Practice Through the Eyes of Women
This article originally appeared in the December 2021 issue of FOCUS.
Charm is deceptive, and beauty is fleeting; but a woman who fears the Lord is to be praised. Honour her for all that her hands have done, and let her works bring her praise at the city gate. (Proverbs 31:30-31)
As we were discussing this issue, one of the things we knew we needed to address was how gender-based discrimination is still something being experienced by our female members. After consulting with a small team of female members, it was decided that we should open up the question to our female members to share from their experience. By acknowledging these ongoing issues, we have the opportunity to support one another and to work to change the systems that perpetuate sexism. One member shared quite frankly: “My father’s sexism was so extreme that nothing in medicine held a candle to it, so I really have little to say.” As women, our own personal experience of sexism can be so extreme that our experience in other settings pales in comparison. We are taught to expect and accept less.
One submission commented that one of the most sexist and demeaning experiences she had was at a CMDA Canada gathering. With these stories comes an obligation to examine our own views on sexism and deeply consider how we have changed and what change we have yet to make. As members of the body of Christ, let us be open to this challenge.
These stories have been shared anonymously, but the women who shared with us are our friends and sisters in Christ. They have entrusted them to us in the hopes that all who read it will not only listen, but seek ways to make a positive impact for the women in our sphere of influence.
Unbalanced Expectations at Home
For the most part, I’ve felt well accepted by my patients and colleagues as a woman in medicine. I would say that my experiences of discrimination are far outweighed by many encounters with people from all walks of life who are usually respectful and behave appropriately.
I recall one afternoon working in the OR — and I can’t remember whether it was as a resident or as a surgical assistant — in which two older male surgeons were making comments of the most outlandish kind. They commented negatively on the body of the patient and her lifestyle choices that might have impacted her characteristics, and used crude language. I think, if I recall correctly, that one of them invited one of the nurses to bed with him, stood too close to me, and made milder but still inappropriate insinuations about my own sexuality. I asked the nurses about it later and they stated that this was common for both of those surgeons — one far more than the other — and that they had put up with similar behaviour for years. For me, this was a single incident.
More difficult for me were my first years of residency and practice, newly married to a non-physician and struggling with the expectations to maintain our household in the way that a stay-at-home parent or spouse would. He was afraid, at the time, that it would be this way forever, and that I would always be exhausted with little ability to care for myself, much less manage to put good meals on the table and take care of laundry and cleaning. We have worked through these things. Once residency was over, I chose a pace that was more amenable to being a primary caregiver, hired help with the things that can be helped with, and came to a better family balance. He absolutely contributes, but never wanted to be the person who primarily takes care of the home. This is, of course, fair, and I never expected him to be, but residency was a season that was so difficult to manage. Is this discrimination? Maybe not. But I can tell you that if the roles had been reversed, I would absolutely have stepped in, taken care of the food, laundry, and cleaning for those months at a time while he worked toward freedom from a pace that wasn’t up to him. Now we have built the trust and understanding that we need such that, put in the same situation again, I think we would do better. But I do wish the same had been possible for me then.
Motherhood Penalty
I didn’t really experience sexism until I became a mother. I experienced eye rolling and prying questions about my current (and possible future) pregnancy and was told my vote as a divisional member of our department of medicine would be counted as a half vote until I returned from maternity leave. For many Christians, parenthood unexpectedly impacts our work/home priorities. The weightiness of being the primary teacher and modeler of faith in Jesus to our children sinks in. The desire to work, even as ministry, is tempered by precious years of spiritual formation and a Biblical admonishment to raise our children, which flies in the face of the barrage of societal pressures to outsource rearing of our children. I believe Christian women have a unique opportunity to show true “feminism”; trying to mirror the tenderness of God in our homes and communities (and with our patients at work), laying down our rights to aid/help others, and celebrating the unique way God has used us to enact his miracle of creation with each new birth. For me, to be fully “a woman” (one who was fiercely competitive with men and competed my way into a male-dominated medical field) when I became a mother was a slight shift away from professional life and towards family. This decision was mocked and belittled and misunderstood in medicine, yet the Lord gave extraordinary peace, forgiveness, and a new joy in being able to finally rest in Him.
Nurses Needed for Missions, not Physicians
The most blatant episode for me was when I was in pre-med and attending an IVCF (InterVarsity Christian Fellowship) event in the early 80s. We had a well known missionary speaker join us. I talked with him afterwards and indicated my interest in medical missions and my plan to apply for medical school. He was very discouraging and said that nurses were needed more than physicians. I wonder if he would have said that to a male student!
What Does the Doctor Say?
I have experienced sexism and misogyny in every area of my life as a doctor. From patients who ask, “What does the doctor say?”, as the grey haired women in the white coat and stethoscope teaches her baby faced male resident. From allied healthcare professionals, I am referred to by my first name, while my male colleagues are referred to by their title, Dr. Last Name. I am expected to be nice, calm others down, and my time not considered important. If I am rounding and male doctors shows up, I am dumped as they go attend to the male doctor. From some male colleagues, they will not mentor me or be mentored by me, they are jealous of my success, and try in general to keep me down – both with clinical comments like I get the worst ex cath times or by expecting me to organize and care take those in leadership roles. I have also been demeaned in the form of sarcasm, sexist remarks, and comments about my dress or appearance.
From Match to Practice
This young physician has already experienced substantial sexism in her career. She shares several important stories.
But I was a Girl
As a graduating medical student, I applied to the Royal College emergency medicine program.
I did audition electives, I had extra curriculars, I ran the emergency medicine interest group, I had fantastic evaluations and letters of reference — I was a strong candidate. But I was a girl. For whatever reason, the FRCP EM programs seemed to mostly take students from their own school the year I was applying. At my school, there were 7 of us MS-4s that had applied for the 5 EM spots at our school. Five men and two women. Two of the men were outstanding applicants and I figured would and should get a spot ahead of me. Two of the men were very similar to me and the other female MS-4 applying to EM in terms of accomplishments/experiences. And then there was a 5th male in our class who hadn’t even planned on applying to EM, had done nothing to demonstrate any sort of serious interest in EM, but threw in an application at the last minute (in addition to his applications to OB-GYN and internal medicine). I was warned by a couple of the residents that the program director was a bit sexist and that I needed to “go be one of the bros” (ie. get drunk with the program director at the interview social) in order to get a spot in the program. I was not comfortable doing that for a variety of reasons. Needless to say, I did not get an EM spot. My male classmate that had not done anything to show interest or commitment to emergency medicine did get a spot at our home school. Initially when I heard, I was pretty sad, but just told myself that there must have been something that I didn’t know about that made him a better applicant than me. It wasn’t until the other female applicant put a label on it and called it what it was — sexism — that I could clearly see this. As a Christian, I believe that God used even this for my good. That he directed for me, provided for me, and put me right where I needed to be for training, but God’s redemption of sin doesn’t change the fact that it was not as things ought to be.
Unfortunately, as a relatively new grad staff, I had the experience of being gas lit and harassed by an older male staff member. It started because I made a complaint about his lack of professionalism during a life-threatening emergency in the OR. In the meeting we had arranged to discuss the issue, which was attended by three other much older male physicians (all in their 50s and 60s, and me in my first year of practice), the physician that I had complained about spent 10 minutes yelling at me, calling me names, and making all sorts of nasty accusations about my intent and my character. I am of the opinion that this physician felt he could harass me because I was young and female, and because he was confident that the “old boys club” would support him. And sure enough, no one spoke up. None of the other physicians in that room stood up for me or told him that it was unacceptable to speak to me that way, as I sat there and cried, listening to his awful (and untrue) accusations. Things went downhill from there, and eventually I sought help from a strong, end of career female colleague, who helped me navigate the harassment and stood up for me at the hospital level. Her advocacy eventually led to his being formally disciplined for his harassment.
In addition, there’s just a lot of low level “stuff” that adds up. It’s annoying that no one ever expects you’re the doctor, but it becomes maddening when no one even believes that you could be the doctor, simply because you are young and female. It adds up when male patients exclaim to you, “Women!!!” in response to your education on how their lifestyle is contributing to their medical problems. And yet another patient asking “when the doctor is coming to see them”, just after you have introduced yourself as “Doctor X”, explained their diagnosis and treatment plan to them, and waved your physician ID badge in their face. And to another patient asking “if you have done this before”, and another calls you “dear”. Then the nurses ride you harder than they would ever ride a male physician, not respecting that you believe that it is an issue of patient safety. In addition, patients will defer to your male medical student’s opinion and ignore yours. It just gets tiresome.
Often sexism is intertwined with other issues such as classism, racism, and lack of professionalism. And because it is often a mix of these factors, it is sometimes hard to pinpoint that it was in fact sexism. Often, I think we as professional women are conditioned to give others the benefit of the doubt, and instead to be hard on ourselves. In this way, I think sexism in the workplace contributes to our imposter syndrome, unhealthy perfectionism and burn out.
How is this still a problem?
Sexism in medicine is too painful to talk about – hence I am glad I get to write here than to talk about it – because it is 2021! As a women in early to mid-30s, I didn’t think sexism was going to be one of the major career battles I would have had to fight, given all the amazing warrior female MDs that went before me. But, my first-hand experience has confirmed that this battle is for the long-haul and unfortunately will likely stay with me for my entire career.
As a primary care physician, which now has more female graduates than male graduates, I would have been considered in the “majority” gender-wise, until I entered the workforce and realized that medicine is still male-dominant, particularly in hospital-based settings.
As an ER physician in an urban setting primarily, I am in a male-dominant work environment. Due to intense gender toxicity — everything from subtle ways like men not picking up the more “complex” patients (leaving it to the female doctors), to more overt events like male doctors yelling at female colleagues, most women have left working at my site. Recruitment and retention of female physicians has been very challenging. The administration of the department is aware, but so far has not made any action plan to address any of the events. The bigger challenge, though, is not being taken seriously when you bring concerns forward and just being told: “This is the culture and the culture needs to change and it will take time.” What is worst of all is that, over time, I have learned that there’s no point complaining because there are no consequences for perpetrators.
There are also some specialists that are particularly unkind to female physicians. I was dumbfounded that nobody had spoken up, but it was because some of these specialists are quite powerful and involved with administration at the hospital. So many do not speak up as they feel like no action will be taken.
Then there’s the more subtle ways where females are not well treated. A very classic example is nurses helping male doctors and not female doctors or giving us so much pushback on doing blood work etc (even pre -COVID). This certainly adds to our workload, lowers morale, and can cause us to see less patients. There are other things, like the female physicians seeing more complex patients because sometimes male colleagues don’t pick up the chart. On paper, this results in the overall “volume” of patients seen as lower for female physicians (a metric of performance) and lesser pay as well.
Here is an excerpt from of a response to an email I wrote to my Chief: “Agree with everything you have said. You will see things changing. Over the next few months, you will see increasing number of women physicians starting to take shifts at [the department]… eventually you can start taking on learners as well and be a role model for them.”
As you can see in this response, there’s no “solution” to the problem other than bringing more women into the same toxic environment, which results in poor morale, increased burnout, and higher turnover.
Gender Toxicity
Unfortunately, we have a very low representation of female physicians at our ER. This is certainly owing to a very toxic workplace for female doctors. This is directly shown by the poor track record of hiring of female doctors and retention over the past many years. There is also a difference between the number of female doctors on paper verse those who actually do ER shifts. Between the time I was hired (around summer 2018) and spring of 2020, I was the only female doctor that actively worked here. Since my hiring, I have invited several female graduates from recent cohorts to consider applying, but our reputation has gone so far south that they counter me by asking me to consider leaving!
Anecdotally, I have met female physicians that worked at our ER in the past and there’s a 100% consensus regarding the toxic work environment. The physician I ran into today said, “I am glad I left, I couldn’t take it anymore.”
In my nearly three years here, I have been bullied and verbally harassed on many occasions by colleagues and nurses. Performance meetings would consist of apologies on behalf of others as there was awareness of this mistreatment. I did approach the hospital HR at one point and their response was that since we are not “employees”, HR will not get involved. Their suggestion was to go the Chief of ER / Chief of Staff or CPSO directly. As an early staff career, the last thing I wanted was being dragged into endless politics that simply ends in empty apologies and no real action. Many times, nurses and even patients who have witnessed incidents told me to “file a complaint”, but to whom? When I asked if they could be witnesses, but they were all too scared.
Silenced but Speaking Up
Gender based discrimination occurs more than we think and there are long term consequences to women who have experienced it. Women feel silenced for a variety of reasons. Many withdraw from academic medicine or change careers altogether. We need to rise together and support each other. We must speak out and give voice to those who have been silenced. That is what I am doing. I am taking a stand.
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Each of these CMDA Canada members have courageously shared their stories with us so that we can see the real life, current issues they are experiencing as women in medicine. It is essential that we listen, but also that we take concrete action to help our female colleagues. When we read their stories, are they familiar to us, either in our own behaviours or those of our colleagues?
As Christians, we are not called to ignore the challenges of our fallen world, but to be active participants in bringing about the Kingdom. We have the opportunity to speak on behalf of those being treated without respect. When we see a colleague diminishing our female colleagues, we can stand along her, witness on her behalf, and be an instrument of change alongside her. We can also re-examine our own consciences to identify potential biases we might have.
Several of our female members have given us insights into the ongoing issues they are facing. The stories these women have shared stand as a reminder that we are called as Christians to oppose all forms of discrimination for the love of God and of our neighbour.