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GENDER EQUALITY IN THE MEDICAL FIELD

Gender Equality in the Medical Field Jade Boyd New Mexico State University

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The medical field is one of the most competitive fields, with 53,042 applicants to the 2016-2017 cycle and only 21,030 students accepted (Association of American Medical Colleges, 2017). The type of person it takes to become a doctor, needs not only be smart, but also a people person, strong willed, compassionate, brave, and innovative. What kind of woman does it take to become a doctor? Women choosing to become doctors have to be all that men are and more because of gender inequality. Despite the progress that has been made to support women in medical careers, female physicians are still not being treated as equals to their male counterparts. This essay will discuss the discrimination women in medicine face, why there is such discrimination in medicine, and how the system can adapt to eliminate it. It is no secret that there are fewer women in medicine than men. As of October 2017, there were around twice as many male doctors than there were female doctors in the United States with men totaling in at 623,054 doctors and women at 326,902 (Kaiser Family Foundation, 2017). What do these numbers mean for women who are in the medical field? They give men comfort that they are the majority and with this, the opportunity to say and do things they aren’t held accountable for. Dr. Elise Barney stated in an interview about her experiences of sexism that she had to listen to her male coworkers and superiors “make sexual comments about female patients or nurses. This was considered regular surgeon ‘locker room talk’ and was basically accepted as the norm” (Cooper, 2017). She recalls a dinner she had with her boyfriend who was also a radiology resident. Also in attendance were his fellow residents who were all male and an older male attending physician. She was the only woman and remembers “the conversation centered around how much they disliked women in the workplace” (Cooper, 2017). They went on to complain “that they ‘wouldn’t have any problems’ if [all] radiologists were

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men” (Cooper, 2017). Would they have felt as comfortable saying this if more women had been present? Low numbers of women in the workplace doesn’t just cause social discomforts, but also an unequal visibility of women. According to author and scientists, Susan V. Rosser, the “visibility draws attention to successful performance, but also spotlights errors” (Elbert-May, 2005). Some may say that this would be a benefit for women, since their success recieves more praise, but women are not asking for more praise. Women are asking for equality. Arguing that our successes receiving more attention outweighs our errors receiving more attention is the equivalent of arguing that because women don’t have to pay for their drinks at a bar, they shouldn’t be upset when they are sexually harassed by whoever paid for said drink. This argument also strips away the fact that inequality in medicine goes further than just being outnumbered and spotlighted. The discrimination isn’t just being perpetrated by coworkers and superiors. In Dr. Barneys interview, she mentions how even the nurses, who were mostly female, chose to favor the male residents and ignore the female residents. To her “not only was this disrespectful, but it also compromised appropriate patient care” (Cooper, 2017). Appropriate patient care should be the number one concern to everyone one who works in a hospital. A study was conducted in Germany surveying medical students of both genders and again 15 years later to investigate “the gender differences in long-term effects of education, work experience… and number of children on career success in medicine” (Evers & Sieverding, 2013). The study found that “high final grades at medical school were significantly and positively related to salary but only for men” (Evers & Sieverding, 2013). This along with the findings that number of children was negatively related to career interruptions for men yet

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positively related to them for women further proves that women are not being seen as equal to men in the same situations as them. The scientists cited that “female physicians earn less than their male counterparts in both the United States (Bashaw & Heywood, 2001) and Germany, where in 2006 female physicians in full-time employment earned 24% less than male physicians in the same position (destatis, 2008)” (Evers & Sieverding, 2013). This study gave three ways in which female doctors from the same medical school are being treated as lesser than their male counter parts: correlations of grades to salary, correlations of children to career interruptions, and pay gap. Why are women with the same education and backgrounds being treated differently? It isn’t because women are lesser doctors. According to an article published by JAMA, a prestigious and expensive medical journal, women are actually better physicians than men. Due to its prices, I could only get ahold of the abstract but that was more than enough to learn about a study which looked at the mortality rates of patients and its correlation to gender of their physician. The study “found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.” (Tsugawa, Jena, & Figueroa, 2017) Not only are patients of female doctors living longer and coming back to the hospital less, “female physicians more likely to adhere to clinical guidelines and evidence-based practice” (Tsugawa, Jena, & Figueroa, 2017). This means that women are not just as good as men in their field but are excelling and surpassing them. Although all of the previously mentioned methods of discrimination are terrible things women in medicine endure, they are not the worst of it. The dark and rarely spoken of consequence of ignoring sexism in the medical field is women being sexually assaulted and harassed. In 2015, the Royal Australasian College of Surgeons appointed an expert advisory

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group to research sexual harassment and discrimination. It was found that “Nearly half of all surgeons across all specialties have experienced discrimination, bullying, or sexual assault” (Scott & Matthews, 2015). The research also presented direct quotes from victims the most chilling being, “I was expected to provide sexual favors in his consulting rooms in return for tutorship” (Scott & Matthews, 2015). Not only was sexual harassment found, but also discovered was unfair treatment of pregnant doctors. One woman was required to work 30 hour shifts in the final weeks of her pregnancy. Another had to make up maternity leave when other doctors who had taken other types of leave were not required to make it up. One woman was even told she would only be considered for the job if she had surgery to prevent her from having children. All of these instances are illegal but the women did not feel safe reporting because “the people responsible for complaints were often the perpetrators” (Scott & Matthews, 2015). And when women do report it, they suffer. Surgical resident Caroline Tan was sexually assaulted by neurosurgeon Chris Xenos in 2005. She informed the head of neurosurgery Dr. Banks “to which he is said to have responded with words to the effect of ‘what do you expect when you dress the way you do?’” (Clarke, 2006). She ultimately did win the court case but had trouble finding residency to complete her education because she was “labeled, not as a victim or a brave woman who spoke up, but as a troublemaker” (Bhatt, 2015). Scientists and doctors are some of the most educated people in our society. Why then is discrimination still an issue among them? At the Society for Neuroscience conference, molecular biologist Jo Handelsman presented “findings from hundreds of studies conducted over 30 years, including her own work, that show the depth of bias problems in the scientific community in virtually every aspect of hiring, pay, opportunity, publication and tenure” (Wan, 2017). Handelsman believes that scientists are blinded to their own bias. When she speaks to prestigious

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institutions “the most common response [is] bias may exist in other places but ‘it’s not like that here’” (Wan, 2017). This type of bias is known as Blind Spot Bias. It is when you become biased “because you think you are less biased than everyone else” (Practical Psychology, 2016). It would make sense that scientists and doctors believe they are less biased because of their careers but once they begin to think that, they give themselves the opportunity to become biased and make biased decisions. There is without a doubt a problem that needs to be solved and quickly before more women are hurt and mistreated, but solved by whom? Sue V. Rosser says, “the problem is not with women, but with the institution of science as currently practiced” (Elbert-May, 2005) and she is correct. Women can help by making changes within themselves, checking themselves for bias and making sure to not favor men like the aforementioned nurses who compromised patient care. A helpful tip for women in the medical field who are currently struggling is to “create a small, empowering environment within a larger hostile environment” (Elbert-May, 2005). What should the institution of science do? When Handelsman speaks to institutions about bias, she gives “steps to ensure equality in the field today and in the future generation of scientists” (Wan, 2017). She wants us to plan ahead and “identify your criteria for hiring before reviewing applications to prevent after-the-fact explanations for biased hiring choices” (Wan, 2017). Adopting “a blind review process at scientific journals” (Wan, 2017) can immensely decrease bias and have already been successful, “after a blind review process was adopted at one ecology journal in 2008, the number of papers published by women increased by 30 percent” (Wan, 2017). Handelsman also wants us to “make bias part of larger regular discussions with colleagues so that …everyone is held accountable” (Wan, 2017).

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Despite these great ideas for progress, more needs to be done to end gender inequality in medicine. We as individuals need to hold ourselves accountable. No matter how smart you are, no matter how educated, no matter if you are a minority: remember that you can be biased. Admit when you’re biased and take action to make up for it. Call out your friends when they are biased too because a bystander holds blame just like a perpetrator. Institutions, journals, and any group in a place of power in the science community: make a change. These organizations choose to hide their discrimination instead of openly admitting it and working towards a better future because of shame but wouldn’t it be better to be the first medical school with truly no sexism, than just another institution hiding it. Think of the women, not just students and not just future doctors but actual people. People who are being sexually harassed, who are scared to come forward because they might lose everything they’ve worked so hard for. People who work harder than their peers for less money all while being belittled by their coworkers and superiors. I call on institutions to realize they are harboring an environment for this to happen. Medical schools, surgeons, scientists, administrators, deans, science journals, hospitals: you have more resources and more education than anyone else in our society and you haven’t thought of and put into action a solution for this immense problem? Do better. It takes individuals to make up society, so start the change with yourself, but don’t let it end with yourself too.

GENDER EQUALITY IN THE MEDICAL FIELD References Association of American Medical Colleges. (2016, June 12). [Table A-16: MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools, 2016-2017]. Unpublished raw data. Bhatt, K. (2015, December 14). What Sexism in Medicine Looks Like. In-Training. Retrieved November 19, 2017, from http://in-training.org/sexism-medicine-looks-like-10280 Clarke, A. (2006, December). Sexual harassment may not just be a court case. Aitken partners. Retrieved November 19, 2017, from http://www.aitken.com.au/news-blog/news/sexualharassment-can-run-deep Cooper, J. (2017, April 26). Q&A: Discussing the Ugly Truth of Modern Sexism in Medicine. Medical Bag. Retrieved November 13, 2017, from http://www.medicalbag.com/lifestyle/discussing-the-ugly-truth-of-modern-sexism-inmedicine/article/652959/ Distribution of Physicians by Gender [Advertisement]. (2017, October). Retrieved November 19, 2017, from https://www.kff.org/other/state-indicator/physicians-by-gender/? currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc %22%7D Elbert-May, D. (2005). The Science Glass Ceiling: Academic Women Scientists and the Struggle to Succeed. [Review of the book The Science Glass Ceiling: Academic Women Scientists and the Struggle to Succeed.]. Science Education,89(2), 348-350. Retrieved November 5, 2017, from http://libezp.nmsu.edu:2238/doi/10.1002/sce.20074/epdf Evers, A., & Sieverding, M. (2013). Why do Highly Qualified Women (Still) Earn Less? Gender Differences in Long-Term Predictors of Career Success. Psychology of Women Quarterly,38(1),

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93-106. Retrieved November 13, 2017, from http://libezp.nmsu.edu:2298/doi/full/10.1177/0361684313498071 Herbst , A. (2016, October 4). This is the kind of sexism women who want to be doctors deal with in med school. The Washington Post. Retrieved November 19, 2017, from https://www.washingtonpost.com/posteverything/wp/2016/10/04/this-is-the-kind-of-sexismwomen-who-want-to-be-doctors-deal-with-in-med-school/?utm_term=.32dd594cd811 Practical Psychology (Director). (2016, December 30). 12 Cognitive Biases Explained - How to Think Better and More Logically Removing Bias[Video file]. Retrieved November 19, 2017, from https://www.youtube.com/watch?v=wEwGBIr_RIw Scott, Sophie, and Alice Matthews. "Culture of bullying, sexual harassment widespread among surgeons, report reveals." The ABC, September 9, 2015. Accessed November 13, 2017. http://www.abc.net.au/news/2015-09-10/damning-report-reveals-bullying-harassment-amongsurgeons/6763490. Tsugawa, Y., Jena, A. B., & Figueroa, J. F. (2017). Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians [Abstract]. JAMA Internal Medicine,206-213. Retrieved November 10, 2017, from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2593255 Wan, W. (2017, November 13). Scientists struggle with sexism and racism: ‘We think these bias studies don’t apply to us’. The Washington Post. Retrieved November 13, 2017, from https://www.washingtonpost.com/news/speaking-of-science/wp/2017/11/13/scientists-strugglewith-sexism-and-racism-we-think-these-bias-studies-dont-apply-to-us/? tid=sm_tw&utm_term=.304fea635d51...