Despite notable advances and some encouraging data, female medical students, trainees and physicians still face considerable hurdles achieving equality in the workplace and attaining leadership positions in health care, Hilarie Bass, chair of the University of Miami Board of Trustees, said at the first in a series of professional development courses for women trainees in medicine.
Although women now make up the majority of new medical students, they become a minority soon after joining the workforce, Bass said. “Despite all of the progress of women in the pipeline – they make up more than 50% of most undergraduate classes, and 52% at UM – every year thereafter there are fewer and fewer women who reach success in their professions.
“It is even more pronounced for women of color,” she added.
Multiple forms of bias are often involved, but implicit bias may be most insidious, said Bass, who was president of the American Bar Association from 2017 – 2018 and since then has been president of the Bass Institute for Diversity & Inclusion, which she founded. “Implicit bias is a big problem because many people do not believe they have it. It can be hard to disengage from those unconscious associations.”
Implicit bias can affect hiring, elevation and compensation, Bass said at the event held February 27. Bias has to do with the “continuous bombardment of cultural images you see throughout your life,” she added. Women are often portrayed “as less confident and less competent.”
Attrition can be a consequence of the subtle slights, microaggressions and other examples of unequal treatment, conscious or unconscious, of women trainees and physicians in the workplace. “Employers don’t want you to leave, and they don’t realize they are acting in ways that will make you more likely to,” Bass said.
Within six years of their training, 23% of female physicians were not working full time, compared with only 3.6% of male physicians, she said. For some, despite working hard, the “perception is they will never be treated the same or paid the same as their male colleagues.”
A double standard in parenthood can also spur dissatisfaction and attrition among female physicians, Bass said. “Research shows mothers are penalized in pay and promotions,” she said. In addition, many female physicians who have children believe they are in a “double bind” – that they are not perceived as great physicians because they are mothers and not perceived as great mothers because they are physicians.
Many employers perpetuate a motherhood misperception, assuming women who become mothers will be less committed to work, Bass said. At the same time, “fathers get raises because employers think they will be extra committed as breadwinners.”
Hilit Mechaber, M.D., associate dean for student services and associate professor of medicine at the Miller School, co-organized and hosted the event. She related a personal story. “In 1999, when I approached my division chief about my desire to work part time when I was expecting, his email reply stated that we could work something out, but he noted it could be detrimental to my career.”
“Here I am, 22 years later, still quite involved in academic medicine,” she said. “We’ve made changes, but we have a long way to go.”
Another issue is a persistent pay gap between female and male physicians, Bass said. Although pay for primary care physicians and specialists “has risen 20% across the board, male primary care physicians make nearly 25% more than their female colleagues.”
Rose Van Zuilen, Ph.D., president of the Miller School Women in Academic Medicine group, noted that the Association of American Medical Colleges announced a new initiative in January to address and eliminate gender inequalities. The association covers workforce, leadership and other issues, citing their own research that women physicians in clinical departments make 76 cents for each dollar a male physician earns.
A potential solution is making pay rates more transparent. When salary disparities are no longer secret, she said, a female physician can challenge why a male counterpart is making $2,000 more or $10,000 more a year.
Caroline Granger, M.D. candidate in the Medical Scholars Program, Class of 2021, who also helped organize the event, asked Bass for advice for new physicians about negotiating around the pay gap. Granger is president of the Miller School chapter of the Association of Women Surgeons and president of the Miller School Orthopaedic Surgery Interest Group.
“Generally, we know women historically do not negotiate their pay,” Bass replied. “Males will never accept the first offer. Women, 99% of the time, will take it, thinking, ‘Great, they like me.’
“When women do negotiate, they are typically perceived as more competent but not likeable,” she added. She recommended not making a counteroffer personal. Instead, do research and use an objective measure, such as data for what other people get paid for the same position.
“Now for some of the good news,” Bass said. “Study after study tells us that women physicians provide superior care.” In addition, women contribute different viewpoints and experiences, and “we know more diverse teams come up with better solutions.”
Furthermore, the percentage of women on an operating room team is associated with cooperation. “Cooperation is critical for effective, safety-focused team performance,” Bass added. “In light of this evidence, preventing women from entering or advancing in medicine is denying patients the opportunity for the best quality care.”
Countering implicit bias is not always easy, Bass said. She advised that the trainees raise questions when bias appears to play a role in decisions made by others. Another recommended tactic is to do research before accepting a position. Ask about pay equality and any family-friendly and maternity policies.
“There have been women coming out of medical school long enough, there should be women in positions of authority and responsibility in any place of employment,” Bass said. “If there are not, you should run, not walk.
“As long as you have options, you want to steer clear of places that are not as enlightened.”
The professional development course was sponsored by the SEEDS program and the University of Miami Miller School of Medicine.
“Groups like this have proven critically important to make a difference,” Bass said. “You need these kinds of groups so you can speak openly and determine if you have something to be worried about. You also need these groups to support each other.”
“Sessions like these are at the forefront of how we make changes,” Dr. Mechaber said.