A little after Match Day last year, I was congratulating a classmate on his future as a urologist. He was heading out of intern boot-camp, a short course in the last week of medical school to prepare for the transition to residency. I noticed the cohort exiting the building with him were all individuals going into surgical subspecialties and mentioned it to him offhandedly. He laughed and said, "Yeah and Ob-Gyn's who aren't actual surgeons." I was taken aback. I could barely muster a response that the American College of Surgeons itself considers Obstetrics and Gynecology among its subspecialties.
The truth is I've heard this many times from attendings, but this was the first time I'd heard it from a peer. I had often attributed it to a generational difference, but evidently it had permeated our learning environment. As a medical student, I've found my interests in women's health derided by surgeons and internists, men and women alike. I've adapted, ready for the wrinkled noses, the head shakes, the no-thanks, the why's. Inevitably, I readied myself, too, for the "real surgeons" discussion.
At times, I understand the reasoning: Obstetrician-Gynecologists train for only four years after medical school as opposed to five, and don't cross-train with other surgical subspecialties. Undoubtedly, there is always room for improvement in resident training, across all specialties. However, individuals who pursue careers in more complex gynecologic surgery go through additional years of surgical training. How are they not surgeons when their sole profession is to operate on patients?
In conversation with my fellow female classmates, I discovered we felt similarly: this dismissal of an entire profession was undeniably a product of biases towards women and women's health being considered less serious, important or desirable. There's no prestige in safely reducing women's mortality or improving labor and delivery outcomes. Gynecologists are not urologists prescribing erectile dysfunction medications with millions of dollars in investments behind them. They advocate for contraception, for women's rights to their bodies, only to be repudiated by government, corporations, and physician colleagues.
Nothing demonstrates gender inequality in healthcare better than the persistent gender gap in medical research, where differences in outcomes between men and women are more likely to remain unaddressed in the absence of a woman on the research team. Likewise, there remain widespread disparities in how women are treated for chronic pain. In fact, there's an entire series on how women experience the healthcare system differently than their male counterparts.
With the confirmation of Justice Kavanaugh to the Supreme Court, matters of women's health remain at the forefront of our political discussion, and a history of indifference about women's health relative to men's continues. More importantly, our steps toward progress are at risk of being dissolved by a man accused of violence toward women and a denial of women's rights through narrow legal interpretations of Roe vs. Wade.
I think often about my future as a woman in this country, and even more so about my future as a female physician with a passion for improving healthcare, particularly women's health. I've concluded that it doesn't matter how my colleagues feel about the surgical abilities of obstetrician-gynecologists. Objectively, it doesn't change the job description. However, this devaluation speaks to a larger issue in the way we view women's health in this country. The healthcare system is built such that a specialty increasingly dominated by women for women is not treated with the same respect as specialties dominated by men for men.
How can we collectively improve women's health in an environment where our peers are unconvinced of the necessary and important role of physicians who care for women? To truly improve, we need to change the culture within medicine. We must emphasize that women's health is an integral component of community health, and isn't just about reproductive health, but rather about how we perceive and address healthcare for women relative to men. We need to better incorporate women's health into our medical school curriculums if we want to improve quality of care and reduce physician bias. We need to teach health policy and advocacy in ways that empower women, and we need to provide increasingly stronger avenues for women to support one another.
Finally, in spite of our many attempts to do so, we cannot divorce medicine from politics. As physicians it's our responsibility to recognize our role in shaping the healthcare system in our country. The longer we remain apolitical and apathetic, the greater the risk that our agency in our profession wanes. Our healthcare system needs us. Our patients need us. We can do better. Their health, our health, depends on it.
Mariam Gomaa is a medical student and a 2018–2019 Doximity Author.
