Updated: Apr 26, 2019
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. If you have not read Part 1 yet, click here and 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.
The term “sexual harassment” refers to three forms of abuse. According to the National Academies of Sciences, Engineering, and Medicine (NASEM), gender harassment, unwanted sexual attention, and sexual coercion are all included under the umbrella term that is “sexual harassment.” (10) Gender harassment is defined by this report as “verbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one gender.” (10) Unwanted sexual attention is defined by this report as “unwelcome verbal or physical sexual advances, which can include assault.” (10) Sexual coercion is defined by this report as “favorable professional or educational treatment is conditioned on sexual activity.” (10)
This past year, the NASEM delivered a consensus report in regards to the prevalence of sexual harassment amongst women in academic sciences, engineering, and medicine. Included in this consensus report was the finding that sexual harassment will occur to as many as 50% of female medical students. (10)
Sexual harassment, in every form, is hindering progress being made to close the gender gap in medicine. In undermining a woman’s road to professional and educational development, sexual harassment is jeopardizing the mental and physical health of women. Sexual harassment leads to women withdrawing from leadership opportunities, resigning from their respective institution, or even leaving the field of medicine.
Several assessments of female students and young professionals have suggested the prevalence of sexual harassment within the sciences. According to a University of Texas study assessing sexual harassment prevalence, approximately 20% female science students and 25% of female engineering students have reported experiencing sexual harassment. While this study’s number is outrageous, the approximation of women in medical school who report having experienced sexual harassment is double this statistic, with 47% to 50% of women medical school students reporting sexual harassment. (11)
Despite the recent #MeToo movement , the prevalence of sexual harassment is still commonplace in the workplace; particularly in the walls of a healthcare institution. In fact, data suggests that of the 47-70% of women in practice have experienced discrimination within the healthcare workplace, and 50% of those women have experienced sexual assault. (6) Female physicians consider sexual harassment to be a direct factor contributing to burnout. (2) In order to reduce burnout and increase wellness amongst female physicians, we must eradicate sexual harassment from our workplaces. (2,5, 6,12) The Time’s Up Healthcare movement is a step in the right direction to decrease sexual harassment in healthcare. In order to protect women in the house of medicine and to eliminate sexual harassment in our workplace, hospitals and medical schools will need to create more stringent policies for healthcare providers as well as for patients.
Female physicians are paid less than male physicians. The gender pay gap in medicine has been repeatedly proven in multiple studies, most notably the recent Doximity 2018 Physician Compensation Report, (13) which confirmed that men made more than women in every specialty studied. In other words, there is NO specialty in which women make more than men. When looking at specialty-specific wage gaps, the gap ranges from 14% to 20%, although the absolute numbers can look significantly different. (13) For example, pediatric infectious disease has a gap of 15% with women averaging $173,000 and men averaging $203,000 while orthopedic surgery has a 19% gap but over 100,000 dollars difference in average salary (W $442,000 vs M $543,000). (13) One of the primary discriminatory issues and desired changes amongst female physicians has been closing the evident pay gap. (4) A survey of female physicians describe the pay gap to be one of their main complaints amongst lack of autonomy and resources in the workplace. (14) Financial burdens and unequal pay for lack of apparent reason, thus, contribute significantly to the well-being of female physicians. (2) In a systematic review of career satisfaction amongst women physicians, women reported decreased job satisfaction associated with less financial compensation. (15) When compared to their male colleagues with the same job, women are far less satisfied with components of career such as recognition and salary. (15)
How do we “fix” the pay gap? The answer is complex. Women in the business sector have been found to expect to be paid less pay than their male colleagues and to ask for less pay when negotiating. While we do believe negotiation training for women in the workplace is very important, teaching women to better negotiate is not going to solve the problem. In fact, women are often viewed more negatively and even penalized when they negotiate “aggressively” for more money. Pay transparency, the ability to share salary information or even have publicly shared salary information, will help level the playing field for women and minorities in medicine. When pay is transparent, organizations have to be able to justify each employee’s salary, which limits most types of bias, including unconscious bias related to gender. In addition, pay transparency allows women (and men) to be better informed about their worth, so that they can negotiate more effectively for an appropriate salary. Pay transparency is paramount to decreasing the pay gap.
For women in medicine, one of the successes of the 21st century has been reaching equality in numbers, a feat accomplished in the 2017-2018 application cycle, when 51% of medical school matriculants were women. (3) Women have been at almost 50% now for over two decades, however the expected increase in women in leadership roles has yet to be seen. Women only make up 34% of physicians, 18% of hospital CEOs, 16% of all deans and department chairs. (3,12) Despite the growing numbers of women entering medicine, the leadership gap is still present and powerful.
Several factors impede women from rising to leadership positions within medicine. It has been suggested that societally, women physicians run into a glass ceiling and are less likely to be in leadership positions at elite institutions. One reason suggested for why the glass ceiling exists, is the “sticky floor” model, which proposes that women are given less institutional resources at the beginning of their career in comparison to their male counterparts. (16) A good example of this “sticky floor” is evident when examining grand round presentations by female faculty. One study found that women were only speaking at 28.3% of grand rounds. (17) Female trainees only authored grand round presentations 2.3% of the time in comparison to male trainees at 24.1%. (17) Given the current statistic that 50% of matriculants into the field of medicine are women, this finding raises a red flag as the leadership gap continues to grow.
Lack of mentorship is another reason for the leadership gap in medicine. Despite increasing numbers of women in medicine, the leadership gap and lack of women in top positions, makes pulling other women to the top more difficult. In 2011, according to Women in U.S. Academic Medicine and Science: Statistics and Benchmarking Report, women represented 47% of accepted applicants, 47% of matriculants, 47% of first‐ year enrollments, and 48% of graduates at all LCME‐accredited U.S. medical schools. (18) Despite the fact that women make up approximately half of all medical students and residents, and 1/3 of full‐time faculty, women remain underrepresented in leadership positions. (3) In 2013, females comprised only 15% of department chairs and 16% of deans at US medical schools (Lautenberger et al., 2014). The low numbers of women in leadership positions may contribute to the persistent leadership gap. Without women in higher levels, it can be difficult to find mentors or sponsors to help with career planning and advancement. Recently, 80% (n=415) of female surgeons reported they did not have a female surgeon mentor. (6)
In addition to the numbers issue, women also hinder the promotion of other women at times. There is the phenomena known as the Queen Bee Syndrome, which has been suggested to be prevalent within medical schools, residency training programs, and even in clinical practice, in which females compete with one another and withhold opportunities from other women, (19) or women develop the mentality that younger generations should tough it out as they did in their younger careers. (6)
Women often face an opportunity gap and a mentorship/sponsorship gap, which both contribute to the leadership gap that is seen in medicine. The additional effort expended to overcome these barriers leads to decreased job satisfaction (15) and burnout (6,14,16) in female physicians that is not seen in their male colleagues. Institutions can improve the leadership gap by supporting organizations for women in medicine at their institutions. These organizations can promote better mentorship and sponsorship by increasing networking for women, organizing a mentor/mentee and providing leadership courses for women. Also gender bias training for those in leadership can decrease the unconscious biases that are prevalent in decisions regarding hiring, awards, speaking opportunities and promotion and tenure, providing for more equitable processes. (19)
Now we're really getting into why women in medicine may experience higher burnout rates and decreased wellness compared to their male colleagues. We've touched on gender bias in Part 1, and sexual harassment, the pay gap and the leadership gap in this part 2. Don't miss part 3, which will talk about work-life integration and wellness for women in medicine.
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