Gender Bias in Healthcare

A few months ago, the New York Times published an article on a scandal in Tokyo University Medical School.  https://www.nytimes.com/2018/08/03/world/asia/japan-medical-school-test-scores-women.html  It was found that administrators were purposely manipulating test scores of female applicants to keep their class 30% female. Of their applicants 8.8% of men were accepted and 2.9% of women were accepted. Apparently, it is commonly practiced in many medical schools across Japan. Administrators justified their practice with belief that women were more likely to drop out of their profession after marriage or childbirth which would not help with their national doctor shortage.

I was shocked especially since Prime Minister Abe was trying to promote his policy of “womenomics”, a policy to help the stagnant economy by increasing women in the workforce. I called my close friend who has been working in Japan for almost a year to ask her opinion on the current state. Sadly, she was not surprised by the news and explained to me in job interviews, a standard question for female applicants was their future plans on marriage and children. It is common practice in Japan for married women to quit their jobs to raise their children and difficult to re-enter the workforce after pregnancy.

I found it appalling that not only are institutions are raising the credentials higher for women, but also that their marital status plays a huge role in the job search. Why couldn’t these women have children and work at the same time? Why was there no social support for women with children? And why is there a nonexistent role for the father in child rearing?

This patriarchy reminded me of one my patients who made me question my abilities as a future provider. During my prerounds, my patient inquired if being doctor was the right decision for me. Instead, he could picture me as a great housewife. I was initially speechless. Thankfully, his nurse defended me, asking why I couldn’t be both? I answered his question by explaining to him that I could not imagine myself staying at home. After leaving his room, my feelings of inadequacy turned to annoyance and frustration. I didn’t know if his comment stemmed from my skills or from his gender biases.  My interaction with him made me wonder how many other patients I would encounter during my career who have a similar mindset.

                                                                                                                                                                Cindy Kui

                  DUCOM 2019

Self-advocacy and solidarity in combatting gender bias in medicine

I recently read an article entitled, “Recognizing Blind Spots – A Remedy for Gender Bias in Medicine?” by Loren Rabinowitz. She starts off her piece describing an interaction in which a patient’s wife pushed her aside in favor of speaking to a more junior, male resident who was incapable of completing her request due to his junior status. Although actually qualified to address the request, Dr. Rabinowitz, was overlooked by her patient’s wife and, the junior resident did not bother to clarify the discrepancy. These acts of sexism and similar micro- and macro-aggressions are ubiquitous across our culture, and healthcare is no exception.

    Dr. Rabinowitz goes on to juxtapose the challenges of self-advocacy with their critical importance. She acknowledges that, “perhaps small steps such as taking ownership of our roles as physicians, enlisting allies, and educating our trainees, students, and patients can provide a starting point for the movement toward workplace equality.” I completely agree with her regarding the difficulties and discomfort in clarifying our roles, and I think this is born out of our motivations for pursuing medicine, which are grounded in the genuine provision of care for other people, rather than the nominal authority associated with our titles. Importantly, she notes that clarification is achievable in a way that is respectful to others, kind and compassionate to patients, and defines our roles as medical students or providers. This clarification is important for establishing trust and improving communication which directly impacts care delivery and outcomes. In reflecting on her story and stories of my own, I see that we find strength in solidarity, as it bolsters our care team and communities, and provides support for us when we need it most.

 

Maureen Farrell         DUCOM 2021

https://www.nejm.org/doi/full/10.1056/NEJMp1802228

 

Can we bridge the gap between medicine and motherhood?

An article was recently published by the BBC news regarding the steadily declining number of women in South Korea interested in childbearing and starting a family, causing the country to have one of the world's lowest fertility rates - about 5.5 per 1,000 people.

Some of the reasons cited in this article include that more and more women are choosing their profession and personal interests over starting a family, as well as the complications and costs associated with childbirth. One woman explicitly argues that she would rather "be independent and live alone and achieve [her] dreams" instead of "be part of a family." The independent journeys on which these women choose to embark are deemed so abnormal in South Korea that they were delegated their own title: "sampo,” meaning “to give up relationships, marriage and children.”

This mutually exclusive mindset is largely a consequence of mistreatment of and bias towards women in the workforce. Similar to the policies in place in the United States, women in South Korea are by law protected from such discrimination, however as many women (including myself) have experienced, such laws are often ignored or seldom enforced.

Another woman cited in the article mentioned that after an argument with her boss and being sent to the hospital due to concerns for miscarriage, her boss made a concerted effort to have her fired.

                                           

This message hits home for me particularly as a female entering the medical workforce in just a few months. While trying to decide on a specialty during medical school, and as I prepare for residency, one burning issue that arises almost invariably, especially with female attendings, is the topic of childbearing. The reason I say “issue” is that, unfortunately, the health professions environment often treats it as such. “What if I get pregnant during residency?” for me induces the same anxiety as “What if I get sick?” or “What if I break my leg?” Even as we approach 2019 and the world achieves somewhat increased open-mindedness, society still has a tendency to paint a picture of physicians that is not only cis-white male, but invincible and without their own personal and private challenges. And I think here lies part of the problem in making medical education more family-friendly.

The Family and Medical Leave Act was passed in the United States in 1993 as a means of guaranteeing 12 weeks of "unpaid, job-protected leave" for certain reasons if covered by an individual's employer. Reasons for taking leave include childbirth, but also encompasses adoption, caring for severely ill relatives, personal illness, and up to 26 weeks to care for a servicemember. I would like to emphasize here the “unpaid” portion of this act, because given the rising cost of diapers, clothing, and formula, one can only hope that the residents protected by this act have enough income to support themselves and their baby, if not some additional financial support from a spouse or other family member.

In 2000, the AAFP published guidelines for Family Medicine residents who need to take parental leave. The guidelines were revised most recently in 2017 and encourage that residents be given ample time and accommodations in order to fulfill parental duties. However, the "guidelines" are in actuality just recommendations; each residency program is at liberty to ordain their own rules regarding parental leave (within their legal rights), from the duration to when leave can be taken, to the specific provisions offered (if any) in the event a resident cannot complete certain requirements.

A blanket argument against residency programs, however, is not being made here and should never be made; there are plenty of programs willing to accommodate for residents interested in or expecting to build on their families. And it is also a fair argument that some residents in fact prefer not to have a family during residency, or ever. However, I do think it is safe to say that a larger discussion must be had so that if and when someone, including myself, decides it is the “right” time to have a family, the decision will be treated with respect and understanding, rather than a burden on my colleagues, program, and patients.

 

Gabrielle Pyronneau

    DUCOM 2019

 

References

 

https://www-clinicalkey-com.ezproxy2.library.drexel.edu/#!/content/journal/1-s2.0-S0140673615010910

https://www.dol.gov/whd/fmla/

https://www.bbc.com/news/stories-45201725