While many medical school classes now feature a nearly equal number of male and female enrollees, that parity in numbers among tomorrow’s doctors does not necessarily add up to equality in today’s physician workplace. That appears to be the verdict of a recent survey of about 6,000 women physicians, nearly 80 percent of whom reported facing disrespect or discrimination on pay, benefits, promotions, performance evaluation or their decision-making role. Physician mothers reported an even higher rate of unfair treatment.
The research, published in JAMA Internal Medicine, is drawn from an online survey developed by a Facebook group, the Physician Moms Group. An overwhelming number of those who said that they faced discrimination because they were mothers—almost 90 percent—attributed the discrimination to pregnancy status or workplace policies on maternity leave. More than half of the same group—close to 53 percent—responded they had been treated disrespectfully by nursing and other support staff, and more than 48 percent reported they had been discriminated against based on breastfeeding.
These numbers, said one of the study’s co-authors, Eleni Linos, MD, DrPH, should not be interpreted as a male bias against women. “We don’t have any reason to think men are at fault,” said Dr. Linos. Rather, she said, the “problem may be due to inadequate policies and processes to support and protect women.”
Christina Talerico, MD, a child and adolescent psychiatry fellow at the University of South Alabama and a Resident and Fellow Section Representative to the AMA’s Women Physicians Section (AMA-WPS) Governing Council, did not participate in the survey. However, after reading its findings, she said, “I do think it paints a realistic picture” of some of the issues that female physicians contend with in the workplace.
Many of the problems that she and some of her female cohorts have faced, said Dr. Talerico, stem from a lack of family-friendly workplace policies—or from their lack of application—at many health care institutions. “It’s like the Wild West,” she said, referring to inadequate or inconsistent policies regarding parental leave, breastfeeding, salaries and job promotions.
A late arrival to the medical profession, Dr. Talerico acknowledged that she hid her pregnancy during the medical school application process, lest she be denied admission based on her status as a mother-to-be. “I did perceive that I could be discriminated against based on my pregnancy,” she said.
And once female medical students or physicians give birth, or are about to give birth, they often find themselves in uncomfortable situations with colleagues and administrators about their maternity leaves and on-call coverage.
Dr. Talerico said that one pregnant colleague who fell seriously ill before giving birth became the target of resentment because colleagues had to cover for her while she was on bed rest.
“If it had been a male colleague with a serious medical condition such as cancer, no one would have made a fuss about covering for him,” she said.
Among support staff, an unsupportive attitude
Then there is the matter of disrespect.
“There is less respect for female physicians,” said Dr. Talerico. There is a prevailing attitude among hospital staff—both male and female—that female physicians should be “nicer,” she said, which often means that there is the expectation that they should act less authoritatively.
Dr. Talerico’s University of South Alabama colleague, Maria Hamilton, MD, also a child and adolescent psychiatry fellow, recounted being shunted from room to room to nurse her infant and made to feel bad about her mothering responsibilities. All she wanted, she said, was one designated room at her hospital in which she could breastfeed.
Hala Sabry, DO, a Southern California emergency physician and mother of three children under 4, is the founder of the 60,000-strong Physician Moms Group that organized the survey and released the data to the authors of the JAMA Internal Medicine study.
“I was not surprised by the results,” she said of the survey, which also showed higher rates of burnout among those who reported maternal discrimination than those who did not (46 percent versus 34 percent).
“Medicine doesn’t allow for family planning,” said Dr. Sabry. “When you go to medical school, there isn’t anyone mentoring you on how to live your life.”
Ami Shah, MD, a New York radiologist who serves as an alternate delegate on the AMA-WPS Governing Council, corroborated Dr. Sabry’s account.
“When I was a medical student, resident and fellow in the 1990s,” no one talked about work-family balance, she said, and “when I was pregnant, I had no idea what my workplace’s parental leave policies were. ... In the past, a lot of employers didn’t think about these issues.”
This experience prompted her decision to become involved in the AMA-WPS leadership in 2011.
Dr. Sabry said that the rationale for conducting the Facebook survey was as a call to action for the implementation of family-friendly, equitable policies that benefit all health professionals. These include clearly articulated and fairly enforced parental and family leave policies, accommodations for nursing mothers, transparency in salary negotiations and hiring practices, and more flexible work schedules. She and others interviewed for this story argued the changes they are seeking will benefit their male colleagues—who also want to spend more time with their young children—as much as working physician mothers.
“The male physicians of my generation”—born in the 1970s and ’80s—“are so supportive” of their female colleagues’ professional and family considerations, Dr. Sabry said.
Though there is much work still to be done to mitigate gender bias and create more family-friendly work environments for physicians and other professionals, Dr. Shah noted that some progress has been made, pointing to AMA policies on parental, family and medical necessity leave adopted in 1988 and 2014. The Association also has long-standing policy “opposing sex discrimination in the medical profession” and supporting flexibly scheduled residencies.
And at the 2017 AMA Annual Meeting, the AMA House of Delegates (HOD) directed the Association to “work with relevant entities” to study whether health care institutions provide child care services as well as how those services are organized and paid for. The AMA will issue a report to HOD on the matter at the 2018 AMA Annual Meeting.
In addition, the HOD amended current policy to urge “all medical licensing, certification and board examination agencies and all board proctoring centers” to give breastfeeding mothers additional break time and a suitable place where they can express milk during examinations. That place should not be a bathroom, should be private, and should have an electrical outlet to which a breast pumping maching can be connected.
Drs. Talerico and Shah also said that medical schools and continuing medical education programs should offer female medical students and physicians leadership and mentoring programs that give them the skills and confidence to stand up for their workplace rights.