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April 2013 Bulletin: Women in Medicine

Is Medicine (Still) a Sexist Profession?

Suzanne Koven MD

Suzanne Koven MD

When I was growing up in the 1960s, at the height of the Cold War, there was always some smart aleck boy on the playground who had "facts" to share about the Soviets. His recitation was meant to emphasize how weird, how different, how other our arch enemies were. "They make you wear all brown and gray there." "They eat only boiled cabbage and potatoes." "They tell you what to say and think." And the zinger: "The doctors there are all women."

What a strange place indeed, where the doctors were women! So unlike what I knew. In my world, or at least in my neighborhood, the doctors were men. These included my dad and his male friends, nearly all of them M.D.s. Those who weren't surgeons or the occasional psychiatrists or obstetricians were called "medical men" — that quaint old term for those who practiced internal medicine.

There were no "medical women."

I did have two role models, female members of my future profession. One woman's picture appeared in my father's medical school yearbook.That lone female pioneer in the class of 1943 was mousy and bespectacled — sort of like Bette Davis in Now Voyager, before she meets Paul Henreid. Somehow, even as a very young girl, leafing through the yearbook, I assumed that no handsome lover awaited my father's classmate. She had made her choice -— she had chosen a medical career over a husband and family.

Isn't that awful that I assumed such a thing? But how could I not? The only other female doctor of whom I was aware was our next door neighbor. She had trained as a pediatrician in the same hospital where my dad had done his orthopedic residency, then left medicine when she had kids. She spent her days in the kitchen in a June Cleaver shirtwaist dress, caring for no one's children other than her own — and me, when I came over to play.

The message, which no one ever delivered to me directly, was that women were not meant to be doctors.

And yet.

When it came time for me to choose a career, in the early 1980s, the world, and my world, had changed — dramatically so. My mom, a housewife, had started law school when I entered ninth grade. The woman next door brushed up on her skills and now practiced in a clinic. Because of them and millions like them, when I graduated from (a previously all-male) college, it didn't occur to me that I couldn't do any kind of work I wanted to do — plus have a family.

That's pretty much how it has played out. The few instances of overt sexism I experienced in medical school and beyond have been so rare that they are the proverbial exceptions that prove the rule. There was that urologist who told me no self-respecting man would let a woman near his genitals with a knife. And then there was that patient who wouldn't drop his drawers for me in the E.R. — at first. I did overhear a fellow house officer tell someone that I'd been chosen chief resident because of tokenism. (Okay, that one hurt).

But as my career progressed, even these kinds of isolated incidents ceased. I found my male colleagues mostly respectful, and male patients rarely balked at seeing a female doctor. Occasionally, perhaps having heard that we're better listeners, men now even request a woman doctor. While women in medicine are still more likely than men to cut back on work to care for young children (and more likely to choose lower paying fields like primary care) and thus often make less money than male colleagues, it's a choice many of us feel lucky to be able to make.

No wonder women now make up fifty percent or more of medical school entering classes. It's a long way from 1943.

And yet.

There's still sexism in medicine.

And it's not just something we more mature female physicians remember from early in our careers. A recent thread on the Student Doctor Network about sexism experienced by female medical trainees and even pre-meds generated vigorous participation — including by young women headed for med school who recounted being asked what kind of nurse they planned to be, or being told "you're too pretty for that."

There's a gender gap between male and female physicians' salaries and, as this JAMA article suggests, the difference isn't entirely due to specialty choice or decisions to work part- time during childrearing. Even adjusting for these factors, men make an average of $12,000 more than their female medical colleagues.

Women who do choose to work part-time may face backlash, as seen in a 2008 Businessweek article titled "Are There Too Many Women Doctors?" or in this much-discussed 2011 New York Times Op-ed piece, "Don't Quit This Day Job." In the latter, a female anesthesiologist chastises women, particularly those in underserved fields such as primary care, for working part-time. (In my rebuttal to the Times piece, I pointed out that the fastest growing group of doctors who work part-time actually comprises men approaching retirement).

There's also still sexism against female patients. We may have moved beyond the days of the most egregious paternalism, but women are still more likely than men to have their symptoms attributed to psychological factors, and especially more likely to have symptoms of heart disease misdiagnosed as "stress." Funding for research in women's health still lags, and health care access, especially for poor women, remains suboptimal.1

Perhaps the most pernicious kind of sexism in medicine, though, is the notion that as more women become physicians, the profession will become diminished. An editorial in the British Medical Journal explored this argument in 2012 — though I've heard it elsewhere. The idea is that increasing numbers of women in medicine will "emasculate" the profession, rob it of influence, rigor, and fully committed professionals.

I heard something like that on a playground fifty years ago.

I thought it was pretty dumb then, too.

1Healthcare Quality and Disparities in Women

Suzanne Koven M.D. received her B.A. in English literature from Yale and her M.D. from Johns Hopkins. She also holds an M.F.A. in nonfiction from the Bennington Writing Seminars.She has practiced primary care internal medicine at Massachusetts General Hospital in Boston for over 20 years. Her essays, articles, blogs, and reviews have appeared in The Boston Globe, JAMA, Psychology Today, The Rumpus.net, and other publications. Her book, Say Hello to A Better Body: Weight Loss and Fitness for Women Over 50, was released in May, 2012. Visit her web site www.suzannekovenmd.com. Email her at inpracticemd@gmail.com.

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