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Gender Inequality in Medicine: Too Much Evidence to Ignore

Gender Inequality in Medicine: Too Much Evidence to Ignore

EARLY CAREER PSYCHIATRY

We have long known, based on research from social psychology, political science, and business, that men and women are perceived and treated unequally in our work environments. The difference this year is that we are talking about it much more than usual.  Nothing brings gender quite to the forefront of one’s thoughts like the intersection of—in my case—being pregnant most of last year, applying for a job, and following the news coverage of the election. With our first ever major party female candidate for US president, there has been a remarkable amount of news coverage on sexism.

Author bio:

Dr. Allen is a graduate of the Harvard Longwood Psychiatry Residency Training Program.  She is currently in her second year of the Harvard Medical School affiliated Fellowship in Behavioral Neurology/Neuropsychiatry at Brigham and Women’s Hospital in Boston, Massachusetts. She reports no conflicts of interest concerning the subject matter of this article.

The 2016 election highlighted the difference in standards for male and female leaders. During the election, many articles discussed how voters viewed Hillary Clinton and how her opponents treated her. Her opponents carefully questioned her health, “stamina,” presidential “look,” and lack of broad shoulders1 as coded comments about her gender. She was scrutinized for every aspect of her appearance, especially her clothes, bringing to mind the brilliant demonstration of sexism by a male television reporter in Australia who wore the same suit every day for a year—and nobody noticed.2 Hillary Clinton was perceived by some as cold or aloof; as she herself said, “I had to learn as a young woman to control my emotions. And that’s a hard path to walk. Because you need to protect yourself, you need to keep steady, but at the same time you don’t want to seem ‘walled off.’”3 Post-election coverage has largely focused on how the current President treats women—given the lack of female cabinet members, this comes as no surprise.

Gender inequality at work is well supported by data.  Women tend to be interrupted much more often than men4 and, despite the perception that women talk excessively, men actually do about 75% of the talking in mixed gender groups.5 A Yale series of studies on “volubility” (total amount of time spent talking) cheerily concludes that “though men primed with power talk more, women show no effect of power on volubility” and “powerful women are in fact correct in assuming that they will incur backlash as a result of talking more than others—an effect that is observed among both male and female perceivers.”6  In other words, women who speak up suffer consequences.

Women also get judged more harshly for ethical violations. A recent study analyzing American Bar Association data found that female attorneys were more than twice as likely to be disbarred than males, despite having identical ethical infractions.7 In a follow-up experiment, volunteers were asked to recommend a jail sentence for a hospital administrator who unethically filed a false Medicare claim. If the administrator was named Jack, the jail sentence was 80 days, but if the name was Jane, the sentence was 130 days.7

In academic science, perceptions of scientific achievement and potential are also affected by gender. A 2012 study asked a broad, nationwide sample of biology, chemistry, and physics professors to evaluate the identical application materials of either a male or female undergraduate science student who had ostensibly applied for a science laboratory manager position. Both male and female faculty judged a female student to be less competent and less worthy of being hired than an identical male student, and also offered her a smaller starting salary and less career mentoring.8

Women in academic medicine, as compared to men, perceive lower gender equity, are less likely to believe their institutions are making changes to address diversity goals, are less likely to consider their workplace family-friendly, and report less congruence between their own values and those of their institutions.9 The 2013-2014 American Association of Medical Colleges report on The State of Women in Academic Medicine found that while 46% of all residents are female, this number drops rapidly up the academic hierarchy: only 38% of faculty, 21% of full professors, and 16% of deans are female. The report concluded that “the proportion of full-time full professors who are women has increased since 2003–04, but the percentage of new tenures who are women remains unchanged since 2008–09. Although the percentages have slowly increased over the past 10 years, women continue to hold a smaller proportion of key leadership positions (department chair, dean) than do men.”10

In psychiatry, as in every field of medicine, there is gender disparity in salary and promotion. A 2016 study looking at academic physician salaries showed that even after accounting for physician age, experience, faculty rank, specialty, scientific authorship, National Institutes of Health funding, clinical trial participation, and Medicare reimbursements, female physicians still earned less than males in every field with the exception of radiology.11 In psychiatry, after adjusting for all of the above factors, men earn an average of $211,709, while women earn $14,799 less per year, or $196,909.11 Although the number of women entering psychiatry has been equal to men since 1999, a recent demographic and survey study showed only 12 of 118 psychiatry departments have female chairs, with males much more likely to be in charge of large departments and more likely to be married.12 Women psychiatry chairs report barriers to career development such as little or no mentorship, gender discrimination, and family obligations.12

In reflecting on this data, a woman receiving a job offer may wonder if the proposed salary is lower than would be offered to a male—but there is no way to know for sure. She then may have a hard time negotiating her salary without being seen in a negative light. A 2013 series of studies on salary negotiation and backlash concluded, “Assertive, self-advocating female negotiators suffer backlash consistent with negative masculine characterizations. They are seen as dominant and arrogant, and people do not want to interact on a peer level with them. Non-assertive, other-advocating female negotiators suffer a different backlash consistent with negative feminine characterizations. They are seen as weak and gullible, and people do not want to be led by them.”13

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