If you are a medical practitioner, you’ve most likely heard the name Dr. Elizabeth Blackwell, a British physician notable as the first woman to receive a medical degree in the United States in 1858. A true trailblazer, she broke glass ceilings by impacting gender-based bias in the field of medicine, allowing women to practice medicine all across the country. We've come a long way since 1858, with a few bumps along the road.
The Perceived State of Women in Medicine
Today, we are not only seeing a larger portion of women in the United States entering medical school, with rates exponentially increasing (e.g., 10% prior to the 1970s, to about 50% in the 2000s), but their presence in the healthcare profession is also being acknowledged and recognized for better health outcomes.
This was first brought to light by a 2016 study conducted by a team of Harvard researchers, who examined a random sample of Medicare patients hospitalized between January 2011 and December 2014 and treated by general internists.1 Overall, the researchers scrutinized more than 1.5 million hospitalizations and concluded 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 not clear, but raised many observations that women physicians are more likely to do evidence-based medicine, follow guidelines, and listen to and communicate effectively with their patients.
Most recently, this was further validated by a study in August 2018. The study analyzed two decades of records from Florida emergency rooms, including every patient who had been admitted with a heart attack from 1991 to 2010.2 They showed that female patients were more likely to die when treated by male doctors, compared to either men treated by male doctors or women treated by female doctors. What is also worth acknowledging is that the male doctors in the study were better at treating women with heart attacks when they had more exposure treating female patients, and especially when they worked in hospitals with more female doctors. The study suggests that when the proportion of female physicians in an emergency department rises by 5 percent, the survival rates of the women treated there rise by 0.4 percentage points. This highlights the importance of ensuring a gender-diverse work environment where we can freely emulate specific behaviors practiced by these female physicians and inculcate them in all physicians.
As a result, are the previous bumps in the road now smoothing out for women in medicine? Not quite.
The Real State of Women in Medicine
To put things into perspective, let me describe a scenario. Imagine achieving 10+ years of post-graduate education and training, and then stepping into a patient's room with your stethoscope and white coat, ready to share your expertise and knowledge, to have your patient ask, "When will the doctor be coming in?" This is a reality for many female physicians, even in 2018. This type of stereotyping — whether unconscious or not — is a form of perception bias that affects female medical school students, residents, fellows, and attendings alike, and it has to stop.
Unfortunately, despite a long history of successfully overcoming obstacles, female physicians continue to face challenges. While nearly 50% of medical students are women, only one-third are actual practicing physicians. In addition, specialties such as cardiology remain the most male-dominated, with female cardiologists accounting for only 13.2% of the population. These numbers are even more staggering when looking at the sub-specialty divisions of cardiology, in which only 7.2% of interventional fellows and 6% of electrophysiology fellows are female.
There is also the issue of pay. On average, female physicians earn $20,000 less per year than their male colleagues. These pay gaps are even higher when evaluating more male-dominated fields. With this comes the realization that women remain underrepresented at key career stages, such as senior faculty ranks, department chairs, and medical school deans.
Due to these opposing perceptions of the state of women in medicine, what is clear is that as a society, we should be focusing on ways to equip everyone — men and women — who advocate for advancement of women in medicine. To do so, we have to promote the retention of talented female doctors, scientists, and administrators by acknowledging their worth and promoting their advancement. How can this be done successfully? It should include unconscious bias training as early as medical school, but must begin with good mentorship.
Many have proposed that mentorship have certain features: (1) the structural feature of a dyadic relationship between a more experienced and a junior person, established formally or informally and primarily involving institutional proximity; (2) the interactional feature of a holistic approach to educational, personal, and professional aspects of development; and (3) the temporal feature of development and evolution of the mentoring relationship over time.3
Although it may be unrealistic to formulate a single definition of such a complex and elusive phenomenon such as mentoring, effective mentorship is likely one of the most important determinants of career success. Study after study shows that mentorship allows for mentee well-being by supporting career and personal development.4 Unfortunately, for reasons that are unclear, female physicians have a harder time finding mentors who will support and promote their work. In fact, a Swiss academic research study from 20105 showed that, across all specialties in medicine, women reported having a mentor far less frequently than their male counterparts. A recent study6 also documented that women are less likely to receive sponsorship experiences such as being recommended as a discussant or panelist at a national meeting, write an editorial, serve on an editorial board, or serve on a national committee.
What Can We Do to Correct This?
Promote sponsorship for women.
Sponsorship should not be confused with mentorship. Sponsorship is the public support for the advancement of someone who has untapped leadership potential. Basically, it requires senior leaders to risk their reputations by using their influence and power to provide a high-profile opportunity to their mentees who would otherwise not have been considered for that opportunity. Sponsorship is common and associated with success,7 but as previously reported, women are less likely to receive it. As such, further attention to gender equity in this regard is critical. Organizations need to encourage senior leaders to offer high-profile opportunities to more females. To allow for this, organizations need to provide specific training to their staff — male and female alike — describing ways to sponsor women and encouraging their leaders to consciously review and offer such opportunities. Mentees should also be encouraged to seek connections with higher-level leaders to cultivate this sponsorship. By doing so, this will not only enhance the career of individual women, but also may help diversify the leaders in our medical specialties.
Create individual mentoring programs.
Many institutions have made efforts to formulate individual mentoring programs specifically for women. Although this sounds imperative for each and every academic institution, it may not be as readily available or feasible from an institutional perspective if administration and leadership do not support and insist on its implementation. If this is the case, at least providing the option of enrollment of women in formal networking programs created with the intent for female promotion and career advancement should be encouraged at said institutions. These networking programs help early and mid-career female physicians identify potential mentors. For example, common institutional mentorship programs for female cardiologists include the American College of Cardiology (ACC)'s Mentoring Program and the ACC's Women-in-Cardiology (WIC) sections, which help women create networks that build senior leadership skills. Programs like this can provide important advice that women can’t receive elsewhere, such as advice on negotiation for higher pay or access to ancillary resources, such as a life coach or administrative support. Such programs can improve participants’ overall well-being and self-esteem, as well as provide practical skills, safe spaces for discussions, and opportunities to develop plans for academic success. These national programs can be highly oversubscribed, reflecting the need for institutions to offer similar local programming.
Additionally, it’s important to realize that one size doesn't fit all, and that one mentor doesn’t have to serve all your needs. In fact, it is smart to target a series of mentors depending on the situation and what type of mentorship is needed in your career. Think of mentorship as a board of advisors, including an older and wiser professional who gives big-picture career advice as well as a peer mentor who can relate to exactly what you're going through.
Encourage peer mentoring.
Even with a limited number of senior mentors, women can still benefit from peer support. This can come from a male colleague who understands gender bias and actively supports the promotion of women. However, women should promote one another as well. Meeting periodically with groups of women at similar career stages can be both personally and professionally rewarding. There remains a stigma, particularly in fields where women are rare, that women view other successful women as direct threats to their career goals and may feel there is only so much room at the top. This mentality must change — women need to promote other women by leading where they stand. In fact, creating an "all girls club" could help lead to enhanced collaboration, increased productivity, and real change in institutional policies affecting gender. Informal online social networks such as “Women in Cardiology” on Facebook or @WICBOT on Twitter (as well as the hashtag #ACCWIC) help promote peer support and advocacy.
Persuade more to become mentors.
The mentor-mentee relationship is not one-sided — it should be clearly noted that mentors benefit as well. It’s gratifying to gain fresh perspective and insight, and help further another person’s hidden potential. Probably the greatest reward comes from having your mentee pay it forward by become a mentor as well. The pledge to instruct subsequent generations of physicians is part of the Hippocratic Oath, as is the obligation to honor one’s teachers whose steps you will walk in one day. Continuing the mentor-mentee relationship ensures the next generation of leaders.
Acknowledging the issues facing women in medicine and creating a community of support can allow progress in women’s professional success. The challenges for women in medicine in the year 2018 may not be as daunting as it was for Elizabeth Blackwell in 1858; however, obstacles remain. To see the changes we need, we have to remain positive, promote progress, and continue to cultivate today's female medical professionals into the leaders of tomorrow. As Dr. Blackwell stated, “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.” So let us all — male and female physicians — be the pioneers this field needs to promote and advance gender equity in medicine, by starting with exceptional mentorship.
Disclosure: The author has no conflicts of interest to report regarding the content herein.
- Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213.
- Greenwood BN, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A. 2018;115(34):8569-8574.
- Sambunjak D, Stras SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-1115.
- Decastro R, Griffith KA, Ubel PA, Stewart A, Jagsi R. Mentoring and the career satisfaction of male and female academic medical faculty. Acad Med. 2014;89(2):301-311.
- Buddeberg-Fischer B, Stamm M, Buddeberg C, et al. The impact of gender and parenthood on physicians' careers — professional and personal situation seven years after graduation. BMC Health Serv Res. 2010;10:40.
- Patton EW, Griffith KA, Jones RD, Stewart A, Ubel PA, Jagsi R. Differences in mentor-mentee sponsorship in male vs female recipients of National Institutes of Health grants. JAMA Intern Med. 2017;177(4):580-582.
- Hewlett SA, Peraino K, Sherbin L, Sumberg K. The Sponsor Effect: Breaking Through the Last Glass Ceiling. Harvard Business Review Research Report. Published January 12, 2011. Available at https://bit.ly/2ChJCHJ. Accessed August 27, 2018.