“Do you like vagina?”
A resident physician asked me that when I was a third-year medical student in New York two years ago. He took obvious pleasure in making me squirm. I had just started hospital rotations after two years in the classroom, and over lunch, we were discussing possible areas of specialization, including internal medicine and obstetrics/gynecology. Later that week, while we checked in on patients, he told me, “You’re not wearing make-up today. Maybe you should rethink that choice.”
A few months after that, I was in the operating room with an all-male surgical oncology team. Their skill during long hours of surgery was impressive, but their “bro talk” was disgusting and ostracizing. Over the exposed hepatoduodenal ligament of one anesthetized patient, the attending surgeon’s eyes widened and locked with mine. He took a deep breath and cried out to the assisting resident surgeon, “Splay it open like a Russian whore!” He held eye contact with me and smirked, waiting for my reaction. I somehow found the wherewithal to return his gaze and reply, “I assume the whore in question is a man, no?” I didn’t ask him for a letter of recommendation.
Sadly, these were not isolated experiences. The medical profession is rife with daily indignities and structural bias against women. Because every woman who becomes a doctor has to go through training that’s still rife with sexism, this is a serious problem for the entire profession.
While sexist banter during surgery may seem mostly harmless, the extent and frequency of it, and the aggression towards women it communicates, is a real problem. There are also insidious, subtle signals that female physicians contend with daily. My young female colleagues and I are constantly mistaken for nurses by patients and visitors, only because we’re women. We are referred to as “girls” by patients and medical colleagues alike, while our male counterparts are “young men” or just “men.” The most disheartening sexist assumptions are the ones I make, though — I find myself unthinkingly asking patients, “Who is your primary care doctor, and do you have his phone number?” Even as a physician myself, I have somehow internalized the idea that the profession still belongs to men.
Yes, there are more women in medicine than ever before. But studies estimate that between 30 and 70 percent of female med-school faculty experience gender-based discrimination. A culture like that has serious detrimental effects on women. Those who experience gender discrimination report lower career satisfaction. Female physicians have a higher rate of major depression than women with doctorate degrees in other fields. Overall, men commit suicide four times more often than women; female physicians, though, kill themselves at a rate equal to male physicians.
I eventually chose to specialize in internal medicine. As I interviewed for residency across the country, I was discouraged by how few female department chairs of medicine I encountered: In 12 interviews, I met only one. Just 12 percent of internal medicine department chairs nationally are women, according to the Association of American Medical Colleges. Of the 294 surgical department chairs across U.S. medical schools, only 1 percent are women, and only 22 percent of full-time professors. Even in more female-friendly fields, like OB-GYN, the disparity is clear: 83 percent of residents entering OB-GYN are women, but only 22 percent of the department chairs are.
Female physicians do not advance or get promoted like men do. In the 1990s, women began graduating from medical school at rates roughly equal to men, and this was supposed to lead to equal representation in academic leadership down the line. That hasn’t happened. Women now make up 46 percent of medical school applicants, students and residency trainees, but only 38 percent of medical school faculty, 21 percent of full professors and 16 percent of deans. This is progress, but it’s too slow. In fact, the percentage of new female tenured faculty has stalled at 30 percent in the past few years, and fewer women are now applying to medical school.
If you are a woman who manages to advance in your career in medicine, you can expect to be paid less for equal work. A study of some of the most prominent public medical schools published this summer found that female doctors working there are paid 10 percent less a year — $20,000 — than their male counterparts, after adjusting for a variety of factors that influence pay. In some fields, like neurosurgery and cardiothoracic surgery, the discrepancy is as large as $44,000 a year. If you are a female full professor, you probably make the same salary as a male associate professor, despite outranking him.
Just as we want our little girls to feel free to dream to be president, we should want our female physicians to aspire to be deans, chairs and leaders in their fields. How can we treat our patients fairly when we don’t equally respect each other?