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Women in Medicine

Why aren’t there more women in science and medicine? Just because we lack certain anatomical dangly bits, does that mean we’re less capable? Apparently Harvard’s president Lawrence H. Summers thought so. In a classic case of foot-in-mouth disease, he suggested that innate differences between men and women might be one reason fewer women succeed in science and math careers. His comments (in 2005) predictably set off a media feeding frenzy. I won’t even attempt to get into that nature/nurture controversy. Whatever the statistical generalities, the fact is that individual women can and do succeed in those careers. What really matters is whether qualified women today have a fair opportunity to choose their profession and rise in it.

Something very interesting is happening in medicine. It’s happening slowly, quietly, and steadily, with no help from affirmative action programs.

At the beginning of the 20th century about 5 percent of the doctors in the United States were women. In 1970, it was still only 7 percent. By 1998, 23 percent of all doctors were women, and today, women make up more than 50 percent of the medical student population. In 1968 only 1.2% of practicing dentists were women. By 2003, 17% of dentists were women, and 35% of dentists in new active private practice were female.

In the academic world, women are also making steady progress. By 2003, women held 30 percent of all medical faculty positions and 40% of the faculty positions in obstetrics and gynecology, pediatrics, and public health and preventive medicine. In 1990 there was only one female medical school dean; now 10% of deans are women. Most of the overt roadblocks have dissolved, but women still struggle with certain handicaps. There is still subtle prejudice in some quarters, especially in the older, higher echelons, the “old boy” networks. Women are less likely to have mentors to guide their careers, and women with children are less likely to rise to high positions and to express satisfaction with their jobs.

The status of women has generally improved throughout the world (with a few obvious exceptions). Attitudes have changed, and not only because of the Women’s Liberation movement. I suspect that the most important factor was the availability of reliable birth control. For the first time in human history, women are able to choose whether to have children and when to have them. And women no longer have to choose between career and family: they can have both, just like men always have.

The face of medicine is changing. Some have expressed hope that women will help bring balance to the profession. Doctors who can balance work, family and leisure might turn out to be more humane, understanding, better clinicians.

There is no job women can’t do. Even the military has gradually accepted them. The Air Force is now 20% women; the Army 14%. In 1976 the Air Force allowed the first women to enter pilot training; in 1995 in Kuwait, Martha McSally became the first woman pilot to fly a combat sortie in a fighter aircraft; she eventually logged 100 combat hours.

In 1991, physician and flight surgeon Rhonda Cornum was in a Blackhawk helicopter that was shot down in Iraq. She was captured by Saddam Hussein’s forces and was sexually molested by her jailers while she had two broken arms, a bullet in her back, and other injuries. She didn’t break down, feel sorry for herself, develop PTSD, or leave the Army. She went on to do a urology residency and is currently commander of the Army’s Landstuhl Regional Medical Center in Germany. She’s a shining example of how tough women can be.

A new book has been published that provides a personal glimpse into what it was like for a woman to be a medical student, doctor, and military officer during a critical period of transition in the 60s, 70s, and 80s. The title is Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. I’ll let you discover the author’s name for yourself. She’s no Rhonda Cornum, but she does have some stories to tell.

The book is described as “An irreverent romp through the worlds of medicine and the military: part autobiography, part social history, and part laugh-out-loud comedy.” When the author applied to medical school the admissions committee grilled her: “What if you decide to get married?” Her medical school only accepted 4 women each year.  As the second woman ever to do an Air Force internship, she had to fight for acceptance. Even a patient’s 3 year old daughter proclaimed, “Oh, Daddy! That’s not a doctor, that’s a lady!” She was routinely mistaken for a nurse, lab technician or volunteer. She was banished from the on-call room and forced to sleep on a cot in a treatment room where the lights couldn’t be turned off. She was refused a residency, paid less than her male counterparts, couldn’t live on base, and couldn’t claim her husband as a dependent because he wasn’t a wife. After six years as a general medical officer in Franco’s Spain, she became a board-certified family practice specialist and a flight surgeon, doing everything from delivering babies to flying a B-52. She earned her pilot’s license despite being told “Women aren’t supposed to fly” and eventually retired from the Air Force as a full colonel. She is witness to an era when society was beginning to accept women in traditionally male jobs but didn’t entirely like the idea yet. She found unconventional ways to cope. She once admitted a spider to the hospital, and she publicly corrected her commander’s terminology, saying, “When women fly, we don’t call it the cockpit, we call it the box office.” Her warped sense of humor sustained her and it spices the stories she tells about her experiences and the patients and colleagues she encountered.

My whole family enjoyed reading this book and giggled frequently. It might be of interest to some of you too.

Women may not have achieved true equality in science and medicine, but there are no longer any real impediments. Any woman who is capable and motivated can succeed. It’s instructive to look back at recent history and realize how much has changed in a short time. Things are easier for women today thanks in part to the women who persevered when things weren’t so easy.

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26 thoughts on “Women in Medicine

  1. Fifi says:

    Thanks for sharing your story Harriet. My mom graduated med school in the early 60s (not surprisingly as the only woman in her year), worked to give women access to birth control and to legalize abortion, and then went back and got a psych degree in the 70s. While I didn’t go into science I know more and more young women going into medicine (and neurobiology in particular), it’s great to see.

    I totally agree that the pill and the reproductive freedom it offered had a huge impact on women’s rights (technology can often be a bigger catalyst and easier to change than people’s minds!). It’s one of the main reasons a women’s right to choose is such a crucial issue. With that said, I also recognize the rights my grandmother and women before her helped establish and how each generation paves the way for the next. I salute you all and -as a girl born in the 60s just after my mom’s graduation – appreciate just how lucky I was to grow up in a time and place where choice is possible. Viva la difference!

  2. Michelle B says:

    Harriet’s book sounds wonderful! Thanks for the statistics spanning the decades, showing how much progress has been made in getting women into medicine. I admire you so much, Harriet!

    May I be so crass as to suggest in addition to the availability of affordable, safe, effective birth control as a factor in opening up opportunities for women, the realization by males that two-income households were compellingly attractive also played a prominent role in getting women out from the kitchen.

  3. Meadon says:

    While I understand you used the Larry Summers furore mainly to introduce your topic, academic honesty forces me to point out that Summers’ position has been wildly mischaracterized in the media. As Gould always insisted, one must go back to the original sources: http://www.president.harvard.edu/speeches/2005/nber.html. Summers, of course, doesn’t deny “that individual women can and do succeed in those careers.” But it doesn’t follow that “What really matters is whether qualified women today have a fair opportunity to choose their profession and rise in it.” Whether or not discrimination is indeed the main impediment is an EMPIRICAL question; which we should address without letting our biases get the better of us. Summers might have been wrong about which factors are most important – he might have been wrong that the variance in male vs. female ability is a more important explanatory factor that your favored explanation of discrimination – but he hardly ‘put his foot in his mouth’.

    (I’m not, btw, defending Summers’ conclusions – I remain agnostic, as I don’t know the relevant literature – I’m simply insisting on treating his argument fairly. Something the media has not done.)

    Pinker’s defence of Summer is well worth reading: http://www.thecrimson.com/article.aspx?ref=505366

  4. Harriet Hall says:

    I meant no disrespect to Dr. Summers. In fact, I agree with him. As Pinker says, “the statistical distributions of men’s and women’s quantitative and spatial abilities are not identical.” This is clearly true. The problem is, this necessarily means that the average man is better at some things than the average woman. That’s what set off the media frenzy.

    It is a fact, but it says nothing about the relative contributions of nature and nurture, and it says nothing about the role of discrimination. And it certainly says nothing about the ability of any individual. It doesn’t tell us whether the individual has a desire to develop his abilities. (Maybe some women are good at math but simply don’t find it attractive as a career choice.)

    A public forum does not lend itself to nuances.

    It is undeniable that discrimination has historically played a part in limiting women’s careers, and that discrimination has decreased in recent years. As I said, there are no longer any real impediments.

  5. Fifi says:

    Meadon – Summer seemed to me to be trotting out old sexism dressed up in the latest design of a musty, old get up. Women don’t belong in certain domains because they’re women and therefor lacking in the male qualities required to be successful in certain fields. (The reverse is sometimes used as an attempt to pretend men can’t do laundry – or cook unless paid exceedingly high amounts and allowed to be tyrants in the kitchen – because it’s “unnatural”.) Sure there are neurobiological differences between men and women – though you do sometimes find male brains in otherwise female bodies and vice versa – but the increasing numbers of women in science (and other traditionally male domains) despite the uphill battle it is for many seems to indicate that female brains are indeed up to the task. In the case of medicine, it’s quite possible that women are actually more suited to the task of practicing general medicine and some specialities. Certainly plenty of people I know generally prefer female doctors (both men and women). The other thing that’s slowly changing is the extreme ignorance about women’s bodies and minds that has historically permeated medicine – Summer seems stuck back in that time (no matter how much he’d like to use neuroscience to support his sexism). Add in that in his position he should know better – but maybe it’s just an old male brain thing he’s expressing and he’s just not capable… (Personally I think it’s particular to him and has it’s origins in nurture not nature.)

  6. Joe says:

    It sounds like an interesting book, thanks.

    In defense of Summers, I think he posed a question about differential aptitude; and the answer is “we do not know” (so it was a fair question). We may never know because “science” covers so much territory. We do have good evidence that women usually are better in language arts. We also have good evidence that men are better at mathematics.

    What it comes down to (taking into account the difficulty of assessing “aptitude”) is that, for whatever reason, there may be sex-differences in aptitude- and they are skewed, not randomly distributed (Gaussian). As a result, there are many talented people of both sexes at the top of their fields; but there is no reason to expect a 50:50 distribution. I think that is the point Summers was addressing.

    That said, I recently heard from a female MD (at another blog) who said she was advised to avoid academia and to go into a “family-friendly” specialty. If that is skewing the numbers of women in certain occupations, it is unacceptable.

    Finally, with respect to Summers, I think he was already in bad odor with the faculty before they seized that opportunity to trash him over his comments. I have no connections with Harvard or Summers. I have just given this topic a lot of thought since I first heard about a “need” for female mentors for women. My first mentor (my high school bio teacher) was a woman (note my name, I am not); my dissertation is dedicated to her.

  7. Joe says:

    Please note that I cross-posted with good comments above. I think Harriet was more succinct than I was:

    “It is a fact, but it says nothing about the relative contributions of nature and nurture, and it says nothing about the role of discrimination. And it certainly says nothing about the ability of any individual. It doesn’t tell us whether the individual has a desire to develop his abilities. (Maybe some women are good at math but simply don’t find it attractive as a career choice.)”

  8. pec says:

    It’s an interesting point that women have advanced more because of the pill than affirmative action or the women’s movement. I think that might be true. Without birth control, married women really had no control over their lives, but most women wanted to marry anyway.

    As for innate differences — we often know or hear about little boys who love all kinds of machines and are always taking them apart, but little girls don’t seem to have much interest. There is definitely something inborn.

    Women are advancing more in medicine, politics and business than they are in engineering or computer science. I think it’s because women are as, or more, interested in health and people as men are.

    I am a woman in computer science and we are very very scarce. I never had any natural love of machines, so I’m not sure how I got into this field. I think it was my typically female love of language and logic.

    The differences are not so much in ability, it seems to me, as interest and motivation. Once you get interested in something for some reason, you can learn the details. Women will always be drawn to taking care of children and animals, anything involving interpersonal contact and communication, and anything involving beauty and style. Men will always be drawn to big powerful machines in greater numbers than women.

    I think this is demonstrated by the fact that women have complete freedom now to major in physics and engineering, but the percentages remain low. Psychology, on the other hand, switched from mostly male to mostly female. I don’t think social pressure can explain the difference.

  9. sandswipe says:

    Women are absolutely as good as men are at math. I am a Missouri high school student, and the two highest grades who sit near me in trigonometry are a girl who looks like a cheerleader and a girl named Khitam. The teacher is also a woman, and one of the best math teachers I’ve ever had.

    There most likely is a difference in average aptitude (related to the machines vs emotions thing), but it’s a case of the error bars being bigger then the rest of the graph, turning everything into useless mush. The only real option is to give everyone maximum freedom and point them at something they may like.

    I’m a little ashamed that I didn’t realize the memoirs were those of our friendly science blogger until I reached the comments, but I do have a perspective to add to your story: I personally know four girls in my graduating class who are signed up for the military, and at least ten who plan to do advanced dentistry or medical doctorate degrees. Not only is this sort of advanced academic path allowed to girls, it’s the default. Sexism is dead in American youth.

  10. ellazimm says:

    I think women are better at multi-tasking and handling cognitive dissonance, the latter which must be very handy whilst in the military.

  11. wertys says:

    I think it is a subtle but important point that with the increasing percentage of women in medicine (55% of my graduating class in 1994) there is a definite imbalance in the EFT worked post-graduation. Of the woman at my 10 year reunion who were mothers, none was working fulltime, whereas those of us who were father all were, with one honourable exception. This was a guy who married a urology registrar who was nearly through her training program, so the financial incentive was never there for him to work fulltime as she made a lot more money. Thus it is the poor old average males who are stuck with the jobs which demand a fulltime commitment, and who therefore these days rise almost by default to positions of administrative power. It’s not exactly that there is a glass ceiling, more that most women doctors are opting to be part-time clinicians, and are avoiding the positions of administrative power because of the extra work involved for no extra reward. Please note that there is no misogyny intended with these comments, but as always I think that the real life drivers of these social changes are more complex than they first look.

    Dr Hall’s book looks fascinating. As a former RAAF Medical Officer I might have to check it out to compare ‘war stories’ !

  12. Zetetic says:

    Harriet, I’m very familiar with what you’ve recounted as I have an active duty and reserve military medical background beginning in 1967 as an Army medic progressing to retiring as a Navy Medical Service Corps officer in 2003. I witnessed the progress and trials as women proved their professional worth in medicine both in the military and civilian realm. It was something that they shouldn’t have had to struggle to prove. However, I’d like to relate my own opposite side of the coin experiences with gender politics in the health care professions. When I was discharged from the Army, I returned to school and became an RN – a MALE RN. I experienced children who insisted that I was a doctor and once had an elderly “old boy” physician demand to speak to a “REAL” nurse (meaning a female) when he first encountered me in the CCU. In the mid-1970s, I returned to college to complete pre-medical admission courses and subsequently applied to medical schools. Equality for female medical school applicants at that time was often expressed as biased equal opportunity quota acceptances. I attended a small college known for its pre-medical program where everyone knew their pre-med competitors well. The year I applied to medical school and was not accepted, every female applicant from my college was accepted. My academic and MCAT record was better than all of them. I moved on into the laboratory field and later attained two graduate degrees studying health care administration, public health, quality assurance, risk management and organizational analysis.

    Incidentally, I’ve met the first male Nurse Corps officer commissioned in the U.S. Navy. He had interesting stories that, in some ways, parallel yours.

  13. Zetetic says:

    Going along with the the male versus female and “girls can’t do math” themes here, I recently had an interesting encounter with a young female physician in my organization. When she learned of my background as an RN, laboratory scientist and clinical systems analyst, she said, with a wrinkled brow, “interesting left brain/right brain dichotomy”… Which inferred that nursing was not a science! But of course, with the promotion of things like therapeutic touch, etc. by the nursing profession these days, I’m not sure I don’t disagree!

  14. Fifi says:

    wertys – I think you make good points and women have certainly been the ones looking at how to combine having a career in medicine and more than a facade of family life. It’s still much more acceptable for fathers to not be intimately involved in their children’s lives and to leave the “work” of raising children to the mother. If a woman has children and she’s the primary caregiver in a family (and that caregiving often extends to her husband as well), adding a third job to the two she already has won’t seem that attractive or feasible. I’d say it’s hardly surprising that an educated woman would decide to work part-time so as to be able to be more involved in raising her children while they’re young if she can. I’d think this would be even more relevant when talking about women in a profession who understand the importance of early childhood in shaping a person. I’d suspect a man in the position of being the primary caregiver and who also had a consuming job may feel the same way about taking on an additional unpaid job that’s main reward seems to be power.

  15. Fifi says:

    Zetetic – Yes, sexism most definitely cuts both ways.

  16. overshoot says:

    It looks like I need to point my daughter at this one.

    She’s a graduate student doing research on sociology of gender and the reasons women choose the career paths they do; in her case largely motivated by the fact that despite loving mathematics, gadgets, etc. and a father who loves engineering, she just couldn’t get interested in the physical sciences.

    Go figure.

    One datum for the mill: while women are approaching (or in some cases beyond) parity in some fields such as law and medicine, they are actually making up a smaller proportion of American university students in the physical sciences and engineering than they did ten years ago.

    Theories abound, facts are few.

  17. Calli Arcale says:

    Awesome! I am going to have to read that book.

    I tend to lean towards the “nurture” side for most of the differences between men and women, but then, there are learning disorders which occur more strongly in men. (Autism, for instance.) This could reveal some underlying biologic trends. Sometimes it is possible to gain new insights into a process by studying the ways it goes wrong….

    As far as women pilots, I read a thing a while back that suggested that women might be biologically better suited to be fighter pilots than men. However, this had nothing to do with mental acuity. Women tend to be smaller, and smaller people are generally somewhat* less susceptible to g-forces. ;-)

    *”somewhat” is important to mention, because training makes a huge difference in tolerating high g loads, probably enough to overwhelm the physiological differences in many cases.

  18. scubajim says:

    At one point in my career I worked for a large insurance company. A good percentage of the Actuarial students were women. (probably around 40 to 50 percent) A reasonable percentage of the Actuarial Fellows (Actuarial students who had passed all the exams; which on average takes about 7 years) were women. I can assure you that those women were talented, good at math etc. Actuarial exams are difficult exams and there is no affirmative action to pass the exam. The Fellow Society of Actuaries doesn’t give anyone a break!

    Clearly women can do math. I cringe when I hear girls fall for – and repeat – the “I’m a girl and can’t do math crap.” (Yes, there are people who have a tough time with math, but the absence of dangly bits isn’t the cause.)

    Interestingly the last two Primary care physicians I have had over the last 15 years have both been women. I feel a little odd when I have to drop the shorts, but it isn’t because I don’t think they are qualified. (as I assume women must also feel with a male Dr. It was funny when my wife saw my GP when we moved to a new place about 20 years ago. She had a bad cold and so I sent her to him. She came back and said, “You didn’t tell me he was a hunk!” I hadn’t thought about it but he was a handsome guy with a pleasant nature. )

  19. Joe says:

    scubajim wrote “I feel a little odd when I have to drop the shorts, but it isn’t because I don’t think they are qualified.”

    Men aren’t accustomed to getting nekked in front of women … who are sober.

  20. daedalus2u says:

    I went to a good talk by Simon Baron-Cohen the other day. He is the autism researcher who developed the “extreme male brain” hypothesis of autism (which I have issues with, I think it is too simplistic). He is doing research which he talked about correlating fetal testosterone (measured during amniocentesis) with behavioral characteristics later in life. He is following a ~300 child cohort and his primary hypothesis is that higher testosterone will correlate with distance along what he calls a “theory of mind” axis and a “systematization” axis. He has some interesting results.

    http://www.autismresearchcentre.com/research/project.asp?id=13

    It turns out that testosterone synthesis is regulated by NO, and low NO is what causes high testosterone. Estrogen causes high NO levels.

    http://www.andrologyjournal.org/cgi/content/full/26/3/369

    His hypothesis and data is completely consistent with my low NO hypothesis of ASDs. My view of the characteristic axis of the autism spectrum as “theory of mind” vs. “theory of reality” and has nothing to do with gender. The high male/female ratio comes from the NO differences due to testosterone vs. estrogen.

    What ever the innate differences between males and females, being told that you are no good at something damages your performance in it. Being told (wrongly) that ability at math is enhanced by a Y chromosome (or dangly bits), worsens performance in females.

    http://www.sciencemag.org/cgi/content/full/314/5798/435

  21. Harriet Hall says:

    I am prompted by the “dropping the shorts” reference to repeat an anecdote that is in my book. During my internship, as I was getting ready to do a rectal exam on an old man, he started laughing. It reminded him of the first rectal exam he had ever had. He told me how he was an innocent young recruit fresh off the farm, and when the doctor told him to bend over and spread his cheeks, he bent over and pulled the sides of his face apart with his hands. He had no idea what was coming.

    The corpsmen in our flight surgeon’s office used to tell patients “You have a choice of a male or female doctor; the female’s fingers are smaller.”

    And my Dad told me if a man was hesitant to let me examine him, I should tell him “If I see something I haven’t seen before, it probably needed treating anyway.”

  22. Two cents from someone who has read Harriet’s book: it’s a page-turning kick from start to finish. I’ve been a Harriet fan for about 5 years, based on her keen intellect and on the content and style of her writing; we’ve corresponded about authorial and editorial issues several times, but have never met in person (only in the era of cyberspace could this have happened), and until recently I knew nothing of her background other than that she was a family practitioner. When she let her fellow bloggers know of her book, I ordered a copy and was delighted to learn more about her and to be utterly entertained by her distinctive, economical prose, imagining the twinkle in her eye and the chuckles that must have punctuated her typing as she wrote.

    Sex differences aside, my take on Harriet’s particular gift is that she was unafraid of success. She could have done almost anything in the realms of academics, professions, management, business, the military, journalism, or many other pursuits (she doesn’t tell us about artistic endeavors, er, unless you count knitting). She has a quick mind and appears to have found the entire range of primary and secondary education easy, but so do many others, both boys and girls. Harriet seems to have been free of what plagues so many smart people in their formative years: Demons of Doubt.

    Among other things, that made her well-suited to ignore and/or overcome (depending on the situation) the entrenched sex bias in the military and in military medicine during her career, which began in the ’60s.

    Harriet, if this embarrasses you I apologize, but it’s one of the prices of celebrity. ;-)

  23. Thanks for the plug, Joe. Dr Hall and other readers: we discuss at Terra Sigillata the recent Business Week article on increased female representation in medicine being cited as an alleged contributor to the US and UK physician shortage and the two BMJ point/counterpoint essays from 5 April that stimulated the BW article.

  24. wackyvorlon says:

    It reminds me of Mother Jones. An incredible woman, she worked tirelessly to organize coal miners. One occasion, in particular, sticks out in my mind. You see, she was not a large or physically strong person. She weighed about 90 pounds, and stood less than five feet tall.

    This was in the time when the mine owner’s would hire thugs and criminals to intimidate the miners with violence. She was walking, at night, with some fellow wobblies. It turns out there were some of these thugs up on a nearby hill, with a gattling gun. They opened fire on her and her friends. While they ducked for cover, she hiked up her skirt and climbed the hill. She walked up to the gun and put her palm flat over the end of the barrel. She looked them right in the eye, and said, “You’re not going to shoot my boys.” They backed down and left.

    In my opinion, that takes a legendary amount of courage.

  25. Harriet Hall says:

    Re: Mother Jones and courage

    In my book I explain how women may have more “balls” than men; some women have effective “balls” while some men have only ineffective “meat” balls. :-)

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