Gender bias in medicine – does it exist?

Despite significant advancements in gender equality, the medical field has long been scrutinised for issues related to gender bias. This case study explores whether gender bias exists in medicine by examining research, personal testimonies, and institutional policies. The findings are drawn from conversations between the Medworld Institute and a series of doctors. They highlight the persistence of gender disparities and the efforts to address them within the profession.

Medicine has traditionally been male-dominated, with women only beginning to enter more significantly during the latter half of the 20th century. While the number of female medical students and professionals has increased, gender disparities in career advancement, pay, and representation in leadership roles remain. Gender bias can manifest in various ways, from the underrepresentation of women in certain specialities to differences in patient treatment by male and female doctors.

“Gender difference is intimately stitched into the fabric of humanness. At every stage in its long history, medicine has absorbed and enforced socially constructed gender divisions” (Cleghorn, E (2021, June 17). Medical Myths About Gender Roles Go Back to Ancient Greece. Women Are Still Paying the Price Today. Time Magazine. Retrieved September 14, 2024).

The ‘feminisation of medicine’ is a term often thrown about, and too often, it’s discussed in negative terms. Dr Charlotte Chambers argues that it’s the wrong term altogether and that it’s these attitudes and oversights that are part of the burnout problem;

“I'm particularly concerned about the way in which we describe the growing numbers of women in medicine as the ‘feminisation of medicine’. That's a very simple linguistics slip, but it's actually a pejorative description if you think it. Because, it suggests that medicine has never been gendered and it's only now becoming gendered that we have growing numbers of women in it – it’s not necessarily an accurate representation in my view.”

Another recognised theme was that women have to work harder to be recognised for their contributions. In Charlotte’s interviews, many of the doctors recalled being misidentified by patients as nurses or ignored in favour of male colleagues.

“What is the broader significance of those minor acts of misidentification? How, over time, can they coalesce to make women work harder to assert themselves as legitimate medical professionals? What does it mean if you're routinely getting misidentified or treated differently by your staff?”

One surgeon reported being routinely handed incorrect equipment by her nursing staff over a long period of time. She’d politely ask them to get the correct equipment, “But, it wasn't until she lost her temper one day, slammed her fist down and swore at the nursing staff – and, in many ways, acted ‘like a surgeon’ – that her request was adhered to.”

Dr Charlotte Chambers highlights that entrenched attitudes in medicine are contributing to poor workplace cultures.

“It is so important to foster collegial ways of speaking, treating each other as people who do have lives and commitments, and, in many instances might have a hell of a lot of stuff going on outside of work as well.”

She adds that everybody has biases – that’s normal – but recognising this is key.

“Take the Harvard Implicit Bias test; it's incredibly confronting. But once you recognise that you have bias, then there are additional steps to do things about it.”  

“Despite the growing or the gender balancing of the profession, problems with gender pay gaps and lack of women in leadership positions persists. And that's precisely due to this problem, we're not willing to recognize the fact that they have an issue with gender bias and that bias can influence their subsequent actions around employment practices and advancement opportunities.”

‍‍Dr Mariam Chaalan told The Medworld Institute: “I write this as a strong female who likes to think of herself as assertive and resilient. But even with my strong and confident attitude I would stumble and fall. There were days I would come home to an empty house following a monstrous shift and I would just sit and cry. I was tired of the anxiety that lurked deep in my belly every living moment. The fear that I would never be good enough. The fear that I would miss something important or the fear that I would be judged by my colleagues. I had moments where I would question my existence.

Working in an environment rampant and rife in sexism, bullying, and unrealistic expectations, I was always questioning myself, denigrating my strengths, and perseverating over my inadequacies. When you would ask for help, you were deemed incompetent or acopic.

So instead, I allowed the system to dictate that we are to "suck it up" that it's all part of the process of being the "better doctor". I was jaded and disappointed in a system that continued to let me down despite me giving it everything I could.”

“Over the years, I have encountered numerous incidents of gender bias from patients and colleagues. They may not realise what they are saying and genuinely believe they care. However, they have mistaken their actions as kindness rather than gender bias.

Of course, there’s cultural bias also, where patients do not feel they want to be seen by female doctors. Or we are constantly being regarded as less than we are.” Dr Shan Shan Jing told the Medworld Institute.

Key findings:

1. Disparities in Specialisation and Leadership:

Studies show that women are underrepresented in high-paying specialities like surgery, orthopaedics, and cardiology. The most recent demographic data reveal that only 6.5% of practising orthopaedic surgeons are women. As far as we know, only two women have held chair positions in academic orthopaedic programs in the United States (National Library of Medicine, Despite Growing Number of Women Surgeons, Authorship Gender Disparity in Orthopaedic Literature Persists Over 30 Years. Retrieved 13 September 2024).

In New Zealand, a study undertaken by The Herald revealed: “While more than half of the country's medical graduates are women, they only account for 6.5 per cent of orthopaedic surgeons.” Russell, E (2021, May, 15). The uncomfortable truth: Top male doctors earn up to $73,000 more than female colleagues. The New Zealand Herald. Retrieved September 14, 2024).

Leadership positions, such as department heads and deans, are still largely male-dominated. For example, despite efforts to close the gender gap, only 18% of medical school deans in the U.S. are women. (National Library of Medicine, Misconceptions about women in leadership in academic medicine, retrieved 13 September 2024)

In the male-dominated field of plastic surgery, sexism is palpable. Dr Shan Shan told the Medworld Institute she’s often subjected to sexist attitudes, mainly from patients. “One commonly reported sexist attitude is female doctors being treated as inferior, or referred to as ‘the nurse’ – even when they’re be introduced as the doctor or surgeon. Many say they have to work harder than their male peers to gain the respect they deserve.” 

2. Pay gap in medicine:

Numerous studies have found that female doctors earn less than their male counterparts. A 2020 report showed that female physicians in the U.S. earn 25% less on average than male physicians. This pay disparity persists even when controlling for factors such as hours worked, speciality, and experience. (Dill, J and Frogner, B (2023, December 27) The gender wage gap among health care workers across educational and occupational groups. National Library of Medicine. Retrieved September 13, 2024). 

A study conducted by The Herald in New Zealand found that: 

“Top male doctors earn up to $73,000 more than their female colleagues each year, despite working the same hours and job responsibilities. 

There are nearly 1200 more senior male doctors employed by the country's public hospitals compared to female, with women making up just a fraction of many highly paid medical positions.

A gender breakdown of New Zealand senior doctors shows 3459 are male and 2276 are female.” (Russell, E (2021, May, 15). The uncomfortable truth: Top male doctors earn up to $73,000 more than female colleagues. The New Zealand Herald. Retrieved September 14, 2024). 

3. Gender bias in patient care:

Gender bias can also affect patient care. Studies suggest that female doctors spend more time with patients and have better patient outcomes, yet they are often undervalued for this emotional labour. Conversely, female patients may receive less aggressive treatment for conditions like heart disease when treated by male doctors.

“In Australia, research from the University of Sydney in 2018 found that females admitted to hospital for serious heart attack were half as likely as men to get proper treatment and that they died at twice the rate six months after discharge.” Ritchie, H (2024, July, 13). Doctors dismissed these women as hysterical. Now they're fighting back. The BBC. Retrieved September 14, 2024. 

A study published in The Journal of the American Heart Association found that women who suffer from heart attacks are less likely to receive life-saving treatments compared to men, highlighting potential biases in patient care based on gender.

4. Barriers to work-life balance:

Female doctors often face unique challenges in balancing work and family life. Studies suggest that women in medicine are more likely to experience burnout due to these competing demands. The lack of adequate maternity leave and support for working mothers contributes to this issue, limiting their ability to advance in their careers.

A 2016 Association of Salaried Medical Specialists (ASMS) study showed that 70% of women in medicine in their 30s exhibited burnout.

A BMC Medical Education study suggests that “Data demonstrates female doctors have an increased level of both psychological distress and depression compared to males [1, 2]. At a systems level, prolonged working hours and lack of flexibility in the workplace leads to increased levels of stress and burnout for both male and female junior doctors [3, 5].”Hoffman, R, Mullan, J, and Bonney, A (2023, January, 20). “A cross-sectional study of burnout among Australian general practice registrars.” BMC Medical Education.Retrieved September 14, 2024. 

A 2022 study by the American Medical Association revealed “57% of female respondents reported at least one symptom of burnout. Among male respondents, by contrast, 47% reported experiencing burnout. (Berg, S. (2023, September 12). New data sheds light on the gender gap in physician burnout. AMA. Retrieved September 14, 2024). 

4. Personal accounts

One commonly reported sexist attitude is female doctors being treated as inferior, or referred to as ‘the nurse’ – even when they’re be introduced as the doctor or surgeon. Many say they feel they have to work harder than their male peers to gain the respect they deserve.

It’s a theme that took over social media recently when three male vascular surgeons published a ‘study’ called Prevalence of unprofessional social media content among young vascular surgeons. The authors suggested that potentially unprofessional social media content included ‘provocative posing in bikini/swimwear’. After an outcry, The Journal of Vascular Surgery retracted the study and posted an apology.

Doctors like Dr Shan Shan took to social media to protest, posting pictures of themselves in bikinis along with the hashtag #medbikini.

“I love all aspects of my job. It’s innovative, creative, and different for each patient. A lot of people have a default idea of plastic surgeons being like that of nip-tuck males with ultra-egos, but the reality is very different. Cosmetic surgery is a small part of what we do as plastic surgeons.”

In interviews with female doctors, many report experiencing gender bias throughout their careers. 

Dr Shan Shan Jing told the Medworld Institute: “Even after I’ve introduced myself as a doctor, I’m still often considered as a nurse. This is especially true for doctors in training before they become a consultant or an independent practitioner.

I’ve come to accept that I can’t change others' perceptions or biases. I can only adjust my personal feelings, which means letting go most of the time.

But when you’re down or you’ve had a tough day, comments like that make you feel grossly under appreciated. It doesn’t help when you’re ethnic and petite like me either. There’s a lot of type-casting of what a doctor or surgeon should be like. As a result, I’ve to work harder to gain the appreciation and respect of my colleagues and patients alike. This is something I had to accept at the start of my career.”

Progress and Initiatives:

Despite these challenges, notable efforts have addressed gender bias in medicine. Many institutions have implemented policies to close the pay gap, increase diversity in leadership, and provide more support for work-life balance. Programs like the Women in Medicine Initiative aim to promote gender equity through mentorship, advocacy, and research.

‍

Resources for female doctors in Australia and New Zealand:

Australian Medical Women’s Federation (AFMW): The AFMW offers a supportive network for female physicians in Australia, advocating for gender equity in medicine and providing leadership opportunities, mentorship programs, and resources for professional development.

New Zealand Women In Medicine (NZWIM) Similar to AMWF, NZWIM is dedicated to supporting female doctors in New Zealand. It promotes women's health, offers networking opportunities, and supports female physicians at all career stages. This initiative provides a platform for female doctors to share experiences, seek advice, and support one another. It operates across social media and organises events and workshops tailored to the needs of women in medicine.

The Royal Australasian College of Physicians (RACP) Women in Medicine: The RACP offers resources, policies, and programs to support female physicians in achieving work-life balance and overcoming professional hurdles.

The Royal Australasian College of Surgery The RACS ACS college is committed to expanding the number of women in surgical training and to ensuring the training programs do not disadvantage them.

The RACGP Doctors for Women in Rural Medicine (DWRM) This RACGP DWRM committee aims to elevate, empower, and encourage women working in rural practice by working to identify and meet their unique interests, challenges, and needs and empower them to reach their full professional capacity, in turn supporting rural communities.

Mental Health Services: We care about your wellbeing, and we know that you probably don't have that much time on your hands, so here is a list of some services which offer mental health and wellbeing support in Australia and New Zealand.

Conclusion:

Gender bias continues to exist in medicine despite increasing awareness and efforts to address it. Women face disparities in pay, leadership opportunities, and work-life balance while also experiencing bias in patient care. However, with ongoing advocacy, institutional change, and support programs, there is hope that the medical field will become more equitable for all genders.

This case study highlights the importance of continued research and initiatives aimed at dismantling gender bias in medicine. While progress has been made, much work remains to achieve true gender equity in the profession.

Recommendations:

• Policy changes: Institutions should implement transparent policies to address pay disparities, promote work-life balance, and increase female representation in leadership roles.
• Mentorship and sponsorship: Establishing formal mentorship and sponsorship programs for women in medicine can help address disparities in career advancement.
• Awareness and training: Gender bias training for healthcare professionals can help reduce unconscious bias in patient care and improve workplace dynamics. You can take the Harvard Implicit Bias Test here.

References:

‍

1. Brown, A Erdman, M, Munger, A, and Miller, (2019, June, 17). Despite Growing Number of Women Surgeons, Authorship Gender Disparity in Orthopaedic Literature Persists Over 30 Years. National Library of Medicine. Retrieved September 13, 2024.
2. Berg, S. (2023, September 12). New data sheds light on the gender gap in physician burnout. AMA. Retrieved September 14, 2024. 
3. Cleghorn, E (2021, June 17). Medical Myths About Gender Roles Go Back to Ancient Greece. Women Are Still Paying the Price Today. Time Magazine. Retrieved September 14, 2024. 
4. Dill, J and Frogner, B (2023, December 27) The gender wage gap among health care workers across educational and occupational groups. National Library of Medicine. (retrieved September 13, 2024).
5. Hastie, M Lee, A Siddiqui, S, Oakes, D and Wong, C (2023, May 17). Misconceptions about women in leadership in academic medicine, (retrieved September 13, 2024).
6. Hoffman, R, Mullan, J, and Bonney, A (2023, January, 20). “A cross-sectional study of burnout among Australian general practice registrars.” BMC Medical Education.Retrieved September 14, 2024. 
7. Ritchie, H (2024, July 13). Doctors dismissed these women as hysterical. Now they're fighting back. The BBC. Retrieved September 14, 2024. 
8. Russell, E (2021, May 15). The uncomfortable truth: Top male doctors earn up to $73,000 more than female colleagues. The New Zealand Herald (retrieved September 14, 2024).

‍

‍