In my 13-year journey to becoming an eye surgeon, I worked and lived every day believing that gender inequality in medicine was a relic of the past. I trained during a time when more women than men were graduating from medical school. In my ophthalmology residency class, five out of six of us were women. In my cornea and refractive surgery fellowship at the number one eye hospital in the country, three out of four of us were women. Throughout my training, I had access to prominent women attendings and mentors who showed me that it was possible to "have it all." I was convinced there was nothing a physician who was a man could do that a woman physician couldn’t.
But that all changed once I graduated and entered the real world practice of medicine.
At one of my very first job interviews, the senior surgeon, a man, asked me swiftly and bluntly, “When are you planning to get pregnant?”
I was shocked and had no idea how to respond except to tell him what I knew he wanted to hear. “Not any time soon,” I replied.
It was at that point I realized that the medical training, surgical skill set, and work ethic I had acquired over the past decade were not enough. My suitability for the job was overshadowed by my gender and the inherent biases that came with it — reduced productivity and a lack of commitment. Unlike the safe haven of academic training, the real world of medicine was all about the bottom line, and I was a walking (soon-to-be pregnant) "financial liability."
I never took that job nor the other job offers from the predominantly senior men practice owners I encountered. I decided to buy a practice down the street, and, in 2020, after having a baby in the middle of a pandemic, I achieved a record year in production while balancing motherhood as a new mom. As the sole surgeon at the practice, I rushed back to the OR after only five weeks of maternity leave and found ways to pump discreetly at work, all while balancing a needy newborn at home and double the surgical load. It wasn't easy, but it reaffirmed my assertion that doctor moms were resilient, multitasking problem solvers, and far from the liability that some employers believed us to be.
Gender bias in medicine is an ongoing, problematic occurrence today. But because it is largely unconscious, it is both ubiquitous and difficult to discern. When I was asked about my pregnancy plans at my first job interview, I was taken aback, but couldn’t quite pinpoint exactly why it made me feel so uneasy at the time. I now know that what the interviewer did was a form of gender and maternal discrimination and illegal, according to the Pregnancy Discrimination Act of 1978.
While women physicians have made huge strides since Elizabeth Blackwell, the first women physician in the U.S., graduated from medical school in 1849, women still make only $0.66 to $0.75 for every $1 a men physician makes. And while there are more women leaders in medicine today than ever before, women make up only a tiny portion of department chairs, hospital CEOs, and practice owners.
The reasons for the gender pay gap in medicine are complex, multifactorial, and not always related to gender bias. However, some have gone as far as to call it a myth: Women simply choose to enter lower paying specialties, perform less lucrative procedures, see fewer patients, and bill less overall, skeptics say.
But with the majority of physician-mothers carrying the burden of family responsibilities at home, compared with physician-fathers, it becomes clear that those decisions are not always by choice.
We are also learning more and more that women physicians are being paid less for the same work done. A recent study published in Ophthalmology revealed that women ophthalmologists earn significantly less (~$33,000) than their men colleagues in their first year out of training, even when controlling for demographic, educational, and practice type variables such as work days and OR time. While the reasons for this discrepancy remain unclear, it begs the question of whether employers are (unconsciously or not) viewing and treating women physicians differently from their men colleagues in regard to compensation.
Indeed, a well-known ophthalmic consultant on a health care podcast recently attributed the lack of well-trained “gonzo workaholic” surgeons to the new generation of physicians who strive for a “balanced lifestyle” and young women surgeons who “naturally want to be forming a family” and work only part-time. In those few words, women physicians were characterized as less driven and less productive than their men counterparts, thereby reinforcing hackneyed stereotypes that further perpetuate gender inequality in medicine.
One thing we know for certain is that the pay gap between men and women physicians is not a reflection of the quality of patient care provided. Studies have shown that women primary care physicians spend more time on average with each of their patients during office visits. In a highly publicized 2017 study, patients of women surgeons had fewer surgical complications, lower hospital readmission rates, and an overall lower risk of dying in the first 30 days compared with their men counterparts. Regardless of gender, the fight to reform physicians’ pay to more accurately reflect the quality of care provided remains an ongoing battle in medicine today.
The good news is that we've come a long way, but there is still much to do. Just like the reasons for the gender pay gap in medicine are complex, the solutions to the problem are multifold. We need to encourage shared delegation of family responsibilities at home, provide more support for working moms in the workplace, facilitate career advancement for women, and increase compensation transparency in medicine. Most importantly, we need to acknowledge the problem and put an end to the implicit gender biases that we all have. Keeping an open dialogue and engaging in difficult conversations like this one go a long way toward making gender inequality a true remnant of the past for the next generation of physicians.
Share your thoughts and experiences on gender inequality in medicine in the comment section.
Dr. Dagny Zhu is a nationally acclaimed, board-certified ophthalmologist specializing in cornea, cataract, and refractive surgery. She is medical director of NVISION Eye Centers in Rowland Heights, California. She is active on social media (@DZEyeMD), where she promotes health and science, champions women and POC, and provides inspiration and mentorship to the next generation of physicians.
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