UO > Feature > Respect More than Money

When Leslie Lundt, MD, was getting dressed to go into the operating room as a resident at Johns Hopkins in the mid 1980s, two dressing-room options were available to her: She could enter the doctors’ side or the nurses.’ She chose to enter the dressing room for doctors. “It’s not really my style to make a stink,” says Lundt. “But the next day, the signs had been changed.” After that, the signs read “men” and “women.”

For years now, women have been challenging men’s domain in medicine. Although it was 1849 when Elizabeth Blackwell became the first woman to receive a U.S. medical degree, as late as 2003 only 25.8 percent of practicing physicians were women, up from just 7.6 percent in 1970, according to data from the American Medical Association.

Lundt is now a psychiatrist in private practice in Boise, Idaho, but she grew up on the south side of Chicago, an area she describes as having been “very traditional.” Accordingly, she saw her career options being limited to either teacher or nurse. Her third-grade teacher was a bit more far-sighted.

“She said, ‘Why don’t you want to be a doctor,’” Lundt says. “This was the biggest newsflash to me—that a girl could be a doctor. I had never heard of a female doctor before. I had no idea.”

The times, they are a-changin.’ According to the American Association of Medical Colleges, slightly more women (18,015) than men (17,712) applied to medical school in 2004; women comprise 49.5 percent of the class admitted for the 2004-2005 academic year. And of the 15,996 individuals who graduated in 2004, 45.9 percent were women.

Though the number of women in medicine may be increasing, the gender gap is still wide, more acutely experienced by some than others, but well documented nonetheless. In fact, three studies published in the last five years chart a lack of respect afforded women physicians—by female nurses. In addition, compensation tends to be unevenly skewed toward men and professional advancement (especially in academic medicine) seems halted for women by a glass ceiling.

As with all sweeping generalities, though, there are exceptions to the rule. While gender discrimination may have run rampant 30 years ago, institutional supports as well as the sheer number of women in the workforce —certainly many more than in previous decades—may be changing the face of medicine today.

When Annabel Barber, MD, a general surgeon at University Medical Center in Nevada,

interviewed for her residency in Alabama in 1984, she was told point blank they had never hired a woman but they might be willing to give her a shot. She declined and instead went to work at Cornell Medical Center in New York.

“I didn’t want to be their experiment,” she says. The chairman at Cornell himself was married to a physician. Barber has worked with him ever since.

Recently, a national company with which Barber has worked in the past approached her regarding a course on hernias they wanted her to teach. She made plans to teach it before representatives from that company told her they’d changed their minds; “Men didn’t want to be told how to do operations by women,” Barber says she was informed. “I thought to myself, ‘Repeat that, please. Did you just say that?’” She asked to keep the company’s name private.

Kathryn Stewart, MD, the medical director for care management at Chicago’s Mt. Sinai Hospital, remembers working for a private sector HMO in California where the majority of her colleagues were male. The men would take two-day deep-sea fishing trips—on company time even—which the women physicians were officially eligible to join, but when Stewart organized a monthly dinner for women in medical management, she was told to “cease and desist” because the men in the office were uncomfortable with the women meeting without them.

Their experiences don’t seem uncommon. Many women physicians have stories regarding gender-based discrimination at work. Additionally, many also seem to feel they must work harder than their male counterparts to prove themselves.

Some also may feel they have to work harder to be paid the same salary as men. A study published in the June 2000 Journal of General Internal Medicine details the results of the Physician Work Life Study, a nationally representative random stratified sample of 5,704 doctors in primary and specialty non-surgical care. The survey contains 150 questions assessing career satisfaction and other aspects of work life.

Among the study’s findings: Mean income for women is approximately $22,000 less than that of men. Incidentally, women are 1.6 times more likely to suffer burnout than men.

A more notorious example of gender inequality in medicine arises in terms of academic rank.

The field of academic medicine may seem particularly unjust to women physicians. In the August 2004 Annals of Internal Medicine, an article titled “Compensation and Advancement of Women in Academic Medicine: Is There Equity?” finds that “female medical school faculty have not advanced to senior academic ranks and positions in proportion to their numbers in academic medicine.” The report states that among the 1,814 faculty respondents (of both sexes, from 25 randomly selected schools across the country), 66 percent of men but only 47 percent of women with 15 to 19 years of seniority were full professors. (Logistic models accounted for many other professional achievements, including total publications, hours worked per week, department type, etc.) As academic rank increased, the number of women represented declined.

In fact, certain specialties—such as emergency medicine and orthopaedic surgery—actually reported a decline between 1995 and 2000 in the percentage of full professors who are women.

Another study, commissioned in 2000 by the dean of the College of Medicine at the University of Arizona called “Generating Respect for All in a Climate of Academic Excellence” (GRACE), shows large differences in perception of treatment of male and female physicians. The data showed that 28 women faculty were under-compensated. They subsequently were
given raises.

Diane Magrane, MD, believes that these days, the real discrimination that happens in the medical workplace is the result of the system itself. Magrane, who is associate vice president for faculty development and leadership programs at the Association of American Medical Colleges, says that faculty physicians’ workloads are enormous and women, who tend to be more committed to their families and communities than men, are finding themselves stretched thinner and thinner.

“Women have a tendency to perform more service, to spend more time with patients, and still in 2005, to have the primary responsibility for the family,” Magrane says. “And when you drop that into this system, set up in the 1800s, it creates an environment that’s disrespectful.”

She goes on to clarify that it’s not men who are ‘disrespectful’ toward women. It’s a system that “favors men’s accomplishments more than women’s, particularly if men have someone else who’s taking responsibility for the family.” But, she says, men are starting to take more responsibility for their families. “Society is changing.”

Additionally, the system for advancement in academic medicine is changing.

“The system that relied on individual negotiation with your boss for increases in salary is giving way to a system that is much more transparent in terms of the resources and salary everyone is given,” Magrane says. Also, the system of how faculty advances in rank is changing. For example, some schools are increasing the length of time that everyone—men and women—has to complete the requisite amount of research and publications to achieve tenure.

“The good news is that the discrimination from the ‘50s, ‘60s, and ‘70s is no longer a part of people’s value systems and our culture,” Magrane says, pointing out that she believes we’ve gotten rid of overt discriminatory behavior and language, such as the phrase that women are taking men’s places in medicine. “What we’re left with, though, is the system in which we work, which is inherently discriminatory.”

While some may believe the discriminatory practices of individuals in medicine have ceased, studies have shown that female doctors often have a hard time gaining respect, not necessarily from their physician peers but from female nurses.

According to a Norwegian study published in the journal Social Science and Medicine in 2001 (“The Doctor-Nurse Relationship: How Easy is it To Be a Female Doctor Cooperating With a Female Nurse?”), female doctors are often afforded less respect and confidence from nurses and given less help than their male colleagues. Indeed, the physicians surveyed saw the nurses as trying to cut them ‘down to size.’ According to the study, the female doctors perceived that the female nurses were targeting women physicians because they saw them as more of an equal match.

Additionally, a Canadian study published in the February 2003 International Journal for Equity in Health looked at the same relationship, this time from the nurses’ point of view. It found that nurses were more willing to serve and defer to male physicians. The nurses approached female physicians on a more egalitarian basis and were more comfortable communicating with them, yet the nurses were also more hostile toward them. The article noted that the “elimination of the power differential of gender” was a cause of this hostility.

Lundt, the psychiatrist, has experienced this lack of respect from female nurses. “Usually you go in and bond with the women in your workplace—but that certainly wasn’t the case,” she says of her residency, although she coped.

“My approach was always to be as professional as possible,” Lundt says. “My attitude was that this is a sisterhood [women in health care]. We have to stick together. We should be friends, we shouldn’t be fighting about this. This is crazy.”

Another study published in 2004 in the journal Academic Medicine looked at the attitudes of American female nurses and female residents toward each other. In many ways, it echoed the previous two studies, finding that for female nurses, occupation was secondary to gender, which makes gender the most important link between female nurses and female residents. On the other hand, for female residents, gender was secondary to occupation.

The study also noted dysfunctional communication patterns between the residents and nurses.

“(Female nurses) relate to you as a female first, and they also see you as an equal,” Stewart says. “They expect the men to give them orders.”

But, Stewart says, that attitude of physician as god is part of the problem.

“That’s part of what’s wrong with health care,” she says. “We need to learn to work collaboratively. A nurse needs to be able to stand up and say, ‘I don’t understand why you’re doing this.’ I’ve had nurses save my behind several times.”

Other physicians have noted that while they weren’t treated inappropriately by female nurses, “the male medical students got much more attention and service,” one doctor says. However, the same physician says she’s also noticed the same thing happening between female physicians and male nurses, noting that the exchange between doctor and nurse can be almost sexual.