This week’s Views from the Chair is the last post in September, which is Women in Medicine month. For this column, Dr. Grumbach asked a number of women faculty members for their thoughts on the subject without any other prompt or guidance. We are grateful for these contributions.
I never had a women mentor throughout my medical school, residency, fellowship or as faculty. I have had male mentors who have helped me navigate my path to where I am and I am really grateful to them. Never once did they make me feel that I was competing in a man’s world, and I realize that that is not the norm as I speak with other women faculty members about their experiences. I was always made to feel like I was the mentee who they wanted to really succeed. While I am so grateful to them for their support and advice, I wish I had women mentors whom I could have looked up to and felt comfortable discussing the complexities of work-life balance with, as I never brought that up with my male mentors. As I now mentor female medical students, residents, and junior faculty, I struggle with how to best advise them about these issues that I faced at their stage of their careers. In 2022, there is definitely more acceptance of not accepting gender roles. I am so happy to see how much more confident the women of today are to ask for what they want. These are all steps in the right direction, but we do have a long way to go toward gender equality and equal pay for women.
When I graduated from Medical College of Wisconsin in 2011, we were the first graduating class of women to outnumber our male counterparts. In a society where girls and women face unrealistic standards, such as the physiologically impossible proportions of Barbie or the hopeless promise of smooth skin contained in expensive little tubes of wrinkle cream, I felt proud to be part of that historic, progressive group where brains, not Botox, mattered. Unfortunately, discrimination in our field is still prevalent: I remember being advised not to wear my wedding ring on job interviews, not to bring up that I have children, I remember an attending in residency who directed his questions only at the men in our group, a patient who asked me to remove my mask because I have pretty eyes and he wanted to see the rest of my face. Beyond these indignities, national statistics show we are compensated significantly less than our male colleagues for the same work. But as we share our love of science with other young women, gain representation in medicine, and tell our stories, I am hopeful we can steadily move the needle and grow as a profession and society.
I recognize that I am a proud heir to a long line of women doctors. Last night when I was reading a book to my daughters about Elizabeth Blackwell, the first woman in America to receive a medical degree, my oldest daughter excitedly exclaimed, “women CAN be doctors.” It reminded me of the sacrifices that so many women underwent in order to help create a world that is more equitable and just. I honor their efforts and hope to pay it forward for the next generation of women physicians.
I will share something said by a patient early in my career. Setting: c.1992, residency, Iowa City VA, continuity of care clinic. Patient: WWII veteran, first visit with me. He does not know why he is on “so many medications” and “I don’t know what they do or why I need them.” I found a piece of paper, drew 3 columns, listed name of medication in column 1, category in column 2, what it did to/for him in column 3. “Furosemide | diuretic | makes you pee, lowers blood pressure” and so on down the list. When I was done the patient gave a heavy sigh, smiled, and said, “That’s what I like about you lady doctors, you explain things so well.” Up to that point I might have bristled a bit at being called a “lady doctor,” but on that day I thought, if this is what it means to be a “lady doctor,” then so be it.
During my medical school rotations, the male colleagues wearing white coats were referred to as “doctors,” while females were presumed to be “nurses.” I attributed these gender disparities to the patriarchal nature of Indian society. When I chose to pursue my residency in the United States, I was shocked to find similar biases deep-rooted in healthcare here. I thought I could get around the disparities by working harder and proving myself to be worthy of the same recognition as my male colleagues, but that didn’t always happen and in the process of doing so I started to experience burnout.
Over time I realized the importance of women in leadership roles serving as role models for their junior colleagues. I was fortunate to find women like Dr. Linda Thomas Hemak, my residency program director, a dynamic leader and passionate about primary care, who was instrumental in the creation of the Wright Center for Graduate Medical Education, a national family medicine program to address ongoing nationwide primary care shortages. Another impactful presence for me was Dr. Shubhra Shetty, an infectious disease specialist who was instrumental in establishing the first Ryan White Infectious Disease Clinic in Northeast Pennsylvania, providing dedicated care to over 400 HIV patients. She went on to become the associate dean for the Geisinger Commonwealth School of Medicine.
I aspire to become the one to inspire and mentor the next generation of women trainees.
Being an early career physician, I’ve learned to not just put in the hard work, but also to advocate for myself and not settle for anything less than my male counterparts.
When I think back at my journey to become part of Women in Medicine, I want to first acknowledge that I would not be here if it weren’t for some great educators and mentors that saw something in me and challenged me to be more than the farmworker I was destined to be. As you can imagine, Latina Women in Medicine are few. Only 3.4% of the current physician workforce in the United States identify as Latina, while 19% of the US population now identifys as Hispanic, Latino (a, x), or Chicano (a, x), only second to the non-Hispanic white population. It is clear there is a mismatch in the care we deliver versus what we ideally should offer. As we all know medicine is not immune to implicit bias and academic medicine is no exception. The missed opportunities that can be gained by educating, mentoring, hiring, and promoting Latina physicians include, but are not limited to, greater familiarity with Latinx Communities (e.g., an asset in community based participatory research and other research), bilingual skills (less information lost in translation), and personal experience that poise Latina physicians to be capable of providing culturally concordant care to their patients—this is value-added that deserves acknowledgement and compensation. However, in an effort to increase diversity and representation, Latinas (all women of color) more frequently are tasked than their counterparts to engage in recruitment, committees, or other activities that may not be heavily weighted for promotion—a “tax” for being a woman in medicine and in a STEMM field. We also want to be in positions of leadership such as physician scientist, specialists, and deans. I recognize that despite our current gender equity gap, we have come a long way since Margaret Cleaves walked through these wards, but we must and should do better if the field of medicine is truly to serve our community. To the men in medicine who dedicate time to educate, mentor, hire, and promote women in medicine, thank you.
Sometimes, we have to promote ourselves. Just go out and be very active about trying to find an opportunity.
~ Dolores Huerta (one of my earliest mentors)
When I was asked to put down my thoughts about being a woman in medicine, my first thought was, “I don’t feel like I have been treated differently from my male colleagues.” Then I read some of writings from previous series for women in medicine and realized how far women have come. Prior generations of women in medicine had to overcome both subtle and overt sexism and bias in order to prevail in their respective fields. And it was only recently that women began to receive equal compensation as their male colleagues. I am thankful that I’m in a division and department who have been supportive of my goals and efforts as a physician scientist, regardless of my gender.
Many years ago, three women from a nomadic family half-jokingly asked me if I was really a woman, because I didn’t know how to spin wool. (Or fold dumplings, for that matter.)
As an anthropologist, I light up learning about the richness of human genders over time and across societies. Still, I wrestle with the constraints of my gender in the cultural worlds I move through, including at work. At the same time, I recognize the privilege that comes along with being a cisgender woman in those worlds.
At the University of Iowa Carver College of Medicine, I feel lucky to have mentors and leaders who support and guide my work, and to work in a department that values the work of women and is working to improve diversity, equity, justice, and inclusion overall. Still, it feels intimidating to make a public statement in a work context about being a woman in medicine. For a moment, I sparkled with thoughts of a poem or experimental film—full of contradictions and mysteries—that might better communicate how I feel about those paradoxical delights and furies. But among lots of deadlines and missed deadlines, I chose simple prose over art.
I hope the department and college redouble our efforts to include and support all those who can contribute to better health for all, during “Women in Medicine” month and all year round.