January 21 marked the one year anniversary of the Women’s March, one of the largest coordinated marches in world history. It was a movement that both celebrated and captured our individual voices and collective power. Similarly, another milestone for women occurred on February 3, the birthday of Dr. Elizabeth Blackwell, the first woman in the United States to graduate from medical school in 1849.
For the first time, more women than men are enrolled in medical school, representing 50.7% of all students. On the surface, it might seem that we have achieved equality. But the numbers don’t provide a full picture of the state of women in medicine. For example, a recent study linked the increased rate of depression in women physicians, and cited work-family conflict as a factor.
Shortly after its release, a male physician wrote an op-ed in response to the study. As two female physicians, we closely read his response and tried to understand the expertise and perspective he brought to the conversation. No doubt, his voice added support to the challenges women face in medicine. At the same time, however, it made us question where the voices of women were.
At best, the piece represents a man trying to understand and empathize with women’s experiences. At worst, it manifests what Charley Bordelon described as “the audacity of privilege” in Ava DuVernay’s television show, Queen Sugar. Each woman brings her own unique experiences to her role in medicine. There is no universal female experience, but who tells this story shapes perceptions of reality.
Now more than ever, the solution is more women in medicine, not fewer. We need to understand how women achieve success and leadership positions and how this might follow a different path than it has for men. Defining these roles also means standing up against a field replete with hierarchy and tradition.
Despite 150 years having elapsed since Dr. Blackwell graduated from medical school, medicine continues to struggle with how to define and to value the unique role of women. The question of whether gender still matters is easy to answer. It matters now, and it will always matter. It matters because of ingrained sexist societal norms which manifest in the work environment.
Data show that gender inequality may not be due to differences in behavior, but rather due to bias and the perception of women. We have heard male physicians say, ‘You can’t be a serious pediatric cardiologist if you have kids’ or ‘We shouldn’t hire her, she’s going to go part-time as soon as she gets married’ or, ‘She’s just too emotional’. These comments do not reflect all men, but they do reflect an underlying bias and an inappropriate comfort by saying these things in the presence of others.
It matters because of inherent biological differences and the role of bearing children which requires some time away and, perhaps, a change in priority for a period of time. It matters because even in self-described egalitarian households, women still do the majority of housework, women care for aging parents more than do men, and women continue to be underrepresented in leadership positions in medicine. It matters because facing workplace opposition, combined with additional shifts at home, often compels women to step back from their careers more often than men. This tension is too often transmitted to the next generation of women as ambivalence, and can lead to questioning our calling to medicine, and even to depression.
But there are ways to mitigate, to assume control, and to develop a collective voice in medicine. As stated by Dr. Blackwell, “For what is done or learned by one class of women becomes, by virtue of their common womanhood, the property of all women.” This is manifested as women have recognized the power of their voice in the #MeToo movement and Time magazine’s Person of the Year, The Silence Breakers. To allow women opportunities and to define their roles in medicine requires hospital and university support. In order to maintain the emotional and physical well-being needed of physicians, individuals must seek help from partners, friends, and family. To do so also sets an strong example for working woman for the next generation.
Women also need to sit at the table – not near or away from it – if we want to effect change and model what this new reality can look like. This need not be complete devotion to work at the consequences of family and mental health, but increasing the presence of women in enacting solutions will give permission for others to find their own reality, to have influence, and to reclaim control.
To be sure, it does matter when men acknowledge the challenge of women in medicine, and male collaboration is needed now more than ever. But we can only represent our own perspectives. We cannot represent the experiences of single parents, divorced parents, parents who are working while experiencing their own illnesses, and women’s myriad of diverse experiences. But we can acknowledge that who tells our stories impacts how they are received if we are to tackle the bias that women face in medicine.
Real progress begins when we recognize that women have multiple dimensions and experiences that shape who they are, and their roles as wives, mothers, and caregivers cannot be sidelined. For them to become leaders in medicine – and in every other profession – requires understanding the nuances of what is actually happening in their lives – as told by women in medicine.
Angira Patel, MD, MPH, is assistant professor of pediatrics and medical education and a member of the Center for Bioethics and Medical Humanities, both at Northwestern University Feinberg School of Medicine, a pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voice Fellow through The OpEd Project.
Sarah C. Bauer, is a developmental pediatrician in Chicago who explores and reflects on relationships between patients, families and physicians through narrative, poetry and visual arts.