Thoughts from the Dean

Women in Medicine

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October 16, 2015
Women in Medicine

Advances notable but barriers remain

The first 12 women to enter Harvard Medical School did so in September, 1945. Now, 70 years later, it seems almost unfathomable that this school had not admitted a woman until then. Other U.S. medical schools had been admitting women for years.

However, at the end of the World War II, even though women dominated other health professions, they represented a very small fraction of the medical profession.

Today, at Harvard and elsewhere in the U.S., comparable numbers of men and women graduate from medical school, and women populate every field of medicine, and medical science—achieving distinguished status in all of them. In fact, my wife and both of our daughters are physicians, making a world in which only men are doctors foreign in so many respects. The advances women have made in medicine over the years are remarkable.

Yet there remain issues to be understood, addressed and resolved regarding the status of women in the profession. With gender-balanced admissions first achieved in the 1990s, it isn’t surprising that women remain a minority, representing approximately 30% of today’s total physician workforce. Beyond this fact, which should predictably change with the passage of time, there are interesting questions regarding how women physicians select specialties and advance their careers, achieve desired levels of work-life balance, and are compensated for their work.

Women enter all specialties and sub specialties, but they disproportionately gravitate to some, such as internal medicine, pediatrics, obstetrics-gynecology and psychiatry, over others such as some surgical and interventional fields. Is this because of different professional interests, external pressures or other factors? Over the past 70 years, the previously dominant role of women in child care and family matters has evolved to reflect greater equality, but still differences persist.

These ongoing, but highly variable, disparities of external responsibility may explain in part why women physicians with families gravitate toward fields seen as hospitable to work-family and work-life balance with shorter workweeks, more predictable schedules and greater potential for part-time status. Whether these outcomes should be seen as a problem for the medical workforce—or a welcome solution to the need for personal and professional satisfaction—is a matter for discussion.

Are women physicians fairly compensated compared with their male counterparts? Not surprisingly, this is a complicated issue that may be difficult to resolve. Several studies report woman doctors do receive reduced compensation, but a meaningful assessment requires normalization for specialty, work hours and career path, among many other factors.

I have the impression—validated by some careful studies of academic physicians—that even when the data are carefully normalized, women do receive reduced compensation. As a profession, we have an obligation to examine this issue, and to determine whether it reflects yet unknown differences in job roles, or the effects of other factors, including hidden biases.

An additional disparity is the gender differences in academic rank among faculty in U.S. medical schools. Physicians with medical school appointments represent 9% of U.S. physicians, and of these there are half as many women as men. Among these faculty, there is a much lower percentage of women than men with the rank of full professor, though there have been impressive and steady gains over recent decades. When adjusted for age, experience, specialty and measures of research productivity, this difference between the sexes in academic rank is greatly reduced, but it still persists, suggesting the possibility that some other confounding factors, or bias, whether conscious or not, might be involved. Most medical schools have responded to these concerns with programs aimed at addressing these issues to support the careers of women physicians.

Whatever the remaining problems, it is clear that from 1945 to today, the status and impact of women in medicine has been enhanced. Not only are half of our students women, but they also are entering and succeeding in all specialties of our profession. Though more are needed, women are among the chairs of the best departments and leaders of our greatest academic medical centers and medical schools, and they are illustrious biomedical scientists and academicians.

There is nothing that a woman in medicine cannot do. It is our responsibility, however, to identify remaining barriers to full gender equality, so that medicine will be an exemplar for all fields of human endeavor, as it certainly should be.

Reprinted from the Wall Street Journal