Bias, Bravery and Burnout: The Journey of Women in Medicine

“If society will not admit of woman’s free development, then society must be remodeled.” -Elizabeth Blackwell

In 1897, after sending letters requesting admission to multiple medical schools, Elizabeth Blackwell received an equal number of “rejection letters.” But unlike the stock replies that I received years ago, or today’s med school hopefuls get in the mail — “Thank you for your interest. We received thousands of outstanding applications…” — Ms. Blackwell’s letters stated she was “intellectually inferior.” One medical school dean, perceiving her presence as a threat to the male contingent, wrote “You cannot expect us to furnish you with a stick to break our heads with.”

Dr. Elizabeth Blackwell (1821–1910)

Elizabeth Blackwell didn’t break any heads. What she broke down instead was far more impactful: gender-based bias in the field of medicine.

In honor of Women’s History Month, I reflected on the many women who blazed a path — in the United States and worldwide — for females to practice in the same noble and demanding profession as Drs. William Osler, Sigmund Freud, Frederick Banting and Albert Schweitzer. What I found was quite astounding.

Prior to her groundbreaking admission to medical school, Blackwell worked in a tobacco-growing district in Kentucky where she gained her “first practical experience of negro slavery and the crude civilization of a Western slave State.” The gross injustices towards black slaves, left a “profound impression” on the budding physician. “Kind as the people were to me personally,” she wrote in letters to her family in England, “the sense of justice was continually outraged.” This same moral foundation would fuel her pursuit of medicine: “The idea of winning a doctor’s degree gradually assumed the aspect of a great moral struggle, and the moral fight possessed immense attraction for me.”

As a female physician — and, according to the Association of American Medical Colleges, one of over 281,000 active women doctors in the United States — I am deeply grateful to the moral courage of British-born Blackwell. She was, in fact, one of several women medical pioneers around the world. Brazilian obstetrician, Dr. Marie Durocher (1809–1893), was the first female physician in Latin America. Gynecologist, Dr. Elizabeth Abimbola Awoliyi, became Nigeria’s first female doctor at a time (1940s) when only 8 out of 57 secondary schools allowed female students and over 60% of girls underwent female genital mutilation (widely considered a human rights violation.)

Author, Lipi Roy, MD, left, writing a prescription for patients in Port-au-Prince, Haiti (April 2010, four months post-earthquake).

When I think about the diverse career paths achieved by women armed with a medical education — from academia and research to global health and government — my heart swells with inspiration and admiration. Over the past century, we have seen Dr. Barbara Ross-Lee become the first African American female Dean of a U.S. medical school; Dr. Virginia Apgar revolutionized neonatology; Dr. Antonia Novello became the first female (as well as Hispanic) U.S. Surgeon General (Dr. Joycelyn Elders was the first African American U.S. Surgeon General); and Dr. Margaret Chan was elected as the director-general of the World Health Organization.

14th Surgeon General of the United States, Dr. Antonia Novello

The army boots of progress continued to march forward.

Today we are not only seeing a larger percentage of women physicians in the U.S., from 9.7% in 1970 to 32% in 2010, but their presence has been associated with better health outcomes. A December 2016 study in the Journal of the American Medical Association showed that elderly hospitalized patients treated by female internists had significantly lower mortality and hospital readmission rates than those cared for by their male counterparts. The reasons were unclear but according to family doctor, Sarah-Anne Henning Schumann, women are generally considered to be better listeners, more nurturing and possess more emotional intelligence.

So, the previously turbulent waters are now clear-sailing for women in medicine, right? Not quite.

In spite a long history of successfully overcoming obstacles, female physicians continue to face challenges. While nearly 50% of medical students are female, only one-third of practicing physicians are women; and specialties such as cardiology and orthopedics remain male-dominated. And then there’s the pay gap: female physicians earned $20,000 less per year than their male colleagues; the gap was as high as $44,000 in male-dominated surgical subspecialties such as neurosurgery.

Another challenge: burnout. While a rising concern for both sexes, according to a study in the Journal of General Internal Medicine, burnout was likely to be reported 1.6 times more often by women physicians. Manifesting as emotional exhaustion and cynicism, burnout in women doctors was typically caused by an inability to balance work and home life, as well as a lack of control over workplace schedule. The added stress of being a mother in medicine significantly increased burnout among female doctors.

Women physicians report more burnout than male physicians.

Other disconcerting trends were noted among women physicians. One-third of female physicians reported sexual harassment in the workplace. And the suicide rate among female doctors is double that of the general female population. Challenges to progress will persist. How we respond to them will define us — just as they had for our heroic predecessors.

The lives of women have always been complex. Over time, the specific demands may have changed, but the pressure remains the same. The responsibility of caring for a patient is a privilege, but it can also be a burden; one that is added to a pre-existing mountain of burdens. So while we look back, recognizing the hurdles overcome by many a female pioneer, let us remember that much remains to be done. We must continue to cultivate today’s female medical professionals into leaders of tomorrow and of generations to come. The challenges of navigating unknown paths may seem daunting, but the rewards can be transformative — as eloquently articulated by Dr. Blackwell: “It is not easy to be a pioneer — but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world.”

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