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Strong presence: Greater diversity in medicine

Asian-American women are increasingly becoming a force in the medical community.

By Beth Wilson, amednews correspondent. March 10, 2003.

Linda Dairicki Shortliffe, MD, began her medical studies in the mid-'70s, accustomed to being different.

"When I entered medical school, I'd always been treated like a minority," said Dr. Shortliffe, whose grandparents emigrated from Japan. "What you said as a minority can be ignored. Whereas a white male may say the same thing and it's like you didn't say anything."

Dr. Shortliffe, now a professor and chair of urology at Stanford University's School of Medicine, found her own path to success, albeit quietly. "I didn't have a lot of people to talk to," she said of her medical school days. "Nobody really told me about anything. I didn't know about a lot of the [professional] societies."

Today's female Asian-American medical students may not face the isolation Dr. Shortliffe dealt with 30 years ago. Asian-Americans are the largest segment of women entering medicine, behind whites, and the group is gathering strength, acceptance and political savvy.

Stephanie Su, MD, and Dorise Yang, MD, are both fifth-year residents in otolaryngology-head and neck surgery at the University of Chicago Pritzker School of Medicine. Both came to the United States from China as young girls.

Citing the growing number of women physicians and those of Asian origin, Dr. Su says her ethnicity plays little, if any, role in her work.

There were 3,928 Asian-American women in medical school in 1992 and 5,994 in 2001.

"Some of the stereotypes are good stereotypes, like Asians are very hard-working," she said. "Overall, I didn't feel there was any extra stigma."

She and Dr. Yang are each other's support system.

"When we started, we were the only two female residents in surgical services," Dr. Yang said. "With Stephanie, I can speak to her in Mandarin, and that's a different type of connection. My English is still not perfect, so I don't socialize the same way. I'm funnier in Chinese. I speak with more humor and more slang because I'm more at ease."

Not only may greater numbers of Asian-American women lead to more supportive relationships, but it often results in more visibility and stature.

"Asian-American women in particular are rapidly becoming more of a force," noted Robert Witzburg, MD, dean of admissions at Boston University's School of Medicine.

He has noticed a rise in Asian-American women applicants. "All you have to do is look at our freshman class," he said.

The school does not specifically consider gender and ethnicity in its applicants but it does track gender. Dr. Witzburg said that 57% of this year's applicant pool is female.

Economic diversity

Asian-American women applicants hail from both advantaged backgrounds and from economically disadvantaged households, in which parents may be working three jobs to support their children and their education.

"We've seen a significant increase in both groups," he said. "We're providing opportunities that they might not have had in their country of origin."

Overall, Dr. Witzburg believes the growing number of Asian-American women in the field represents a positive change in medicine.

Helen Li, MD, agreed. "The more medicine mirrors our patient population, the more comfortable patients will feel."

Some words of advice

But Dr. Li did encounter cultural challenges like Dr. Shortliffe's during her early days in medicine. "I was raised to be very modest," said Dr. Li, an associate professor and director of vitreoretinal diseases and surgery at the University of Texas Medical Branch, Galveston.

In medicine, especially in academia, "you're supposed to show everyone your achievements to get ahead," she said. "Chinese believe in modesty -- not 'tooting your own horn' -- and this puts us at a disadvantage to those who believe self-promotion is a form of self-confidence, which is a valued attribute in this country."

Asian-American women made up about 20% of the 2001 class at a Chicago medical school.

Eventually Dr. Li learned how to temper her cultural modesty with Western bravado. "I needed to do what you need to do to get ahead."

Dr. Li also learned to network strategically, build a base of mentors and take advantage of leadership opportunities -- all of which she would strongly recommend to today's Asian-American women medical students.

Like Dr. Shortliffe, Dr. Li felt she learned these lessons on her own, with few early role models or mentors.

"I would tell them," Dr. Li said of new medical school students, "to realize mentors are very important and to seek them out. Do this in addition to focusing on your medical education. Strategically networking will take you further in your career."

Today, both Drs. Li and Shortliffe make it a point to advise and mentor junior faculty members.

Dr. Su counts many women on the University of Chicago staff as her mentors or role models. Our department has so many attendings who value both medicine and their family, she said. "They're all married and want to go home and see their kids.

"If I was in another place with all male attendings, it would be different. I couldn't relate to that."

Working in an environment with other women helps Dr. Su feel at home. In turn, she believes more Asian-American women will follow her example.

"The growing number will influence the younger generation," she said. "They'll have more role models. When you see more people like yourself, it may influence your decision."

Many Asian-American women students and physicians said their parents shaped their decisions to enter medicine. They tended to value higher education, particularly in the fields of science and math.

"Most Asians are pushed to go into the sciences, and one of the most prestigious careers is being a doctor." said Dr. Su, who wanted to be not only a doctor, but a surgeon, so much that she stands on two steps to perform surgery, compensating for being 5 feet tall.

"Higher learning is ... strongly emphasized, and if you're a physician, you bring your family so much respect," she said.

Asian-Indians often share this sentiment as well, Dr. Su said. "I see first- and second-generation families push their kids into medicine."

That correlates with a qualitative study conducted of 20 Asian-Pacific Islander women medical students at Northeastern Ohio Universities College of Medicine in Rootstown, in which most women said their parents encouraged or pressured them to enter medicine, or made the decision for them. Twenty percent said they made their own decision.

Regardless of the motivating factors, many believe the number of Asian-American women physicians will continue to rise.

"I think this trend will continue," said Eliza Chin, MD, who edited This Side of Doctoring: Reflections from Women in Medicine. "The numbers are increasing at the collegiate level."

At Northwestern University's Feinberg School of Medicine in Chicago, the number of Asian-American women students more than doubled from 17 in 1985 to 35 in 2001, when they made up roughly 19.7% of the 178-person class, according to statistics provided by Jack Snarr, associate dean for student programs.

At the University of Kansas School of Medicine, Kansas City, the number of Asian-American women matriculants since 1991 has almost doubled from five students to nine students in 2002, while the overall number of applicants has declined, said Sandra McCurdy, assistant dean for admissions.

Overall, the number of Asian-American women enrolled in medical school has increased by more than 50% to 5,994 students in 2001, from 3,928 in 1992, according to the Assn. of American Medical Colleges. AAMC considers the minority group Asian to include those who identify as being Asian, Thai, Filipino, Indian, Pakistani, Chinese, Japanese, Korean and Vietnamese.

Good for all women

As the number of Asian-American women physicians increases, Dr. Chin believes issues relating to women physicians in general, such as flexibility in the workplace, will gain further momentum.

"People are realizing doctors have a life," she said, "because in the past you were on-call all the time and you really belonged to your patients. Now patients' expectations are changing."

"The culture of medicine has changed," she said. "Women can support each other and be successful. Now they have a collective voice."

For example, Dr. Li said that officials at the University of Texas are addressing the issue of a tenure clock working against those women who take time off to have children.

As a specific group, Asian-American women may be more attuned to Asian health issues and make more effort to serve that community and other minority groups, Dr. Li said. They also may call for more equal representation in clinical medical studies, specifically the inclusion of women and minority women.

"They're not just sensitive to their own culture but other [minority] cultures because they are minorities, too," Dr. Li said.

Additionally, the group may be more understanding of alternative approaches to medicine.

"My mother gave me herbal medicine," Dr Li said. "My mind is open. I don't have a deaf ear when my patients tell me about those things. As time goes by, it may gain more acceptance as part of the mainstream."