, DO, president of the American Medical Women’s Association, says that women still face significant challenges as they pursue their careers. While they may not experience discrimination quite as blatant as Birnbaumer did when she was a trainee, there are still significant hurdles they must overcome.
“Even though we are seeing parity in the numbers, and we have for a couple years now, what we are not seeing is parity in pay for women or in the opportunities to advance in their careers,” she explains. “And it’s the kind of stuff that, over the course of a career, can really hold someone back from reaching their true potential.”
With so many women entering the field-and looming fears of physician shortages-many observers hope that women will help to transform medicine for the better. Women today constitute the majority of physicians in countries with highly effective healthcare services. But how can healthcare fulfill the promise of women in medicine when women continue to face the same systemic obstacles as previous generations?
The promise – and barriers
There is good reason why so many see women physicians as integral to solving many of medicine’s problems. Research studies suggest that women physicians spend more time with patients, on average, than men-and focus more on discussions about preventative medicine.
Female physicians are more likely to closely follow evidence-based clinical guidelines for care. And patients who see a female physician are less likely to be re-hospitalized within 30 days or succumb to their illnesses.
While many of these studies are small, the collective results suggest that, especially as medicine moves to value-based models of care, women doctors are a valuable asset to healthcare, says Susan Hingle, MD, MACP, a professor of medicine at Southern Illinois University School of Medicine and former chair of the American College of Physicians’ Board of Regents.
“These are very targeted studies, but in multiple situations and in multiple specialties, we see that women physicians are showing better outcomes than male physicians,” says Hingle, who co-authored a position paper regarding improving gender pay equity.
But studies also show the challenges women working in medicine commonly face. Timothy Hoff, Ph.D., a professor of management, healthcare systems, and health policy at Northeastern University, has been studying such barriers for decades. And despite the growing number of female physicians, many of those issues have not improved over time.
Hoff noted in a recent Medical Economics blog post that women are more likely to experience work-family conflicts, less likely to be promoted or selected for leadership positions, and still experience high rates of sexual harassment. On the whole, they also make significantly less money than similarly qualified male physicians.
“We have a fairly pervasive situation where physicians who are doing the same job are getting less money just because they happen to be women,” says Hoff. “That’s a problem. And these issues are deep-rooted and long-standing trends in this particular field that need to be addressed.”
Moving toward change?
Many physicians, even women physicians, say medicine is close to or has already achieved gender parity, says Gebhard. These physicians refer to their own personal successes, the growing number of female doctors and medical students, and the fact that high-profile leadership positions, including the presidency of the American Medical Association, are now being occupied by women. At times, Hoff says, it is difficult to see the discrepancies.
“Doctors are some of the most successful people in the country,” says Hoff. “They work and sacrifice an awful lot to get where they are. In some respects it’s difficult for people-once they reach what they think is the pinnacle of what they see as their own hard work and perseverance-to understand they are not being treated the same ways as their peers.”
At times, those very discrepancies can be used to make the case that medicine has become more female-friendly. In a recent New York Times article, three female physicians discuss how they make time for their growing families while continuing to work in medicine. One switched to a less demanding (and less lucrative) specialty where she could better control her hours. Another took a position as a hospitalist where she works predictable shifts. The third is working remotely, doing radiology scans from home.
“The possibility that the establishment might allow these women to stay in competitive, highly successful, and lucrative careers was never mentioned in this piece,” says Gebhard. “Men manage to have families and stay in those kinds of careers without a problem. But here, these women had to make sacrifices. They had to give up potential earnings and leadership positions. Is that really such a big improvement?”
While Birnbaumer acknowledges Gebhard’s point-and notes that these issues are not unique to medicine-she thinks the article shows that things are improving, albeit slowly, for women. And for male physicians, too.
“Thirty years ago, women had to choose between family and career. There was no middle ground,” says Birnbaumer. “But having women in the field has changed how medicine is practiced and just what is possible. Today, there are options so you can have a better work-life balance. Women drove that.
“And the male residents I work with are just as interested in options that allow them to have more time with their families,” she adds. “As more women enter the field, I think we’ll see more changes in the way medicine is practiced that will benefit everyone.”
The future is female
Experts agree that the medical profession is at least starting to recognize that it needs to change so that women can achieve greater parity, both in terms of opportunities for advancement as well as remuneration. Hoff suggests that addressing the myriad challenges that women face, including implicit biases about abilities and sexual harassment, as early as medical school will help to change them in the future.
“If medical schools and residency programs start addressing these issues during training-because that’s when they start -and challenge the way that women have historically been viewed and treated, it’s an important start,” he says. “We also need as many strong female role models as we can get going into leadership positions so we can change those implicit biases people have about women.”
LaTasha Seliby Perkins, MD, a family physician in Washington, D.C., and a board member of the American Academy of Family Physicians, agrees. It’s one reason why she decided to take on a leadership position in the organization, even while experiencing a high-risk pregnancy.
“I want every single person in medicine to see women as leaders,” she says. “I want them to see women taking on more demanding roles in more demanding specialties and succeeding, whether they have a family or not. I want more women to apply for challenging jobs, to ask for more money, and know that they have earned their place at the table. That kind of visibility is vital not only to our success as women, but to the success of medicine as a whole.”
Krystal Savice, a third-year medical student at the Touro College of Osteopathic Medicine, has already taken on a leadership position as a student with the Student National Medical Association, and is set on becoming a residency director in the future. She intends to be the change she wants to see in the field.
“Women have made a lot of strides in medicine and are demonstrating just what is possible,” she explains. “We will become the leaders we need.”