Opportunities for Women

There are three major issues facing women in medicine today, namely (1) professional acceptance, (2) gender bias, and (3) family.

Professional Acceptance

A significant conference entitled “Woman MD” was held at Johns Hopkins University School of Medicine. In attendance were 200 female doctors from across the country who met to study the impact of the increase in the number of women entering medicine. Among the major issues raised were that:

1. Women physicians were looked down upon for showing feelings of tenderness and sadness toward patients and their families, thereby violating what is considered implicit medical standards of behavior. It was pointed out, however, that demonstrating sensitivity and compassion is not incompatible with the need for the doctor to also demonstrate strength.
2. Women physicians often enter specialties they did not originally want because of various family obligations.
3. Women physicians, especially young ones, were concerned that they would not be able to have both a career and a family unless they found a mate who would help with the housework and child rearing — or unless they were untiring “superwomen.”

In a summary of the symposium, the women doctors were warned of two separate “pitfalls”: an intolerance of the emotional responses of the other sex in times of stress and possible discrimination if they tried to change the medical system too much.

In general, the attitude of young women physicians toward their professional futures is optimistic. The forces responsible for changes have been the trail-blazing efforts of older women, together with changes in societal values and laws. Having become firmly convinced that medicine is a suitable career choice, more and more women are applying to medical schools and discriminatory barriers are falling.

Gender Bias

In the early 1990s several medical journals published the results of surveys among female medical students and residents regarding harassment. The results indicate that between 50 and 75% experienced some form of gender discrimination. The offensive behavior took the form of denied professional opportunities, malicious gossip, sexist slurs, and even sexual advances. Surprisingly, harassment varied with different fields, being most prevalent in general surgery and least in pediatrics. Students were reportedly harassed by both faculty and residents. While harassment during medical training is quite common, women face this issue more intensely because of their gender. The hierarchical nature of the medical power structure, with men in the upper echelons, is thought to contribute to this problem.

Gender bias impacts on women negatively, both directly and indirectly. It may slow their advancement, thereby keeping them in a lower pay scale, and may also be psychologically damaging enough to lower self-confidence and sometimes work performance.

Efforts are being made to curtail harassment. This includes periodic publication by the medical school of its policy against discrimination, presenting “Gender Neutral Awards” to faculty who are especially sensitive to gender issues, establishing workshops where the relationship between genders are discussed, sponsoring lectures, publishing newsletters, and providing support groups.

Family

A recent survey indicated that about 10% of female medical graduates had one or more dependents. This represents about 3,000 medical school students. While the issue of childbearing during medical training years has long been known to educators, little progress has been made to satisfactorily resolve it. The problem is being addressed on an ad hoc basis, which may in some cases provide for flexibility, rather than by having written institutional policies addressing maternity leave. As the percentage of women medical students increases, this issue will probably be brought to the forefront.

There is conflicting advice being offered on preparing for parenting, with some advocating preparation, while others emphasizing the importance of the need to adapt as problems arise. Certainly, medical residents, who frequently are guaranteed about six weeks of parental leave, should advise their program directors well in advance so that adequate coverage during their absence can be provided. It should be noted that a substantial number of residency programs do not have written parental leave policies and that those that do vary.

Of special significance are the child-care arrangements that are made prior to delivery. In most cases where a day-care center or other facility has to be used, the availability of a backup care provider is still essential. A supportive spouse is a key element in the quest to attain successful parenting.

There appears to be no ideal time for a woman physician to have a child. Young children may make it difficult to pursue her studies and training, and she may be at a financial disadvantage during that part of her life. Conversely, delaying child bearing may result in infertility as a result of normal age-related changes. This is a highly personal choice, and individual circumstances will influence it. Young women, perhaps, should seek the advice of older women physicians as they make their plans.

For additional information see:

Journal of the American Medical Women's Association, May/June 1992.

Working and Parenting by B. Brazelton, Addison-Wesley, 1985.

Day-Care: Finding the Best Child Care for Your Family, American Academy of Pediatrics, Dept. C/H, 141 NW Point Blvd, Elk Grove, IL 60007.

Medicine and Parenting, 1991, and Building a Stronger Women's Program, 1993, AAMC Publication Sales, 2450 N Street NW, Washington, DC 20037.

Bottom Line

• • Currently at least 50% of all applicants to medical school are women.
• • Currently, almost 50% of all those admitted are women.
• • Given the above situation, it is anticipated that half of all prospective residents will be women, but their distribution among the specialties will vary greatly.
• • Women are admitted to all U.S. medical schools. The last remaining all-women medical school accepted its first male students in 1970.
• • Women tend to not do as well as men on the basic science segment of the licensing exam. In the second and third parts, which are clinically oriented, the gender gap apparently disappears.
• • Women medical students appear to experience more stress than males, which may be manifested as depression, increased alcohol use, and personal problems.
• • More than half the women specialists are board certified.
• • The number of married women entering medical school is low (about 15%). By graduation this number usually doubles.
• • Women predominantly favor specialization in pediatrics, psychiatry, family practice, and obstetrics/gynecology. Only very limited numbers are seeking postgraduate training in general surgery and consequently, any of its subspecialties.