Recently, when a prominent medical journal asked if there was gender equity in medicine, many Australian female doctors flatly said no.
It’s notable that their monosyllabic but eloquent reply did not satisfy the editors and they had to write a letter imploring the editors to stop perpetuating the disparity by posing an archaic question which has already been answered.
Reading the ensuing commentary, I couldn’t help but reflect that the gender gap in medicine is actually a gap in respect. Women in medicine are not accorded the respect they deserve, neither from their male colleagues nor, sadly, from many patients. Remember the black American specialist who was told to pipe down during a flight emergency because the situation needed “an actual physician”? She wasn’t unique.
“What do you think, doc?” a patient winked at a man. “Does she know her stuff?” “She’s my boss,” my resident stammered. An old man with a failing heart couldn’t breathe but sneaked his hand up an intern’s skirt as she auscultated his chest. She told me that rather than risk a scene at the dawn of her career she quietly removed his hand and continued.
Women in medicine suffer discrimination from the time they are students to the time they retire. When men introduce women physicians, they skip their professional title and address them by their first name more often compared with male speakers.
Female doctors are overlooked for opportunities to become dean, chief executive, tenured professor, editor-in-chief, first author and lead researcher. Even after adjusting for years of training, productivity, specialisation and billing, women in medicine earn nearly 30% less than men.
This is despite emerging evidence that female doctors listen to patients longer, interrupt them less and may provide more cost-effective and patient-centred care associated with lower rates of hospitalisation and mortality.
In a multicultural country like Australia, nearly half of doctors are “foreign”. Highly qualified women stand at the unforgiving intersection of gender and race.
In a galling incident, one such woman stepped up to rescue a small hospital embroiled in a crisis. She undertook an urgent audit, but for public consumption the executive wanted a man to present her findings, and warned her not to “be a bitch”.
He was unqualified; she’d written the national guidelines. She offered to resign on principle and the hospital panicked, but not before the man had pocketed a handsome “consulting” fee. Imagine what that money could have achieved for a bit of pay equity.
A senior surgeon openly fantasises about a trainee’s breasts during an operation and she keeps her eyes firmly on the retractor.
A student endures the lurid glances of a male tutor who talks of feeding her a “love potion” and prays for the end of term.
Countless women stress over how to keep a pregnancy quiet.
Where does this awfulness happen? If you listen closely, everywhere. Men in medicine are judged largely by their accomplishments; women in medicine must answer for their attire, attitude and ambition.
Around the world, women encounter outright discrimination, micro-aggressions and casual disrespect – and if they haven’t, that’s a good thing because these things shouldn’t have a 100% strike rate to be real.
When writing about disrespect, I am surprised by how my own humiliation involuntarily bubbles to the surface, much as I have tried to bury it.
Once, a senior male doctor insisted on being my “sponsor” for a role and his recommendation mistakenly reached me. Skimming over any actual accomplishments, he opined that my “resolve and motivation” be tested in an unpaid capacity for a year, with my promotion to be decided by him on a “meritorious” basis.
I was puzzled. I thought he’d applauded me for said resolve, motivation and merit. But there was more. He sealed his case by calling me “high-maintenance”.
From the Urban Dictionary: the definition of a high-maintenance girl is an excessively talkative, over-reactive, highly emotional, attention-seeking female who requires a firm handler. (see also: bitch)
To all the women reading this, I’d love to say that I called out the hypocrisy although I sincerely hope I would do so now from a position of greater strength.
But on that day I became a ball of shame at the perception of being a champagne-swilling, Prada-toting woman when in fact I worked in one of the poorest places in the country with crumbling infrastructure, where despite being threatened and robbed I came to work because my patients were sacrosanct.
When his male boss congratulated his “sophisticated” (unethical) approach to the problem (payment for work), I tearfully searched for confirmation bias. If I stopped to wolf down my first meal at noon, was that high maintenance? If I didn’t want to add to my existing load of unpaid work and had young children and ageing parents, was that high maintenance?
In truth I didn’t know a single doctor who fit that description but now I was it and the accusation stung.
A male surgeon concluded, “You’ve been white-anted!”, which sent me scurrying to the dictionary.
White-anting (Australian, colloquial): the act of bringing down from within, undermining. Derived from the action of termites eating the inside of foundations, often leaving no outward evidence until the structure crumbles.
Some might protest that such broad assertions taint “even the good” men but the point is not to disparage all men, rather to point out the abundant evidence for a lack of respect for women.
Women in medicine tolerate their indignities quietly because to speak is to attract backlash. Their critics silence them by saying that respect must be earned and pay equity must be deserved. They’re told to grow a thicker skin and lectured to get along with men.
In other words, if women were actually as good as men, the problem of gender equity wouldn’t exist. This distorted rhetoric distracts from the very real barriers that obstruct progress.
A recent World Health Organisation report highlights that women fill a staggering 70% of healthcare roles but only a quarter of senior roles. The report is titled “Delivered by Women, Led by Men”.
Publishing pay scales, promoting more women, giving them a seat at the important tables and creating family-friendly policies help gender equity. Holding senior doctors accountable for their conduct towards women is vital because they lead by example. But these ideas aren’t novel, so why is change so slow?
In my opinion, it is because at the heart of change is respect, which is an easy word to say but a really difficult one to teach. The highest goal of medicine is to help patients and it is inarguable that patient care is enriched by the inclusion of women in the highest echelons of medicine.
Gender equity is not about being nice to women doctors – there is a powerful business case for it. But as long as we think of basic decency as a concession and fairness as a gift to women, we will be stuck writing to journals while our patients pay the price.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death.