Member publication of the Massachusetts Medical Society What’s Working for Women in Medicine — and What’s Not So Much BY LUCY BERRINGTON, MS, VITAL SIGNS EDITOR myths — that women choose to leave medicine that female physicians may practice more There may be no more compelling measure of or eschew leadership positions. evidence-based medicine, communicate more women’s ambitions to make their mark on medi- effectively, and treat fewer patients. “We need “You have to dig deeper and not feed into those cine than the numbers; women make up almost to work together on how to move forward,” says stereotypes,” says Julie Silver, MD, associate pro- half of new U.S. medical graduates and a third of Dr. Bombaugh — a goal that is both required fessor in the Department of Physical Medicine the practicing physician workforce. For Women and facilitated by health care redesign. “This and Rehabilitation at Harvard Medical School in Medicine Month, an initiative of the American paradigm shift toward team work and collabora- and the Spaulding Rehabilitation Network, and Medical Association, this year’s theme is Born to tion requires that the voice of everyone caring director of a women’s leadership program at Lead. Women physicians and medical students for patients is heard.” Harvard. “Medicine has women who are really are making and taking new opportunities, grap- good leaders, who have not left the workforce, pling with persistent challenges, and driving Why aren’t women paid equally? but are making less money and missing out on In the context of women’s clinical excellence, the institutional change — a process that may be certain opportunities.” The barriers are especially persistent gender-based pay gap in medicine is accelerated by the rapid evolution of health care acute for women physicians of color. especially frustrating. In April, Doximity drew na- practice and expectations. tional headlines after it published findings from “Medicine is being upended. This a great oppor- a survey of 36,000 physicians who practiced at tunity for women to find our place, versus fitting least 40 hours a week, concluding that women “This a great oppor- into the old model — to change the profes- physicians on average earn 26 percent less than tunity to integrate the sion to reflect the practice and life of women male physicians of equivalent experience. physicians,” says Maryanne Bombaugh, MD, a professional practices Even within female-dominated specialties, male gynecologist who practices on Cape Cod, and and personal lives of physicians make substantially more money, vice president of the MMS. women physicians” the survey showed, undermining the case that That change is already underway. It can be seen — Maryanne Bombaugh, MD, Vice President women physicians choose lower-reimbursing of the Massachusetts Medical Society in the growing variation in medical career paths career options. That argument assumes the door and trajectories, a trend that owes much to to higher-paying careers is equally open, and is women finding creative ways to manage their refuted by physicians who report being steered work alongside family demands, says Kathryn What are women physicians doing right? away from those specialties or admitted reluc- Hughes, MD, an acute care surgeon at Falmouth tantly. “Women ‘choose’ pediatrics more than Women physicians appear to practice medicine Hospital and cofounder of the #ILookLikeASurgeon cardiothoracic surgery, but what’s a choice?” differently than men, and that’s good news movement on Twitter. “Women are expanding asks Dr. Hughes. for patients. A recent study in JAMA Internal medicine to embrace the diversity of how one Medicine found that hospital patients treated by A report by Medscape in April found a narrower can approach this calling,” says Dr. Hughes. women had slightly lower 30-day mortality and pay gap among younger physicians, suggesting “Instead of the traditional straight path, resi- readmission rates than those treated by men. that the issue may be partly generational. In in- dents and medical students are planning gap The difference would translate into 32,000 fewer terviews with Vital Signs, some senior physicians years for research or fellowships. The previously deaths a year in the Medicare population if male described male colleagues’ explicit insistence unique trajectories women experienced are now doctors matched women’s outcomes, according through prior decades that women did not need planned. These varied experiences have become to Ashish Jha, MD, MPH, a professor of interna- high incomes. This bias, now unspoken, may still the norm, and everybody benefits.” Meanwhile, tional health at Harvard School of Public Health, be contributing to pay disparities, according to she says, women saw that the professional and co-author of the study. anecdotal reports — such as that of a surgery network supporting male physicians — the Old group in which lower-reimbursing procedures Boys’ Club — had value, called it mentorship, This a great opportunity to integrate the profes- were routinely routed to a female surgeon, and and broadened access to its benefits. sional practices and personal lives of women higher-reimbursing cases to her male coun- physicians, says Maryanne Bombaugh, vice For “Voices of Women in Medicine,” Vital Signs terpart, even though the woman was more president of the MMS. talked with 20 women at varying stages of their credentialed. medical careers. The recurring themes of those “[W]e need to learn more about why these conversations are explored in this issue, and differences exist so all patients have better out- Why aren’t women promoted equally? While women are advancing at all levels of on the MMS website and social media plat- comes, irrespective of the gender of their physi- academic medicine, they remain a relatively forms. They ran counter to surprisingly durable cian,” wrote Dr. Jha. Some evidence suggests continued VISIT MASSMED.ORG untapped source, studies show. Women physi- these doctors’ career success may be contribut- cians and researchers are less likely than men ing to relatively high burnout rates, she says. “The Society has been to be promoted in academic medical centers. And because those physicians are more likely actively supporting Again, the reasons may be less about choice and than others to work with underserved patient women in medicine more about subtle institutional barriers. populations, their untapped potential weakens for three decades,” the profession’s efforts to address health out- Some of those barriers may be found in unex- says Alice Coombs, come disparities. pected places. A recent report in the journal MD, an anesthesiolo- PM&R, on which Dr. Silver was lead author, Awards are just one measure of inclusivity, and gist at South Shore Hospital and a examined the distribution of awards by several Dr. Silver does not generally see any bias as in- past president of the MMS. “An orga- national specialty societies. The researchers took tentional. She has assembled a team of thought nization can flourish when diversity is those awards as a metric for how women and leaders to collaborate with specialty societies part of its fiber and DNA; it benefits men are navigating organized medicine, a key on inclusion. “Medical societies are perfectly from the brilliance that comes with all factor in career success. They found a strik- positioned to be amazing partners,” she says. groups. The governance structure of ing absence of female award recipients. Even The report did not look at statewide physician the MMS embraces the creativity and medical societies that have made a commitment societies. The MMS, however, is looking at itself. innovation that comes with diversity in to diversity (the demographics of member- A key strategic objective is ensuring that our membership.” ship) may have a way to go on inclusion (the membership represents the Commonwealth’s equal opportunity for members to benefit from — Alice Coombs, MD, Past President of the increasingly diverse physician workforce and and contribute to that institution), the report Massachusetts Medical Society medical student population. The Society re- suggests. cently voted to collect demographic data, a criti- “Well over than half the physicians coming out cal step in tracking metrics for guiding strategy of medical school are from underrepresented related to inclusion. groups: women, LGBTQ, disabilities, racial and ethnic minorities. Women alone are close to 50 percent,” says Dr. Silver. Institutional barriers to VISIT MASSMED.ORG.