Let's talk about wellness in female physicians. We are going to bring you some DATA on why women in medicine have HIGHER rates of burnout than their male colleagues. I'll give you a hint - it has to do with gender bias! This series is going to run for the next few days, so don't miss any part of this awesome series on Women & Wellness in medicine brought to you by Abigail Schirmer, MS-1 and our founder Melissa Parsons, MD.
There are many stress-inducing issues for a physician today: charting in an electronic health record, handling mistreatment, managing performance metrics, all while penultimately being responsible for patient lives. Given the high burnout rates among physicians, it is apparent that these stressors have taken a toll on physicians across the United States. Female physicians, however, have higher burnout rates than their male colleagues (50% of females vs 39% of males) (1) due to several confounding factors: gender bias, the gender pay gap, the leadership gap, sexual harassment, and the challenges of work-life integration, including maternal discrimination. (2) Despite the fact that women have been entering medical school at a rate approximately equal to males for the last two decades, gender inequalities still exist. Women experience gender bias from colleagues and patients, and the pay gap and leadership gap continue. (3) Dealing with these biases while caring for patients, a family at home, and achieving work-life balance, leads to reduced career satisfaction and burnout.
While many of these issues are not exclusive to women, such as growing a family or work-life balance, recent data and statistics suggest that women are more significantly impacted by these additional responsibilities. Several studies have identified factors which contribute to perceived burnout (Figure 1) individually through comparison of female physician to male physician responses. Factors which have been identified to contribute to burnout include the gender pay gap which can contribute to imposter syndrome and reduced career satisfaction; increased societal expectations and corresponding reduction in work-life balance; instance of stereotyping and sexual harassment; and the leadership gap which leads to lack of mentors, decreased administrative roles (Figure 1). These factors, and their precursors, contribute to the subsequent decline in mental health and wellness as well as increased stressors which add to the evolution of burnout. In this paper, we identify and evaluate the specific components contributing to female physician burnout and discuss what interventions and steps can be taken to reduce biases, gaps, and scenarios that actively contribute to burnout.
Figure 1
Gender Bias
Female physicians encounter gender bias through the eyes of society, colleagues, and patients alike. Gender bias creates a foundation for several other concerns such as the pay gap, leadership gap, and sexual harassment. According to a recent 2017 study, 66.3% of 4507 respondents reported experiencing gender discrimination. (4) This bias has been evidenced to begin in medical school, (5) wherein over 50% of applicants and matriculants are women, (3) and to continue throughout a physician's career. (2) Discrimination due to physical appearance, (6) gender stereotyping, (7) and exclusion from administrative decision-making (4) have impacted female physicians who also reported decreased career satisfaction.
In matters of appearance, female physicians who appear more feminine or attractive have been discriminated against by colleagues and/or patients. (6) Behavior which contradicts gender stereotypes of women, including loud verbal communication and voice modulation, have led patients to view female physicians as more dominant (in a negative way) suggesting that patient’s see verbal and non-verbal cues differently among female and male physicians. (8) Countering gender norms within the healthcare setting was found to potentially harm the patient-physician relationship and the care that a patient may receive. (8)
These gender biases may stem from patients, physician colleagues or ancillary staff, with the repercussions of these biases being noticed by female physicians. Studies have shown that female physicians have significantly more concerns about gender judgement than men. (9) These increased concerns of gender judgment found in female surgical residents were also found to have significant association with negative well being, increased emotional exhaustion, and depersonalization, (9) which are all components of burnout. (2,9) However, regression analysis of this data displays that the reverse of stereotypical roles, such as men serving in traditionally female roles or stereotype that they must outperform women in surgery, may result in concerns of gender judgement from male physicians as well. (9) This presence of gender bias has been correlated to burnout, making gender equity a prime target for improvement of burnout among female physicians. (9)
We've talked a little bit about the gender bias that women in medicine experience and how that affects wellness in this first part; part 2 and part 3 will look at other factors that affect wellness for women in medicine, including the pay gap, the leadership gap and work-life integration. Don't miss the entire series!
Medscape National Physician Burnout, Depression & Suicide Report 2019. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#4. Accessed April 3, 2019.
Byerly SI. Female Physician Wellness: Are Expectations of Ourselves Extreme? Int Anesthesiol Clin. 2018;56(3):59-73. doi:10.1097/AIA.0000000000000197
The State of Women in Academic Medicine 2013-2014 FINAL.pdf. https://members.aamc.org/eweb/upload/The%20State%20of%20Women%20in%20Academic%20Medicine%202013-2014%20FINAL.pdf. Accessed October 12, 2018.
Adesoye T, Mangurian C, Choo EK, et al. Perceived Discrimination Experienced by Physician Mothers and Desired Workplace Changes: A Cross-sectional Survey. JAMA Intern Med. 2017;177(7):1033–1036. doi:10.1001/jamainternmed.2017.1394
Nora L, McLaughlin M, Fosson S, et al. Gender Discrimination and Sexual Harassment in Medical Education. Academic Medicine. 2002;77(12):1226-1234.
Robinson GE. Stresses on women physicians: Consequences and coping techniques. Depression and Anxiety. 2003;17(3):180-189. doi:10.1002/da.10069
Linzer M, Harwood E. Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians? J Gen Intern Med. 2018;33(6):963-965. doi:10.1007/s11606-018-4330-0
Schmid Mast M, Hall JA, Cronauer CK, Cousin G. Perceived dominance in physicians: Are female physicians under scrutiny? Patient Education and Counseling. 2011;83(2):174-179. doi:10.1016/j.pec.2010.06.030
Salles A, Milam L, Cohen G, Mueller C. The relationship between perceived gender judgment and well-being among surgical residents. The American Journal of Surgery. 2018;215(2):233-237. doi:10.1016/j.amjsurg.2017.08.049
National Academies of Sciences, Engineering, and Medicine. 2018. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/24994.
Sexual harassment is rampant in science, landmark report finds. https://www.statnews.com/2018/06/12/sexual-harassment-science-nasem-report/. Accessed April 3, 2019.
Mangurian C, Linos E, Sarkar U, Rodriguez C, Jagsi R. What’s Holding Women in Medicine Back from Leadership. 2018:8.
Doximity 2018 Physician Compensation Report. https://blog.doximity.com/articles/doximity-2018-physician-compensation-report. Accessed April 3, 2019.
McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The Work Lives of Women Physicians. J Gen Intern Med. 2000;15(6):372-380. doi:10.1111/j.1525-1497.2000.im9908009.x
Rizvi R, Raymer L, Kunik M, Fisher J. Facets of Career Satisfaction for Women Physicians in the United States: A Systematic Review. Women & Health. 2012;52(4):403-421. doi:10.1080/03630242.2012.674092
Carnes M, Morrissey C, Geller SE. Women’s Health and Women’s Leadership in Academic Medicine: Hitting the Same Glass Ceiling? J Womens Health (Larchmt). 2008;17(9):1453-1462. doi:10.1089/jwh.2007.0688
Boiko JR, Anderson AJM, Gordon RA. Representation of Women Among Academic Grand Rounds Speakers. JAMA Intern Med. 2017;177(5):722-724. doi:10.1001/jamainternmed.2016.9646
Jolliff L, Leadley J, Coakley E, Sloane RA. Women in U.S. Academic Medicine and Science: Statistics and Benchmarking Report. 2012:59.
Carnes M, Devine PG, Isaac C, et al. Promoting institutional change through bias literacy. Journal of Diversity in Higher Education. 20120528;5(2):63. doi:10.1037/a0028128
Cheesborough JE, Gray SS, Bajaj AK. Striking a Better Integration of Work and Life: Challenges and Solutions. Plastic and Reconstructive Surgery. 2017;139(2):495-500. doi:10.1097/PRS.0000000000002955
Schueller-Weidekamm C, Kautzky-Willer A. Challenges of Work–Life Balance for Women Physicians/Mothers Working in Leadership Positions. Gender Medicine. 2012;9(4):244-250. doi:10.1016/j.genm.2012.04.002
Verweij H, van der Heijden FMMA, van Hooff MLM, et al. The contribution of work characteristics, home characteristics and gender to burnout in medical residents. Adv Health Sci Educ Theory Pract. 2017;22(4):803-818. doi:10.1007/s10459-016-9710-9
Potee, Ruth A., "Medicine and motherhood: shifting trends among female physicians from 1922-1999 at Yale University" (1999). Yale Medicine Thesis Digital Library. 3038. http://elischolar.library.yale.edu/ymtdl/3038
Mattessich S, Shea K, Whitaker-Worth D. Parenting and female dermatologists’ perceptions of work-life balance. International Journal of Women’s Dermatology. 2017;3(3):127-130. doi:10.1016/j.ijwd.2017.04.001
Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and Childbearing Among American Female Physicians. J Womens Health (Larchmt). 2016;25(10):1059-1065. doi:10.1089/jwh.2015.5638
Baptiste D, Fecher AM, Dolejs SC, et al. Gender differences in academic surgery, work-life balance, and satisfaction. Journal of Surgical Research. 2017;218:99-107. doi:10.1016/j.jss.2017.05.075
Woodward CA, Williams AP, Ferrier B, Cohen M. Time spent on professional activities and unwaged domestic work. Is it different for male and female primary care physicians who have children at home? Can Fam Physician. 1996;42:1928-1935.
Spataro BM, Tilstra SA, Rubio DM, McNeil MA. The Toxicity of Self-Blame: Sex Differences in Burnout and Coping in Internal Medicine Trainees. J Womens Health (Larchmt). 2016;25(11):1147-1152. doi:10.1089/jwh.2015.5604