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US-POLITICS-BIDEN

An illustration shows three women doctors in white coats looking to the viewer with skeptical expressions on their faces.

Shirlene Obuobi

When my co-resident went on maternity leave, my colleagues turned on her.

Residents had gotten pregnant before, but always during more “convenient” times. In this case, my co-resident did the unspeakable: She got pregnant early in the year, after the annual schedule had been set. Her leave meant that her colleagues had to take on unexpected additional blocks in the intensive care unit and on nights. One senior resident described her as irresponsible.

This experience is not uncommon among female physicians in the United States. The fact is, though medicine has gotten more diverse, its culture remains hostile to us.

As a female cardiology fellow, I am no stranger to the challenges faced by women in medicine. Not only are female doctors held to a different standard than men when it comes to family planning, we are regularly subjected to dismissive and hostile comments from patients, nurses and even other doctors.

I recently asked my female colleagues to share some of the gender-based criticism they’ve received over the years. Patients have commented on their makeup and appearance. Co-workers have offered unsolicited advice about the impact of career choices on family. Patients have assumed they weren’t doctors because they are female. One doctor told me she was criticized for the pitch of her voice; another for talking too much to her patients.

A comic panel reads: Real things people say to women doctors. An illustration shows three women doctors with speech bubble quotes of remarks they've heard. To Dr. Alba Mariner Gonzalez, orthopedic surgery: How can I trust a doctor's decisions when she paints on her eyebrows. To Dr. Sana Haq, neonatal intensive care (NICU): Are you sure you want to do ICU? It'll be hard to get married and be a good mom. To Dr. Lisa Mack, emergency medicine: Taking another break? Most of the other women pump before and after clinic.

The illustration continues with three more doctors and speech bubbles showing real things that have been said to them. To  Dr. Kathryn Winters, Palliative Care: Thanks for trying to explain that about my meds, sweetie, but I asked to talk to the doctor. To Dr. Alexandra Allman, internal medicine: Please lower the pitch of your voice. Women's voices can be hard on the ears. To Dr. Amrita Kaur, Family Medicine: You need to pick up the pace. If you wanted to talk to patients so much, you should have been a therapist.

The hostility toward female doctors doesn’t make sense. Studies show that <a href="https://www.washingtonpost.com/outlook/2022/01/21/patients-get-better-care-female-doctors-sexism-persists-medicine/" target=_blank>female surgeons have better patient outcomes</a> than male surgeons. Women physicians spend more time with patients during clinic visits, and tend to have <a href="https://jamanetwork.com/journals/jama/fullarticle/195191" target=_blank>better communication practices</a>. Patients who are assigned to female physicians are more likely to <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255" target=_blank>survive their hospitalization</a>.

In general, female doctors are really good at their jobs. But that hasn’t stopped other doctors or patients from treating us like we don’t belong.

I had a patient who, over the course of his admission, I had seen for several days and had numerous conversations with him and his many family members.

Still, when the male X-ray technician walked into the room behind me, he let out a long, exaggerated sigh. “Finally,” he proclaimed, “I’m seeing a doctor!”

<a href="https://www.aamc.org/news-insights/sexual-harassment-medicine" target=_blank>Sexual harassment</a>, both from patients and colleagues, also runs rampant — a 2018 report from National Academies of Sciences, Engineering and Medicine demonstrated that about half of trainees who identified as women experienced sexual harassment, almost double the rate seen in other science and engineering fields.

Personally, in my few short years as a physician, I’ve had <a href="https://www.instagram.com/p/CWn6YXdlARp/?utm_source=ig_web_copy_link" target=_blank>male patients</a> masturbate in front of me, a senior physician referring to my body as “tight” during a medical school interview, and more than one patient has interrupted serious conversations about their health to slap my bum.

Arghavan Salles is a minimally invasive surgeon and scholar whose research focuses on gender equity, implicit bias and physician well-being. Due to the hostility she experienced as a surgeon, she has taken a step back from clinical practice, a decision that <a href="https://docs.wixstatic.com/ugd/3fdf20_b47503c5516f4b61b42dc04b94605f15.pdf" target=_blank>40 percent of female doctors make within six years of finishing training</a>.

“The reason women are leaving medicine is multifactorial, and it’s not, as some might suggest, due to women not wanting to work full-time,” she said.

The list of reasons, she says, is long: <a href="https://www.washingtonpost.com/national/health-science/why-are-female-doctors-introduced-by-first-name-while-men-are-called-doctor/2017/06/23/b790ddf2-4572-11e7-a196-a1bb629f64cb_story.html" target=_blank>microaggressions</a>, sexual harassment, undermining of our work and lack of support for families in the workplace.

Last year, the Journal of the American College of Cardiology reported on the <a href="https://www.jacc.org/doi/10.1016/j.jacc.2021.12.034" target=_blank>challenges women in cardiology</a> face during pregnancy. More than 40 percent experienced a salary decrease during the year of pregnancy, 36.5 percent reported pregnancy complications, nearly 75 percent reported treatment by colleagues that would be considered discriminatory or illegal.

Statistics like these are the reason I’ve considered quitting cardiology. I worry that long shifts and toxic work environments might compromise my health and the health of any pregnancy I may decide to carry.

This concern is far from unfounded; female physicians have rates of i<a href="https://ashpublications.org/ashclinicalnews/news/1426/Female-Physicians-Face-Higher-Rates-of-Infertility?searchresult=1" target=_blank>nfertility and miscarriages that are almost twice those of the general population</a>, with more than 40 percent of female surgeons suffering a pregnancy loss.

Though female physicians tend to have better outcomes and communication practices, this doesn’t necessarily translate to <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2014.900892?casa_token=57om96cHkgwAAAAA%3A8bI_yT91hic9myCXQJhRPIp_TO6eCb6Um75I45BAAxiYMvZusWOfavhK5KMZTzSMKZOCr-NOUzsq" target=_blank>higher patient satisfaction</a> scores.

If anything, patients and other health care workers seem to expect more time and increased communication with female physicians. One study found that women receive <a href="https://pubmed.ncbi.nlm.nih.gov/34993875/" target=_blank>26 percent more inbox messages </a>from both colleagues and patients than their male counterparts.

The gender pay gap in medicine isn’t because women work fewer hours. <a href="https://www.nejm.org/doi/full/10.1056/NEJMsa2013804#:~:text=Female%20physicians%20represent%20a%20growing,less%20than%20their%20male%20counterparts.&text=The%20magnitude%20of%20and%20reasons%20for%20this%20pay%20gap%20are%20still%20debated." target=_blank>The New England Journal of Medicine </a>reported that female primary care doctors generate less visit revenue because they spend more time in direct patient care.

“Women physicians must be excessively available and take the time to build social capital in order to gain cooperation for patient care, for which we are rewarded with slower promotions and less pay,” Salles said.

In the past, women in medicine have endured these challenges simply by putting their heads down and working hard. I often find myself walking a tightrope, one in which I must be competent but not arrogant, likable but not a pushover.

But women are no longer a silent minority in medicine — there are now more female medical students than male. With this comes the opportunity for a long overdue culture shift, one that will hopefully prioritize patient centeredness over paternalism, evidence over dogma, and compassion over tradition.

And initiatives like the <a href="https://www.womeninmedicinesummit.org/" target=_blank>Women in Medicine Summit</a>, founded by oncologist Shikha Jain, provide opportunities for all physicians to come together to brainstorm ways to achieve a more hospitable environment for not only women but all forward-thinking physicians.

“Ensuring that we not only keep women in medicine, but also promote them into leadership positions, is overall better for patient care and outcomes, not just for women’s health, but for everyone’s health,” Jain said.

When I first entered the medical world, the advice I received was to assimilate into its masculine structure. But embracing all aspects of my personality, particularly through my writing and my art, has been a powerful tool.

When I set out to write a book, I didn’t pen the hard-hitting medical nonfiction often expected of physician writers, instead I wrote a fictional love story about a Black woman in medical school. My comics are colorful, tongue-in-cheek and often take on the issues that female doctors face.

I advocate for physician wellness and openly talk about challenges female doctors face. I’ve decided to allow myself to be me. And I think my patients are better for it.

I’m not one of the boys. And that’s a good thing.

Shirlene Obuobi is a second-year cardiology fellow at the University of Chicago medical center. Her comics about navigating health care appear on her Instagram @ShirlywhirlMD. She is the author of “<a href="https://amzn.to/3IAeD9p" target=_blank>On Rotation</a>,” a novel about a Ghanaian American medical student.

An earlier version of this article incorrectly stated the last name of Sana Haq as Haaq. The story has been corrected.

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Shirlene Obuobi, MD

Rude comments and bottom slaps: The things female doctors put up with.

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The rude comments and hostile behavior female doctors put up with

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