Women in Medicine

There is a YouTube video of a U.S. Navy pilot making an aircraft carrier landing in bad weather that fascinates me.  It clearly takes skill, ability, and guts to put a $67 million jet down on a rolling and pitching deck.[1]  Very few people have those abilities and among them is Lt. Madeline Swegle, who in August 2020 became the Navy’s first Black female tactical aircraft pilot and, in the process, earning her Wings of Gold.

Just a few decades ago, Lt. Swegle wouldn’t have had the chance to fulfill her dream of becoming a naval pilot as the military branches did not believe that women had a place in combat, nor did they believe that women were physically fit or coordinated enough to handle combat equipment.  And being Black wouldn’t have helped as even in the 1980s and 1990s (and despite the proud history of the Tuskegee Airmen) few African-American men were chosen for pilot training.

For much of our country’s history women have been second class citizens and the fight to obtain equal status with men, legally and in the marketplace, has been a long journey which has still not ended.  I don’t remember a time when I thought women were less able than men.  It never crossed my mind because as a kid most of my adult role models were teachers and gender didn’t play a part in whether the science, math, or history teacher was a man or woman.[2]  And when I entered college most of my instructors held PhDs, so I assumed that female professors were just as competent as my male teachers.  When I went into the field of mental health, I worked with women who were nurses, psychologists, counselors, social workers, doctors, and administrators.  For example, in the 1980s I worked as the administrator of a large medical center serving a state psychiatric hospital.  I supervised the clinical support departments, many of which had female department heads, such as radiology and the laboratory and I worked closely with the medical center’s clinical director, a female physician. 

What I didn’t realize of course was that even with professional degrees these women did not have a level playing field.  For example, my brother met his wife in grad school, and both received their PhDs in medical research.  Later I found out that it was more difficult for my sister-in-law to obtain research grants than my brother.[3]   And there were other hints of gender inequality.  In my mid-twenties I worked in a bank.  All of the managers, assistant managers, and loan officers were (white) men.  The only position a woman could hold was secretary or teller.

Health care over the past hundred years provided plenty of opportunity for women, primarily as nurses, secretaries, laboratory technicians, and other support staff.  However, medicine and health care administration were traditionally closed to women.  After applying to a number of medical schools, in 1847, Elizabeth Blackwell became the first woman in the United States to be accepted into a physician training program.  Apparently, the dean and faculty of Geneva Medical College could not agree on her admission, so they asked the 150 male students to vote on it, with the understanding that the vote to accept had to be unanimous!  Blackwell graduated with her medical degree in 1849 (there was no systematic medical school curriculum in the 1800s so medical education programs varied in duration and content), but her accomplishment did not change the medical profession’s antagonism toward women.[4] 

Progress, in regard to being accepted into medical school and the male dominated medical community was slow:

“Institutional backlash can be considered one of the causes of the decline in the percentage of women physicians after about 1900. Many previously coeducational schools returned to the policy of excluding women. Four percent of all medical graduates in 1905 were women, but women constituted only 2.6% of medical graduates in 1915. In 1955 less than 5% of medical graduates were women. At Johns Hopkins, the percentage of women students dropped from 33% in 1896 to 10% in 1916. Women who did get through medical school then found it virtually impossible to get into hospital internship and residency programs.”[5]

The women’s movement of the 1970s was probably the catalyst for change as medical schools were pushed into explaining why they were rejecting so many female applicants.  Consequently, by the 1990s nearly 40% of medical school students were women.  Today, more than half of all medical students are women and women make up about a third of physicians currently in practice.

While those numbers reflect advances in gender equality, all is not good news.  For example, when it comes to salary women continue to earn less than their male colleagues.  In part, this is due to women gravitating to lower paying specialties, such as pediatrics, family practice, internal medicine, and women’s health.  According to the Medscape Annual Physician Compensation Study, average annual compensation for a doctor of internal medicine, regardless of gender, was $248,000 compared to cardiology at $459,000.  Forty-four percent of doctors of internal medicine are women compared to just 14% in cardiology.[6]

Nonetheless, the Medscape study found that among the specialties men continue to make more than women – $269,000 for men who specialize in internal medicine compared to $211,000 for women and among all specialists, $376,000 for men compared to $283,000 for women.[7]

There are a number of other reasons why women physicians may earn less than men, for example, one study found that women doctors tend to spend more time with their patients than men, which means they see fewer patients in a day and thus have fewer billable hours.  That’s true of my primary care physician, who is a man; he’s told me that he has to work longer hours to make up the difference but is willing to do so to have a productive relationship with his patients.[8]

The bottom line, however, is that the gender pay gap can also be traced back to gender bias, either overt or unconscious.  For example, a study of unequal compensation among Canadian physicians, where doctors are paid based on a fixed scale, found that male doctors were more likely to receive referrals for complex surgeries, which pay at a higher rate, than their female counterparts.[9]  This appears to be based on the belief that women are not as skilled as their male colleagues regardless of the female doctors’ abilities and years of experience – apparently they haven’t heard of Navy aviator Lt. Madeline Swegle.  Bias also appears to be why women physicians receive smaller bonuses when they work for corporate medical practices.[10]

Because the bias is institutional, one way to counter it is to change the institution.  Although women now make up nearly half of all practicing physicians, the American Medical Association’s Board of Trustees is still dominated by men – 13 men to just 7 women members.  (That’s better than the gender composition of the Republican Party in Congress, where only 14% of Republican representatives and senators are women.)  For example, by becoming more active in AMA activities and politics, women should strive to have equal representation in their professional association and their board, and the decisions made by that group.

In the late twentieth century, the Virginia Slims brand of cigarette marketed their product to women with the slogan, “You’ve come a long way, baby.”  Today, the slogan would be considered offensive, first by labelling women as “baby” and of course by pushing a product to women that causes cancer.  Similarly, women have come a long way in regard to their place in the field of medicine, but as the gender pay gap illustrates, not nearly far enough.

[1] F 18 carrier landing in bad weather and low visibility Military videos – YouTube

[2] The same was true for race, i.e. if my science teacher was an African-American I presumed they were just as qualified as a whiter person.

[3] The situation hasn’t changed.  A 2020 study found that women researchers make about $63,600 less than their male counterparts: Women paid less than men even at highest levels of academic medicine | News Center | Stanford Medicine

[4] Elizabeth Blackwell – Wikipedia; 1864, Rebecca Lee Crumpler became the first African-American woman to become a physician.

[5] Medical Education for Women during the Nineteenth Century | Encyclopedia.com

[6] Gender income disparities exist in other medical professions, such as pharmacy, clinical lab, optometry, etc., but not to the extent it does for medical doctors.

[7] Medscape Physician Compensation Report 2021: The Recovery Begins

[8] Female Physicians Spend More Time With Patients Than Male Doctors Do, But Earn Less : Shots – Health News : NPR

[9] What’s driving the gender pay gap in medicine? (nih.gov)

[10] Why do female physicians earn less than men? Here’s what the women had to say | FierceHealthcare

Leave a Reply

Your email address will not be published. Required fields are marked *