“She’s the Doctor”: A Male Medical Student’s Perspective on Gender Inequity in Medicine
Gregory CJ Moellering, The Ohio State University College of Medicine
Maya S. Iyer, MD, MEd Nationwide Children’s Hospital
Gregory CJ Moellering & Maya S. Iyer, MD, MEd
Introduction
“She was having a seizure this morning and we did not need to do anything because it stopped when we arrived,” the emergency medical technician directly told me as my preceptor and I entered the room. At that time, I was a first-year medical student shadowing my attending, a pediatric emergency medicine physician. I had the biggest “deer-in-the-headlights” look on my face when I realized that I was being addressed as the physician instead of my attending. I had no sense of why the patient seized, let alone how to treat and manage their condition. Feeling overwhelmed, I reactively pointed at my attending praying that she could bail me out of the situation, and said, “Oh, I am not the doctor. She’s the doctor.”
As my medical training has progressed and the longer that I have been in the clinical environment, I have realized that being misidentified as the physician is not a rare occurrence. I can recall several times where patients, parents, and even nurses have addressed me with pertinent medical information despite my female attending physician being in the same room and wearing a long white coat. I was not addressed because of my knowledge base, education level, or experience. They directed their questions and responses to me simply because being a white male fits their perception of a physician. This bothers me at a personal level; however, gender inequity in medicine is ubiquitous.
Nationally, women account for over 50% of incoming medical students, including at my own medical school (1, 2). While this increase is promising for bringing women to the so-to-speak table, there are clearly gender inequities in medicine. In Internal Medicine, a specialty where women are not as historically underrepresented, female physicians only account for 25% of all single authorship publications, and only 33% of all publications have females as first or senior authors (3). Analysis of authorship trends over 10 million academic papers science, technology, engineering, math, and medicine over the last 15 years reveal that at the current rate of increase in women authorship, certain medical fields like surgery will not see gender parity this century (3). Women physicians are also less likely to be introduced formally at grand rounds, particularly with male introductions of female speakers using professional titles for the women only 49.2% of the time (4).
These disparities ultimately impact how women physicians obtain leadership positions.
Although women account nationally for 38% of full-time medical school faculty, they only represent 21% of full professors, 15% of department chairs, and 16% of deans (5). This same leadership disparity can also be seen in various fields within medicine. In 2019, there was only one female nominee for the American Society for Radiation Oncology board of directors and no new women were elected as general members of the group. This lack of representation is surprising given that 25-30% of all radiation oncology trainees and attendings are women (6). These differences are significant because leadership representation influences individuals’ perception of gender value. Male physicians’ incomes still are $27,404 greater than their female counterparts, with 70% of the wage difference explained by the work hours and type of work, leaving approximately 30% of the wage gap completely unexplained (7). If our goal is for medicine to achieve gender equity, we need to change our approach to the problem.
“Three out of four women will report not being regarded as the physician at some point in their career.”
My Personal Beliefs on Gender Inequity in Medicine
Since my first encounter with gender bias in the healthcare setting, I have reflected on what my role is in addressing gender inequity in medicine. I was reminded initially of Kyle Korver’s article on white privilege. Korver, a professional basketball player for the Milwaukee Bucks, describes that as a white basketball player, he does not have the same concerns, such as being arrested at a nightclub past midnight or fans directing racial slurs towards him, as his African American teammates (8). Korver identifies feelings of guilt and responsibility before making the distinction between these emotions. He states that white individuals should not necessarily feel guilty for the color of their skin and the “sins of their forefathers,” but that they should be part of the solution moving forward. These beliefs translate directly into how I feel about gender inequity in medicine. I am a white male, privileged by random chance. Acknowledging this privilege is both difficult and uncomfortable, especially because I realize that I benefit from a system which makes success more difficult to achieve for many of my colleagues.
I have an advantage from fitting a mental construct that many people have developed for leaders. The word “leader” is often equated with “male” and the word “follower” as “female” due to society’s implicit bias (9). This phenomenon happens in medicine with female physicians being addressed as nurses or other non-physician healthcare providers. According to Dr. Basmah Safdar, a pioneer in the advancement of women in medicine, “Three out of four women will report not being regarded as the physician at some point in their career.” She herself testifies that despite practicing for eleven years as a physician, she still gets asked by patients to “go get [their] doctor.” (10) Her experience is exactly what I witnessed first-hand with my attending physician in the pediatric emergency department. These findings are unsettling because there are many talented, intelligent women that do not have the same opportunities as their male counterparts because of implicit bias. A logical thought would be that if we want to improve the healthcare system, we need the best and brightest leaders to be in charge. That goal is impossible if many of our best and brightest are not being given the same opportunities. Ultimately, I believe male providers need to take on this challenging first step of recognizing privilege. While we should not necessarily feel guilty for being male, we should feel responsible for coming up with solutions to this problem.
“We need to recognize the issue and refine our strategies to address the underlying causes.”
Ideas on Improving Gender Inequity in Medicine Now
Governing medical bodies recognize the crisis of gender inequity. In January 2020, the Association of American Medical Colleges (AAMC) “call[ed] on institutions to address [gender inequity] in four primary areas: the physician and scientific workforce, leadership and compensation, research, and recognition.”(11) Several programs are also developing large-scale efforts to address this issue. The Research Partnership on Women in Biomedical Careers, a multi-institutional collaboration investigated over one hundred peer-reviewed journal articles addressing gender equity in academic medicine and determined that increasing female access to grant funding and mentorship resources, managing unconscious gender bias through education, and supporting family home life were effective strategies to promote and support the careers of women in medicine (12). In addition, increasing efforts to counteract the effects of sex segregation is also a proven strategy to reduce stereotype threats in the workplace. When programs increase efforts to retain and recruit female physicians, consciously increase female leadership, and increase exposures to successful female leaders, overall stereotype threat is decreased (13).
At The Ohio State University College of Medicine (OSUCOM), my home institution, we have made strong strides to increase female leadership with four women named as department chairs along with the dean of the OSUCOM. Additionally, the OSUCOM has implemented implicit bias training and increased female representation in the classroom and the medical center. However, 78% of leaders at the college are still men, and from personal experience, male students and physicians tend to not face the same difficulty garnering respect from patients and colleagues compared to their female counterparts (2).
On an individual level, male physicians can also take more responsibility. Historically, men do view gender equity to be important, but are unable to articulate why and have doubts about incorporating gender education into the medical curricula (14). Several male leaders also believe this issue requires too much time in an already packed medical school curricula, is presented in an unscientific manner, and focuses on “male bashing.” (14) These beliefs need to be changed. Male physicians need to see this issue as high priority since it directly impacts the overall quality of healthcare and need to be more active in opening dialogue with our female colleagues about their experiences and struggles. As suggested by the American College of Physicians, medical teams should routinely engage all faculty, including those in leadership positions, and check-in as a group to identify areas within healthcare that propagate gender inequity (15). Moreover, male physicians should promote leadership opportunities and increase female representation on search committees. If nothing else, male physicians should initiate uncomfortable conversations with patients and/or colleagues to prevent behavior that propagates gender inequity.
Overall, gender inequity continues to be a problem in medicine. We need to recognize the issue and refine our strategies to address the underlying causes. It is imperative for medicine that male medical students and physicians make gender inequity their own issue and champion for change.
References
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