About 15 years ago, Alisa Berger, MD, found out she was expecting a child. Entering her third year of residency, it was not a convenient pregnancy. At that same time, the hospital where Dr. Berger worked had just created a policy on parental leave: Both women and men would get three weeks after the birth of a child.
“They were trying to make it fair to men and women … It would be the same [for both genders], and they were missing the mark,” the Bryan urologist told Texas Medicine. “There’s equality, but there are definitely gender differences, and having the baby does take more out of you than just being home to help with the baby.”
It took some initiative, but Dr. Berger resolved what was clearly a dilemma for the physician-in-training. She added two weeks of vacation time to the three-week leave, which was always the plan. But she also took a risk and told her program director that she would take off an additional week after the pregnancy. If the hospital wanted to add that week onto the end of her residency to make it up, then fine. The hospital never asked for that week back.
Experiences like that helped bring together Dr. Berger and 69 other women physicians in September at the Texas Medical Association’s Fall Conference. They met at the Women in Medicine Luncheon, a series designed to find ways for TMA to serve women members more effectively (www.texmed.org/WIMevents).
Controversies at the national, state, and local levels have focused attention on the professional problems women face and the need for solutions, says Robin Rather, CEO of Collective Strength, the marketing firm that facilitated the luncheon discussion. That’s why the dialogue was intended not just to identify concerns, but also to bring proposed solutions quickly to the TMA Board of Trustees for action.
“We’ve never had a better moment, a better portal, to be heard as women in medicine,” Ms. Rather told the packed room of women physicians from across Texas.
The discussion focused on TMA-specific reforms, but the overall goal is to improve the standing of women in medicine and to increase communication with male colleagues, says Lindsay Botsford, MD, a family physician in Sugar Land who represents the Young Physician Section on the Board of Trustees. Better communication is vital because the number of women in medicine is growing rapidly, she says.
“It’s an issue for all of us in medicine because we know that we all benefit when we have a more diverse workforce,” Dr. Botsford told Texas Medicine.
Women make up 31 percent of TMA’s membership. But the demographics of medicine are changing, and that percentage is likely to increase over time. Nationally, women made up 46 percent of residents in 2015, according to a 2018 report in the Annals of Internal Medicine. Also, data compiled by TMA shows that more women than men enrolled in Texas medical schools in 2017 for the first time in 14 years, a trend reflected in first-year enrollment figures nationwide.
A course of action
Luncheon participants discussed four recommendations for the board to consider:
1. Create a watchdog function at TMA to identify discrimination and propose direct action.
Members looked over current TMA policies on nondiscrimination, comparing them with those of the American Medical Association and the American College of Physicians. TMA’s policy broadly rejects discrimination on numerous grounds, including sex. However, TMA policy provides no mechanism for follow-up or enforcement, Jennifer Liedtke, MD, a family physician in Sweetwater, pointed out.
“[TMA’s] policy says, yes, we don’t want to discriminate, but you look at the AMA policy … and they’re asked to analyze data and they’re reporting to someone,” Dr. Liedtke said. “Someone has got to be the watchdog over what is happening with women in medicine.”
The group unanimously supported creating such an administrative watchdog within TMA.
2. Create a women’s section within TMA.
The longest discussion at the luncheon centered on whether TMA should create a section specifically for women. Sections within TMA are groups that focus attention on concerns unique to that group. TMA currently has four sections: medical students, international medical graduates, residents and fellows, and young physicians. Each section provides input into TMA policy through direct access and representation within the TMA House of Delegates.
Most of the women at the event supported creating a section while also recognizing the need to maintain the trust of male colleagues.
“We need to elaborate more on the mix of male and female physicians and how they are able to work well and perform together,” E. Linda Villarreal, MD, of Edinburg, vice chair of the Board of Trustees, told Texas Medicine.
Susan Rudd Bailey, MD, a past TMA president and current speaker of the AMA House of Delegates, says over the years she has changed her view about creating a women’s section. At first, she opposed one because she feared it might leave women physicians pigeonholed or relegated to family matters. She also feared a section might lead to having women in TMA viewed as women first and physicians second.
However, she now believes a women’s section is the best way to improve their representation within TMA.
“One of the primary reasons for a section is not only to focus your interests and to have like-minded people who are interested in the same thing you are, [but to give] you a point of entry into the organization,” she said.
Lisa Ehrlich, MD, past president of the Harris County Medical Society, made a proposal that was ultimately approved: Create a section that has well-defined goals and zeroes in on a few specific topics, especially improving women’s presence in the TMA leadership.
“The section would have a trajectory to be able to come into leadership and also to groom our own leadership,” she said.
3. Create implicit bias training for both male and female TMA members.
Implicit bias refers to unconscious attitudes — both negative and positive — that people hold about race, ethnicity, gender, age, appearance, sexual orientation, and disability. Women physicians at the luncheon said they felt supported by most male colleagues, but some male physicians still use offensive language or behavior.
About 12 percent of female physicians in the United States say they’ve experienced sexual harassment and 13 percent say they’ve witnessed it, according to Medscape’s 2018 Sexual Harassment of Physicians Report. Among male physicians, 4 percent say they’ve experienced it and 14 percent say they’ve witnessed it. Also, 3 percent of males say they’ve been accused of sexual harassment, compared with no women.
In other instances, the problems female physicians face are more subtle and not always obvious to male colleagues, says Tina Philip, DO, a family medicine specialist in Austin.
“In training I had an attending who called the female residents ‘babe’ or ‘honey,’” Dr. Philip, chair of TMA’s Committee on Membership, said in a post-luncheon interview. “That happens a lot [for female doctors], even with patients. While it may seem like a benign comment and may not have any ill intent, it undermines our credibility as physicians in a professional work setting to be referred to that way rather than as ‘doctor.’ It is not likely an issue that most male physicians face.”
The measure to create implicit bias training was supported overwhelmingly.
4. Create an education campaign designed to unify the entire TMA around improving conditions for women.
The campaign would highlight the need to improve promotion, pay, benefits, and other topics important to women physicians, among other professions. The U.S. Women in the Workplace 2018 report — a four-year study of more than 400 companies by the management consulting firm McKinsey and Company and LeanIn.org — found that women, especially blacks and Hispanics, are underrepresented at every level.
And there is no specialty in which women physicians earn more than men, according to the Doximity 2018 Physician Compensation Report. The report found that in 2017, female physicians earned 27.7 percent less (or $105,000) than their male counterparts; in 2016, female doctors earned 26.5 percent less (or $91,284).
New Braunfels family physician Emily Briggs, MD, says a public education campaign would help wake up companies whose management and salary practices affect all physicians.
“If we launch a campaign, then the TMA is showing just how important it is for women to be recognized for all the work that we’re doing,” she said. The education campaign was supported unanimously.
TMA President Doug Curran, MD, congratulated the TMA members participating in the luncheon for tackling problems that are important to the entire association.
“Thank you for what you’re doing, and you’ll get my support completely,” he said.
Dr. Villarreal says women already have made tremendous strides since she started in medicine in the 1970s, when her medical school class of nearly 60 had only six women in it, and patients universally assumed that “doctor” meant a man. Vestiges of that time certainly still remain, she says, but the very existence of the luncheon shows how far women have come.
“Our expectation going into the luncheon was to say, ‘OK, we will not tolerate this but how will we make it better?’” she said. “How will we make it a more visible problem and cooperate to come up with collegial solutions or recommendations? It was an amazing interaction of colleagues.”
Tex Med. 2018;114(12):28-30
December 2018 Texas Medicine Contents
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