There I was, nervous but excited, smartly dressed and proudly wearing my short white coat, the uniform of a medical student. I arrived for my rotation early that day, ever eager to be responsible and make a good impression. Two of my classmates and I lined up at the arrival of our attending for that day. He greeted the two male students and rested his gaze on me. “What are you doing here?” The question surprised me so greatly, I managed to stammer out something like “I’m here for my rotation”.
Before I could introduce myself, the curmudgeonly elderly male physician informed me that he didn’t understand why women went into medical school. “You’re just here to meet a husband” he informed me and went on to explain that I would just quit medicine once I had babies and leave the male doctors to do all of the work.
I had the knowledge to explain all of the physiological responses that occurred in my body – flushed cheeks, twisting stomach, fluttering heart rate, clenched teeth – but I didn’t have the words to defend myself. If I argued with him, he could have written me a poor evaluation, hurting my chances of obtaining honors in the rotation and getting into a competitive residency program. Although my male classmates looked visibly uncomfortable, their silence spoke volumes. No one was going to put their neck on the chopping block to explain that I had earned my white coat and belonged there. No one would encourage me in the wake of his obvious disdain. This was a ‘bootstraps’ moment, and I’ll be dammed if I wasn’t going to cowgirl up, grit my teeth, and take it.
Given the obviously advanced age of my attending, I hoped that his outdated mindset was simply the last remnant of a not-so-great era of blatant discrimination. But here I am, nearly 14 years later, and the negative thoughts toward women medicine persist like a fart cloud that is lingering despite the winds of change.
One only needs to look to the social media backlash against Dr. Gary Tigges to see that female physicians must still battle persistent bias. When asked about the pay gap between male and female physicians, he commented for the Dallas Medical Journal “Female physicians do not work as hard and do not see as many patients as male physicians. This is because they choose to, or they simply don’t want to be rushed, or they don’t want to work the long hours. Most of the time, their priority is something else…. Family, social, whatever. Nothing needs to be ‘done’ about this (pay gap) unless female physicians actually want to work harder and put in the hours,” his comments continued. “If not, they should be paid less. That is fair.”
Why a backlash? Because the pay gap is real, and it has nothing to do with inadequate work ethic on the part of female physicians. We aren’t busy curling our eyelashes to bat at any available suitor, we are practicing medicine, doing procedures, and saving lives.
Female physicians are in fact exceptional at saving lives. An August 30, 2018 Harvard Business Review article entitled How Discrimination Against Female Doctors Hurts Patients cited several research studies that have demonstrated the superior care delivered by female physicians. These results were consistent across hospitalized patients, heart attack sufferers, and surgical patients.
According to the article, “female physicians tend to engage in more preventative care and more-effective doctor-patient communication. Research has also found that female physicians engage in more evidence-based care practices and score higher on medical school examinations, relative to their male colleagues, factors that may account for their better outcomes.”
But although women now make up more than 50% of medical school classes, they account for less than 35% of all active physicians in the US. And are represented far less in leadership positions.
An article in the National Bureau of Economic Research entitled “The Mommy Effect: Do Women Anticipate the Employment Effects of Motherhood” attempted to explain the attrition of women from the workforce. Although they don’t focus specifically on physicians, they do comment about the educational level of the women surveyed.
The authors note that although women have increased their “human capital” in the form of education, they are not having similar increase in the labor market. They assert that this is because women underestimate the “costs” of motherhood, in terms of time, money, and effort to raise children. The examples of “costs” that they provide include childcare, the emotional cost of being separated from their child, guilt over perceived or real underperformance as an employee or mother. They stated that “even the more educated women exhibit large and significant “mommy effects” of decreased employment”.
Based largely on surveys dating back as far as the 1960s of women pre- and post-childbearing, gender role attitudes, and employment statistics, the authors seem to think that women are “shocked” by how difficult having children is and thus drop out of the workforce. What “shocked” me what when they got to the part where they asked “if women are overestimating their future labor supply, are they in fact over-investing in education?” They argue that “female medical students systematically over-invest in education given that female doctors work significantly fewer hours than male doctors.” And go on to assert “from a purely pecuniary perspective, these students should have instead become physicians’ assistants”.
Their assertions about educated women specifically seems to come primarily from what they call “extensive” interviews of 43 sorority sisters from Northwestern who graduated in the early 1990s and state that this population “reflect(s) high-achieving women who have made sizable investments in educations”. In this sample, two out of the eleven mothers who dropped out of the labor forced planned to do so before the actual birth”. Thus, it was a “surprise” to the other nine women and the surprise caused their attrition.
I certainly do not feel that this small sampling adequate represents me. And I didn’t go to medical for ‘purely pecuniary’ reasons anyway! Let’s take a brief look at the economic and other benefits of educated women in general, since we’ve already discussed the benefits of female physicians specifically.
Educated women suffer less maternal mortality, less domestic violence, and enjoy increased self-agency, increased civil and political participation, and more freedom. Countries with higher rates of educated women have higher GDPs and are more likely to have democratic governance. Children of educated mothers have lower infant and childhood mortality, improved nutrition and access to care, and are more likely to be sent to school. Many of these benefits are attributed to the education of the mother, not necessarily her employment status.
Yet despite the well-researched benefits of female education, strictly because of bias, many will be paid less. According to Equity Quotient Consulting Firm, among 446 major U.S. occupations, physicians have the largest median gender-based pay gaps; in some subspecialties, the pay gap is as large as $90k.
Because of the many benefits of having educated women, I disagree the “Mommy Effect’s” interpretation that women might be over-investing in education. Although not every advanced degree comes with an exact dollar-for-dollar return on investment, the benefits of educated women in society are beyond simple measure.
Further, I think they were looking at the wrong question. They asked things like whether or not participants agree “A woman’s place is in the home, not in the office or shop”, “A wife who carries out her full family responsibilities doesn’t have time for outside employment” or “It’s much better for everyone concerned if the man is the achiever outside the home and the woman takes care of the home and family” (seriously, these were some of the questions they asked in their surveys In the years 1979, 1982, 1987, and 2004). Maybe instead, they could be asking questions like how can we create adequate job support for women, allow clear paths to leadership positions that don’t depend on one’s reproductive organs, and what are the most efficacious ways to close the pay gap between men and women.
The facts are that women are paid less than men and that having educated women leads to better health and financial outcomes individually and nationally. The more important “Mommy Effect” we should be focusing on is how to keep these amazing mommies achieving at their highest potential so we can all reap the benefits.