Banner by Katherine Greener
The Mustache Index: Gender Bias in Medicine
by Jill McDonnell
In August 2015, Dr. Heather Logghe took to Twitter in frustration. As a female surgical resident, she was not being taken seriously as an academic surgeon. Why? She didn’t look like an older, white male. Overnight, the #ILookLikeASurgeon movement was born. Female surgeons from all over the world started sharing their stories of gender bias and sexism in the medical field. Quickly, the movement become one of great peer empowerment by both male and female physicians.
Females going into the medical field will almost certainly experience gender bias at some point in their careers, whether that be implicit or explicit. Due to historic gender trends, women in the health field are typically thought to be nurses. While those thoughts may be completely innocent, repeated commentary that undermines a female physician’s achievements leads to self-doubt, which can affect clinical judgement and opportunity for advancement.
Dr. Sara Myers, a fourth-year UPMC surgical resident and PhD candidate in Clinical & Translational Science, noticed that she would think differently and question her own clinical judgement more than her peers. Curious if this was something inherent to women physicians in training, she devoted her protected research time to studying the gender culture in surgery. Myers says that the biggest concerns from female peers are related to professional advancement. “I think that’s a very common theme: will I be taken seriously as an academic surgeon?”, noted Myers. “How hard am I going to have to work to convince someone that I’m just as good as the males in my program?”
Their concerns are not unwarranted. While women and men are going into medicine at the same rates, females make up only 30 percent of newly tenured academic positions, 16 percent of medical school deans and 15 percent of department chairs. Females are also much less likely to receive prestigious awards in their respective fields. JAMA Internal Medicine found that women physicians will make roughly $20,000 less per year compared to men with similar experience, caseloads, and research. The pay gap increases to about $40,000 in some specialties.
Dr. Mackenzie Wehner, a resident at the University of Pennsylvania, wanted to point out the ridiculousness of these statistics by comparing the number of women and men with mustaches in medical leadership positions. Wehner chose mustachioed men because they are rare – the latest data suggests 15 percent of men have mustaches, whereas half of those in medicine are female. Among the NIH’s top 50 funded medical institutions, women made up 13 percent of leadership positions while mustachioed men made up 19 percent. Women outnumbered mustaches in only six of 20 specialties examined. Wehner calls for the mustache index, or the number of females relative to the number of mustachioed males, to be ≥ 1. The current mustache index is 0.72.
Female physicians can have a harder time gaining the trust of some patients and colleagues, despite plenty of evidence that skill sets and competency do not differ among genders. At times, patients don’t realize that the female they’ve been talking to is the doctor, and some feel more at ease when a male doctor validates her opinion. On the contrary, a 2016 Harvard study in JAMA Internal Medicine showed that patients of female physicians had significantly lower rates of mortality and readmission. Myers thinks the media will be one of the key players in translating data like these into common public perception.
Because their knowledge and opinions are sometimes disregarded, female physicians are twice as likely to experience Imposter Syndrome, a phenomenon common among physicians in training where one doesn’t feel worthy to have a professional title or hold a seat in a program. Imposter Syndrome is one of the biggest predictors of psychological distress, so it’s no surprise that female physicians experience burnout at twice the rate of their male peers and complete suicide 2.5 to 4 times more often than the general population.
Discrimination heightens with pregnancy and motherhood. Peer evaluation scores are significantly lower for females who become pregnant during their residency programs, and these scores can have a large impact on letters of recommendation, fellowships, and end-of-residency awards. Going on maternity leave means that colleagues must pick up the woman’s caseload. Once returning to work, women have difficulty catching up on missed learning opportunities and finding a time and place to pump. One study from the University of Florida found that 47 percent of physician mothers who stopped breastfeeding before 12 months did so because of work demands.
And then there’s straight up sexual harassment. A powerful piece published recently on SurgeonMasters tells the tale of a female surgical intern who almost quit from a #MeTooMedicine encounter. One of her (married) chief residents touched her inappropriately several times and regularly made lewd comments about her looks, sex life, and lack of power. The female resident talked with many peers and supervisors about this issue, to which they all responded that there was nothing they could do. After the intern disclosed an unplanned pregnancy with a different man, the chief resident said he would not tolerate her pregnancy messing with his schedule and that she must get an abortion. “This program will not let you finish if you’re knocked up,” he said, but then offered to protect her from administrators if she had sex with him. Despite obvious “punishment” in the form of terrible scheduling and bullying by the male’s “sidekicks”, the woman did have the baby, finished her intern year, and successfully transferred to a different institution.
The personal nature of the doctor-patient relationship means that inappropriate remarks by patients are also not uncommon. Female nurses experience this much more often than female physicians, since nurses spend more time with patients, often assist with personal hygiene, and have less perceived power than physicians. This past February, a male patient physically and sexually assaulted a female nurse at UPMC Mercy.
Luckily, things are starting to change. 2017 marked the first year that more females were enrolled in US medical schools (50.7 percent). Female enrollment has grown by 9.6% since 2015, while male enrollment has dropped by 2.3 percent. Some say that a “culture shift” is underway in terms of acknowledging gender and burn-out in medicine, but Myers is hesitant to make that big of a claim: “Every program that you’re in has a microcosm, and that culture is all its own. So, a ‘shift’ implies that there’s some paradigm, and there isn’t.” Rather, she believes each environment has its own challenges, and it is up to the individuals in each program to navigate those in a collaborative way.
Although females make up just 30 percent of surgical residents across the US, five out of the seven General Surgery interns in UPMC’s most recent incoming class were females. UPMC has created a Diversity Committee to discuss policy changes that will better suit the needs of different genders, races and abilities. Myers is encouraged by the collaboration and inclusion among the residents and mentors she works with, and she urges future physicians to find a solid support system at all levels of the academic hierarchy. She has noted that Pitt’s former basic-science-oriented programs have become much more open to clinical and sociological research, such as her own.
When asked for advice tailored to female students and residents, Myers replied, “That’s hard, that implies that I’ve figured it out. I think it’s probably the same – find somebody you can rely on to pick you up when you fall from grace. And I have that in our program.” As far as burnout, Myers believes you must examine the underlying motivations for your work: “If you believe the job you’re doing has meaning, you will always find a way to overcome unhappiness. Our residency program tries to foster a sense of community with the residents, and I think that’s probably the most important thing that safeguards against burnout.”
Now that more females are entering the field, institutions are beginning to revise existing policies for pregnancy and parental leave and pay closer attention to the unique challenges faced by female physicians in order to prevent burn out and discrimination. In the past several months, females across all fields have started standing up against bias and harassment. Yet, the power dynamic in medicine may continue to be a deterrent for female physicians looking for change. Therefore, it is crucial for institutions to address these issues head on and for male providers to speak up for their female colleagues.