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The Single Biggest Mistake I Made in Training Was Facing It Alone

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“Looking for an older woman with a busy career and outside passions, preferably with children, experience in a two couple professional household is a bonus. Can fit one or all qualifications.”

I have been “on the hunt” for the last few years. Although my description above echoes an old-fashioned singles ad or online dating profile, this hunt is different. I am looking for professional mentors. Why? A decade out of medical school, I recognize the single most important mistake I made in training: undervaluing the critical role of strong female mentorship.

I was naive enough as a medical trainee to think it didn’t matter—that advancement, leadership selection, and pay relied on accomplishment alone. Women comprise the majority of medical school enrollees. Why shouldn’t that translate into a gender-neutral work environment?

For those women in medicine still on the hunt for a mentor, here is a list of topics I wish I would have discussed with my mentor—issues that hit me over the head like a ton of bricks after I left the classroom and entered the world of clinical medicine.

The Gender Pay Gap: Be prepared to be offered less money than your male colleagues. Negotiate for the pay equity you deserve.

Sadly, there is a portion of the medical community who do not believe a gender pay gap exists. Or, they quickly explain it away with childcare leave, part-time status, or family obligations. They suggest that female physicians are less “serious” about their careers.

But, data tells us otherwise. Countless studies demonstrate a sizeable gap between male and female physician salaries based solely on gender.

The 2018 Doximity Physician Salary Survey of 65,000 full-time doctors unveils a gender pay gap of $105,000, which had increased from $91,284 the previous year. This disparity is echoed by a recently published report in the Annals of Internal Medicine that found a $50,000 higher median annual salary for male physicians compared to female physicians.

The pay gap starts with initial job offers. A startling 2018 report from the Center for Health Workforce Studies at SUNY Albany highlighted the doubling of the income gap between newly graduated male and female physicians in NY state, with a starting salary gap of $26,367 in 2016.

Be prepared, ladies, to make 80 cents for every dollar your male colleagues make. And for those naysayers who quickly deduce that this gap is due to fewer hours worked and more childcare leaves, please note that the Doximity survey excluded part-time workers and the Albany data is based on new graduates.

Even after controlling for the usual confounders, a gender pay gap exists and is growing. With strategies like salary transparency and open conversations among colleagues about salary, we can start to move the needle forward on pay equity.

Harassment and Disparaging Commentary About Women in Medicine

A 2018 report from the National Academies of Science Engineering and Medicine revealed that more than half of women in these scientific fields experienced sexual harassment in their careers.

When I was an eager third-year medical student on my first week of clinical rotations, an older male presented for care after falling in a gentleman’s club. As I carefully took his history, he asked me in a very suggestive voice, “You know what a gentleman’s club is, right? Are you always a good girl?” I was shocked and fumbled to respond.

I had another patient deliberately expose himself to our team on hospital rounds later during the same rotation.

Five years into private practice, I have had people comment on my female medical students being “smart and pretty” and touch my female nurses on their bodies to show the exact location of their pain.

No one had prepared me for unwanted sexual comments or harassment from a patient. If a patient makes you uncomfortable, please leave the room and speak to your attending about it. If they don’t understand or respond appropriately, speak to another trusted supervising doctor or program administrator.

Women will be belittled in your presence with disparaging comments. A supervising physician once remarked that women should not be allowed to work part-time after training, calling it a waste of government funding of medical education. While it is true that the Centers for Medicare and Medicaid Services (CMS) help fund resident salaries, hospitals get more than enough “bang for their buck” by employing residents for what amounts to less than minimum wage when you consider total hours worked. We should leave decisions about hours worked to the names written on the loan payoff checks. For those ill-informed and disparaging comments that you will receive about women in medicine, brainstorm some pre-planned strategies or responses.

Be prepared for microaggressions. A nurse asked me once, “What is your least favorite mispronunciation of your name by patients?” My reply was my first name. As female physicians, patients and colleagues frequently refer to us by our first names in clinical settings, choosing to drop the “doctor” titled. It happens so often that it’s become a topic frequently discussed among women physicians in social media groups and in-person networking events.

Recently, we held a local women in medicine symposium where a female surgeon recalled the irking feeling she gets when she completes discussing a surgery with a patient and is met with the reply, “Ok (her first name).” Another doctor quickly shared her story of a departmental meeting where all the male physicians were referred by “Dr.” and she was referred to by her first name.

This is not a coincidence. It is certainly not the result of us all looking young or our roles being not as clear. This lack of “name calling” is one of the microaggressions women in medicine deal with every day. A 2017 study published in the Journal of Women’s Health studied the use of professional titles in introductions as internal medicine grand rounds. Women introducers used professional titles almost all of the time, but when a male was introducing a female speaker, professional titles declined to about half the time.

An easy reply when encountering this would be: “While I do love my first name very much, I would prefer to be addressed as ‘Doctor last name’ professionally or in the office. How would you like to be addressed?” Another option: “I see that Doctors X,Y, and Z are addressed as doctor, and I am referred to by my first name. Why is that?” Let’s work to educate the public on this and move the dial forward.

Family Planning: It’s not easy to have children in training. Here’s why you should ignore the commentary.

I had my first two children when I was a resident, taking three and then four months off to be home postpartum. An attending expressed her disbelief at the length of these leaves and asked, “Don’t you ever want to finish residency?” I returned to work and pumped breastmilk for each of my children. The same attending joked, “If you were my resident, I’d fire you for how much you pump.” Jest or not, point taken. Bias is inescapable for women physicians who dare to start their families in training.

Your decision to take off time to start a family (gasp!) or pump milk for your child (double gasp!!) will be viewed as a testament to your lack of dedication to medicine in general. Researcher highlighted this phenomenon in the Journal of General Internal Medicine in a 2017 study: the retrospective cohort study that looked at 566 residents over a 10 year period and showed a strong association between postpartum status and lower peer evaluation scores.

Abroad, recent scandalous revelations showed Tokyo Medical University docked points from female applicants due to broader social concerns that they would have possibly bear children and turn to part-time work. When discussing this, my husband and I smugly commented on how we can’t imagine living in a country where that happened. Our gender bias in the U.S. may not culminate in such an egregious action, however, despite potential legality concerns, female medical students continue to be asked about marital status and childbearing plans at residency interviews. We can’t be naive enough to think these answers don’t impact negatively rank lists and chances for eventual employment.

Just this past month, a pathologist was awarded $500,000 after winning a lawsuit against the Children’s Hospital of Philadelphia for discrimination. The suit details mocking, false accusations of “unprofessional behavior,” demotion, and an eventual salary cut of over $140,000 after Dr. Kaede Ota announced her maternity leave. With such occurrences, what happened in Japan is no longer unimaginable.

Choosing to start your family is not a personal affront on your co-residents, program director, colleagues, or the general institution of medicine. There is never a good time to have kids, so take some advice from Nike and “just do it.” Certainly, be prepared for the commentary, but remember training is just a phase that will eventually end.

I am happy to say I have identified a few potential mentors over the last year as I’ve become more involved in medical extracurriculars. If you don’t have one yet, purposefully surround yourself with other strong physician women. Network with your local women physicians’ group. Get on social media and find your online community. Ease into it by joining the Physician Mom Group on Facebook—a closed group with over 70,000 members. Set up a Twitter account and join Sunday evening #womeninmedicine tweet chats. Attend a women’s conference.

Find a mentor— find ten mentors. “Find your tribe,” and together, we can work to change the future of medicine.

Dr. Lauren Kuwik is a Medicine/Pediatrics physician as well as a 2018–19 Doximity Author.

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