For good reason there is growing concern about the very real gender gap in healthcare. On the macro level, it influences everything from the delivery of preventive care to the allocation of research funding to one’s ability to purchase insurance. On the micro level, the gap shapes the one-on-one doctor/patient relationship, as evidenced by research showing that your gender and the gender of your physician may dictate how seriously you and your concerns are treated, which medical tests are ordered or what treatments are prescribed.
This is much more than just a women’s issue: it is a public health issue. Are some of the nation’s best doctors being kept out or driven out simply because they are women? Are medical students more likely to pursue certain fields and specialties because of the guidance of their (more often male) mentors? Is the allocation of funds and intellectual resources being decided by an unrepresentative group? Will you be left without the ability to buy individual health insurance because you are a woman? Are you and your unborn child less likely to get good pre-natal care because ob-gyn—a “female field’’—has been deemed less important when research and programmatic dollars are allocated?
First let’s take the gender gap as experienced by women physicians in leadership positions. In the last 25 years women have increased from 30% to 50% of medical school graduates, but a disproportionate number of the decision and policy makers continues to be men. In 2006, the most recent year for which there are statistics, the American Association of Medical Colleges (AAMC) reported that in the halls of medical academia, women comprised 35% of the clinical faculty, but in the higher ranks of associate and full professors, only 28% and 16% were women, respectively. Only 10% of clinical departmental chairs and only 12% of medical school deans were women. This disproportionate representation has enormous effects not only on the female medical student with career aspirations, but also on the choice of policy-making institutional leaders who are drawn largely from these upper ranks.
A staggering 83% of the top positions on medical journal boards and national medical associations are filled by men, signifying a clear bias in the barriers for entry into this protected upper echelon. This leadership controls the research that is deemed worthy of publication and direct the agendas of organized medicine. It is also these organizations to which our lawmakers look for guidance.
And consider your average woman doctor. More than 75% report facing systemic and often not-so-subtle but wholly enervating forms of discrimination. From pay inequity to limited access to promotions, blacklisting to sexual harassment, women rising up in the medical ranks can and will, at any given time, encounter barriers and discover doors of opportunity shut in their faces. When the group sampled is surgeons, this number rises to as high as 90%.
Additionally, according to a US Census Bureau report, after consideration of other variables such as specialty, number of hours worked and number of patients seen, women physicians earn only 63 cents for every dollar that men physicians earn. The report says that there is “no other profession in the US exhibiting greater salary disparities by sex.”
What does the gender gap mean for the quality of care that you receive? Studies have revealed that women are often treated differently from men as patients by both men and women physicians. Women’s complaints are often dismissed or assigned a non-organic (emotional) cause. Diseases and conditions, such as angina, are under-recognized and undertreated in women.
Apart from the treatment of individuals, also troubling is the disproportionate use of research dollars for male vs. female conditions. Consider the treatment of cancer in women. Thanks to public outcry and women’s own initiatives, breast cancer funding has dramatically increased. But other diseases, such as ovarian cancer, have not been accorded the same attention. Screening for this almost uniformly fatal and devastating disease has been deemed too costly, even in high risk populations and even when the disease is almost certainly lethal. Yet resources are allotted to prostate cancer screening and its expensive treatment, though the cancer is much less likely than ovarian to kill and though the overall cost burden to society is much higher than it would be for preventive ovarian cancer screening. All while medical experts know that ovarian cancer is more likely to be fatal—often for younger patients—than prostate cancer.
The reality is that all Americans, not just women, are suffering for this poor use of our most important medical resources. So much so that it’s no longer a matter of if the gender gap in medicine directly affects you, but how? We can no longer squander our precious, limited and already too beleaguered healthcare resources. Internal reviews by every organization involved in the delivery of healthcare, from academic institutions, to hospitals to insurance companies must be completed to reveal the type and severity of the healthcare gender gap. Implementation of transparent hiring practices, salary adjustments, and promotions to academic and hospital leadership positions would go a long way to start to address this unhealthy situation.
Linda Brodsky is a pediatric otolaryngologist. She currently lives and practices in Buffalo, NY.
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