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In Your Face . Anh E-Bui Ho

Women in Medicine . Lauren B. Hartman and Allie Scott

First…

The fourth year of medical school is a unique time in an individual's medical training – it allows not only for reflection on the past four rigorous years, but also it is a time for looking forward, anticipating all the possible directions one's career might go. As former presidents of the University of Virginia School of Medicine's chapter of the American Medical Women's Association, and co-presidents of the student interest group ‘Women In Medicine,' we set aside time to reflect on what it means to be a woman in medicine. In writing this piece, we have drawn from a variety of sources, ranging from published feminist thinkers to those in our immediate community of women mentors and colleagues. Our writing has also provided a timely opportunity to reflect on and honor one of the giants in the modern women's movement, the late Betty Friedan. Her 1963 book, The Feminine Mystique, brought to light the fact that being a woman was more complex than being a housewife. Our project has been wholly enlightening, and through the myriad voices who have contributed to this work, we gained a better understanding of the road we've traveled, and what's to come.

Next…

1. Why Medicine?

‘Math Class is Tough.' –Barbie, 1992

These were Barbie's first words when Mattel issued a ‘talking' version of the doll in 1992. Something of particular interest to us is how we (and others) have found our way into science and ultimately medicine despite such obvious cultural roadblocks, Barbie and otherwise.

We asked ‘what were your motivations for going into medicine,' and a common theme emerged.

"The interaction with people and chance to help others in such a concrete, tangible way." Medical student, age 27

"I wanted to help people in very concrete ways, especially relieving and preventing suffering." OB/Gyn, age 55

"The responsibility that comes with medical knowledge and the impact it has on the lives of others. I am grateful for the ability to help my family and others interpret medical information." Medical student, age 27

"I realized what an enormous privilege (plus responsibility) it is to know people so intimately and be able to affect their lives, for good or for ill, so crucially." Pediatrician, age 58

2. A Rough Road For Women

‘Can a woman who takes charge of domestic life compete professionally with a man or a woman who does not? Being a scientist and a wife and mother is a burden in a society that expects women more often than men to put family ahead of career.'

We asked about sacrifices made to achieve career goals. Not surprisingly, the path has not been easy for anyone.

"The biggest sacrifice for me has been time with my young children. When I'm home all day with them on a weekend, or during a break from school, time goes by so slowly (in a good and bad way). I begin to realize how much goes on in each of their days – all the learning and growing and bonding. On the busiest days, I only get to see my kids for an hour or two, which feels wrong." Medical student, age 27

"The biggest sacrifices were around my personal life…seeing my marriage die and becoming a single parent…losing out on my son's first two years while I finished my residency…and missing many, many career opportunities. That is hard because I had to do what was right for my child, but the system was not flexible enough then to let me do both." Anesthesiologist, age 59

"I constantly wonder if I'm doing the right thing. I worry that I'm not being a good mother to my children and I worry that I'm not studying enough to be a good doctor." Medical student, age 27

3. A Woman's Touch

‘Our scientific methods, as women, as feminists, require seeing things as they are: whole, entire, complex. Our work requires that we see things in context, that we understand and explain our eventful, complex reality within and as a part of its matrix. It is only within its matrix that experience, reality, can be known. And this matrix includes the knower.'

We wanted to flesh out the ways in which being a woman has positively played a role in the careers of those interviewed.

"More than anything else I've accomplished, being a mother convinced me of my own strength and of the value of my intuitive, creative, and nurturing abilities." Medical Humanities Scholar, age 57

"In my field, I think people actually feel more comfortable talking about their skin and issues of so-called ‘vanity' than they do with my male counterparts. I think I can ask more intimate questions and create a better rapport with patients because they view me (as a female doctor) as less judgmental." Dermatologist, age 30

"Since residency, I have always worked in all-female settings. We've always managed to have collaborative and egalitarian relationships with lots of open communication. This has never been possible in the institutions with which I am secondarily associated (academic departments, hospitals, etc.) which are all organized in a more traditional male model: hierarchical, competitive, and secretive." OB/Gyn, age 55

"On a practical note, being a working mother has made me very good at prioritizing, multi-tasking, and using time efficiently – skills that are essential in a physicians' career." Medical student, age 27

"Not only does being a woman innately suit being a physician better – we listen better, we are more empathetic and more patient with patients. But motherhood also is one of the great teachers for physicians. Raising a child teaches you about how to motivate and when to be tough and when to be gentle and how to have unconditional love." Anesthesiologist, age 59

4. Silent but Deadly

‘Many people may be willing to concede that women have not been given a fair shake, that social attitudes and scientific institutions are in need of reform. They may also be willing to concede that women are excluded in subtle and invisible ways."

In what ways, subtle, invisible, or overt, have our contributors felt excluded from medicine?

"Oh, let me count the ways – a few professors and even more fellow (male) students in med school – where I was one of 8 women in a class of 125 – said explicitly that I was taking the place of a better-qualified man. Overhearing a male faculty colleague telling another male faculty member that "the smartest female medical student I've ever known couldn't hold a candle to the dumbest male student." Pediatrician, age 58

"The bigger surgery cases were always given to the males in my residency program over the females. The Attendings seemed to divide them out that way." Dermatologist, age 30

"Making a suggestion in a meeting that is greeted by silence only to have a man make it ten minutes later – in virtually the same words – and have everyone laud it to the skies. Another issue is that the timing of the hurdles of medicine – boards, residency, starting a new practice – all are timed when women are in their best child-bearing years. We are always forced to do two or more major life tasks at the same time. There is no let up, no flexibility and no sense that there are other alternatives." Anesthesiologist, age 59

5. To Heck With Balance

‘A 1993 study by the Families and Work Institute of New York found that in dual-earner families, women did 81% of the cooking, 78% of the cleaning, 87% of the family shopping, and 63% of the bill-paying. Professional women work roughly 15 hours longer at home each week than do their husbands.'

We asked "How do you strike the balance?"

"Most days, I don't think I do. It's a constant struggle to find that elusive ‘balance.' I think it's just a series of daily decisions – whether to study or take my kids to the park, whether to use this time to read or load the dishwasher. In the end, if I'm feeling completely overwhelmed, I look at my life and am comforted by the fact that the most important things are in place. I have a strong marriage, three children who know they are loved, and the opportunity to learn and use my knowledge to help others." Medical student, age 27

"There's no such thing as balance – there is only passion. If we can maintain our passions for work and whatever we want outside of work, to heck with balance. I've never felt balanced for a minute – I always feel like I'm about to topple over under the demands of work, family, outside interest, and community. I feel like the luckiest person alive because I am free to engage in each of those spheres passionately." OB/Gyn, age 55

"It's not OK to me to be less competent/knowledgeable as a physician because I have a family, nor is it OK to be an absentee mother/wife/friend, but at some point, one will likely suffer for the other. It's a work in progress." Dermatologist, age 36

"Mostly by doing what I want to do (obviously within some limits!), having decided long ago that I was not primarily interested in academic advancement. I could as well interpret that as meaning that I chose not to fight, that I gave up on the possibilities of advancement, but it hasn't really felt that way. I just haven't ever cared (there's the freedom of being female again) whether I get the titles or the big office. I do care, very much, that I am paid fairly, and I've been able to negotiate that without too much difficulty, mostly by sheer persistence and a little good luck." Pediatrician, age 58

Finally…

‘Bringing feminism into science will require hard-fought battles in a complex process of political and social change. Science departments cannot solve the problems themselves because the problems are also deeply cultural. But that does not let them off the hook. Change will have to happen simultaneously in many areas, including conceptions of knowledge in research priorities, domestic relations, attitudes in preschools and schools, structures at universities, practices in classrooms, the relationship between home life and the professions, and the relationship between our culture and others.'

While this quotation articulates some of the work that remains to be done, as physicians-in-training, we are grateful for the contributions of those who have already blazed this trail and the insight we have gained throughout this writing process. Overwhelmingly so, what needs change the most is the way we measure ‘success.'

Historically, success in academics has been largely based on traditionally ‘male' parameters – namely, funding as reflected by federal grants, attaining tenure, and ‘checking all the boxes' so to speak on the way up the ladder towards department chair and Full Professorship. After reading our contributors' thoughtful reflections, we have concluded that success can be more subjective and personal than we were once led to believe. The 27-year-old medical student and the 59-year-old anesthesiologist have both lamented the same obstacles when faced with the challenging balance of motherhood and full-time working professional. On closer examination, each of these women feels certain that hers has been a successful path: they both commented that their experiences of motherhood have enriched their medical career, and both are at peace with their successes at work and at home, without the need for the external validation of positions like chairperson that we initially thought necessary.

Whether it is learning to tap into our passion, forging our own paths based on who we are and what we are interested in, or working towards maintaining clinical excellence and nurturing the next generation of physicians, we realize now that this is success.

This process has been enlightening and will serve as a reminder down the road when perhaps ‘traditional markers of success' are slipping by us – to step back and evaluate the bigger picture. The road is wide open – we could work toward being a department chair if that is important to us at the time. What has been liberating about this process is realizing that it's not the only thing that is important. What's equally important is the health and happiness of our patients, our families, ourselves. We realize that we don't have to "do it all" but rather be passionate about what we choose to do. And finally, never forgetting that we are equals with our male colleagues, we'll continue to fight for equality as those before us have done, and we'll know at the end of the day that we are proud to be women in medicine.

We want to thank all of our contributing voices.

 

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