Building support and allyship for women physicians: We need your help!

Rebekah Bernard: ©Rebekah Bernard

Women Physicians Day, observed annually on February 3, is intended to recognize the contributions of women in medicine. But it’s also a good time to acknowledge some of the unique challenges of women physicians. I’m talking about core issues to the practice of medicine that face all physicians, but seem to be more pronounced in women: Higher burnout rates, feeling less fulfilled by the practice of medicine, and more depression. Of greatest concern, women doctors have a 24% higher chance of dying by suicide than the general population.

While systemic changes are undoubtedly needed for all physicians, there are steps that we can take as individuals to support our women colleagues.

Recognize and acknowledge the challenges that women physicians face.

A few years ago, a male physician made headlines when he wrote that the gender pay gap was simply because women physicians “do not work as hard… because they choose to, or they simply don't want to be rushed, or they don't want to work the long hours.”

While women physicians do work 4.4 fewer hours per week than men (on average, with the gap in hours extending from just 1% for single physicians to 18% for physicians with children), studies show that women physicians may expend more energy on patient care, including more time face-to-face time during office visits, more inquiry into psychosocial issues, and more time on counseling.Women physicians also take longer on documentation in the electronic health record and receive more staff and patient messages than men physicians.

One of the reasons for these differences may be that women physicians tend to attract patients with more complex psychosocial problems as well as more patients described by doctors as ‘frustrating.’ In general, patients tend to be more demanding of women physicians: speaking more during office visits, sharing more medical and psychosocial concerns, and sending more portal messages.

While some argue that women are just not as good at setting boundaries, the issue may be that patients (and staff members) approach women doctors differently than men. A fun anecdote that explores these differences involved male and female co-workers who accidentally switched email accounts for a week, with surprising responses from clients depending on whether they were using male or female names.

Consider the impact of child raising and other family obligations on women physicians.

At one of my first jobs, my employer asked me if I had children. When I said no, he responded, “Good, I’ll be able to get more work out of you.” In addition to the awkwardness of the question, I felt hurt on behalf of my colleagues with children, who I knew worked every bit as hard as me, and then some.In addition, these women experienced the emotional strain of balancing roles at work and at home, which is likely a factor in burnout rates.

While men physicians also have duties at home and in caring for children, studies show that women physicians tend to take on more of these responsibilities, in part because men are more likely to have a stay-at-home spouse with that primary responsibility. But even in households where both partners work outside the home, traditional gender roles are still very much the reality – partly because many women want and value those roles, and partly because the responsibility just ends up on their shoulders.

We can help support our colleagues by recognizing this additional workload and acknowledging that it may not be possible for women physicians to take on extra roles or leadership positions in certain phases of their lives (unless they have very strong support). On the other hand, we should re-offer these opportunities as women enter mid-career, when children are older. In fact, studies show that women physicians often thrive in mid to late career, making up differences in publications and showing improved mental health as their children become more self-sufficient.

Awareness of this surge in productivity later in women’s careers is important because many leadership opportunities and training courses are geared toward physician trainees or early career physicians. Programs should consider targeting women a bit later on in their career trajectories—or be ready to welcome them back if they have to take a break for a certain period of time to focus on family needs.

Acknowledge that gender bias is real – and it affects men and women.

Every one of us experiences unconscious automatic thoughts and assumptions about the world and other people. These thoughts stem from our upbringing, life experiences, and the way we internalize societal messaging, and can lead us toward bias.

For example, when women are asked about the types of messaging they received growing up, they are more likely to say that they were taught to value being nice, respectful, and helpful than to take a stand or share their point of view. This may lead to later unconscious negative thoughts about women taking on leadership roles.

This type of gender bias has been demonstrated in numerous studies. The famous ‘Howard/ Heidi’ experiment asked Columbia MBA students to rate the qualities of a described venture capitalist. Half the group were told that the investor’s name was ‘Heidi’, and the other half were given the name ‘Howard.’ While students scored both Howard and Heidi as equally competent, both male and female students liked Howard much better – Heidi was rated as too ‘aggressive’ and unlikeable.

Similarly, in a study of science faculty identical job applications were rated more highly by both men and women reviewers when they were labeled with a man’s name than a woman’s. Further, the male candidate was offered a higher starting salary and more career mentoring. Another study showed that both male and female students ranked their online professor more favorably when they were told the instructor was a man than a woman.

Gender bias is so prevalent that when linguists entered a sentence into a ChatGPT system program involving a female physician and a male nurse, the system just COULD. NOT. COMPUTE. In fact, it accused the authors of giving it illogical sentences or making a typo rather than being able to comprehend that the ‘doctor’ in the case was a woman and the nurse a man.

While gender bias is real, we needn’t feel guilt or shame for having automatic thoughts. Instead, we should simply acknowledge them and then work toward practicing intentionality—moving moving past our feelings and examining and applying data and logic to our decisions.

Provide sponsorship for women physicians.

One of the best ways of practicing intentionality to support women physicians is to provide sponsorship, a concept that is different from mentorship.While a mentor offers encouragement and advice, a sponsor is someone who actively uses their position of power, influence, or privilege to help another move up in the world. Examples of this type of advocacy can include bringing up a person’s name for leadership opportunities, introducing them to the right people, writing letters of recommendation, asking for input during group discussions, and offering invitations to speak at conferences or sit on panels.

For those of us who are not in a position of leadership, we can help our colleagues by something as easy as facilitating networking: If you are at a meeting where you know many of the participants, find a newer colleague and walk them around making introductions. Ideally, find something that the people you are introducing have in common to help them make a connection.

Because women physicians are less likely to receive recognition and awards than their male colleagues, you can help by raising awareness of their work—share their posts and tag their projects on social media or nominate them for a community or organizational award.

Special outreach to women is important, because women often view the world a bit differently than men. Studies show that women tend to underestimate their abilities and performance, even when they do just as well. This ‘imposter syndrome’ may lead women to be less likely to apply for a promotion or run for a leadership position. I use myself as an example of someone who benefited greatly from sponsorship: A leader in my medical organization took note of my participation in events and suggested that I run for a position in leadership. If it hadn’t been for his encouragement, I would never have had the chance to serve on a Board that has brought me great personal and professional satisfaction, as well gaining me further opportunities to lead.

Support and call out behavior that hurts women physicians.

I was shocked to learn that medicine, a field that should have the ultimate degree of professionalism and ethical standards, has the highest prevalence of sexual harassment of all Science, Technology, Engineering, Mathematics, and Medicine (STEMM) specialties (according to a 2018 report from the National Academies of Science, Engineering, and Medicine). This assessment is based on reports like a 2019 survey of Louisiana women physicians, which found that 53% experienced some form of sexual harassment from patients or their families, and a shocking 69% experienced unwanted sexual attention from their colleagues. A 2021 study of women medical students in the United Kingdom found that 56% experienced sexual harassment—and of great concern, many episodes of harassment by patients happened in front of male colleagues, who did not take action to address the behavior.

I am calling on all of us to advocate for your sisters in the House of Medicine. Please don’t allow inappropriate remarks to be made or let sexist attitudes go unchecked. Although it can be uncomfortable, you have the power to stop this behavior, simply by acknowledging it and stating that it is unacceptable. Advocacy from male allies is incredibly powerful, as studies show that male feedback is often viewed as more legitimate in countering sexism.

You can also help women doctors to overcome sexism by correcting patients when they call a woman doctor a nurse or address her by her first name. Step in if you hear women physicians being talked over or interrupted before they finish speaking.

Thank you

The bottom line is that we truly need each other to ensure that our patients receive the best care. On Women Physician’s Day, I thank you for your sponsorship and support of women physicians—it is so essential, so valuable, and we appreciate it from the bottom of our hearts.