MD Barrio-Rentería M. T, Galván-López J. M., MD Hernández-Fernández D., Maldonado-Moreno K. A.
Despite more than 40 years of human rights and feminist advocacy, gender equality still has a long way to go and remains a complex issue; specially in health and science environments. The central matter in this essay is gender-based discrimination in medicine, more specifically against women, nonetheless the concept of gender needs to be defined: “Gender” is an evolving social construct that refers to the sociological and cultural behaviours, attitudes or feelings associated with masculinity or femininity (Brown, 2021). The WHO Global Health Workforce Network Gender Equity Hub, reports that women in the health and social care workforce are under-represented in management, leadership, and governance. Gender-based discrimination is present in every level and includes, belittling remarks, inappropriate jokes, denial of opportunities, behaviours or conducts (Brown, 2021).
Approximately 75% of the global health workforce is female but they only hold a small fraction of leadership positions. Women remain a minority in surgical specialties and the wage gap is reported through all specialties (Shannon, 2019). The UN Educational, Scientific and Cultural Organization’s Women in Science data shows that less than 30% of the world´s researchers are women, comprising 45% in Latin America and 32% in North America, even though the proportion of female researchers is increasing worldwide, women still publish fewer research papers than men and are less likely to collaborate internationally (Shannon, 2019).
In medicine, women are paid 8% less, this being attributed to “domestic responsibilities” given that female physicians take lighter schedule because they tend to be the primary caregivers of their children, they´re also less likely to hold positions of power, and when they achieve those positions, they are paid less than the men in equivalent roles due to implicit biases that result from gender schemas that are culturally ingrained (Kowalski, 2020 & Kuo, 2020). Unconscious biases are also present, a study conducted by the University of Nebraska examined linguistic choice and gender disparities in letters of recommendation for surgery residents; where men tend to be described as future leaders using terms such as dominant, confident and intelligent whereas women tend to be described as compassionate, calm and family centered (Hoffman, 2019 & Brown 2021). In 2015, 85% of females in surgical fields recall having suffered at least one form of gender-based discrimination throughout medical school, residency and professional practice, not only from colleagues and superiors. The two more common sources reported were patients and nursing staff; the majority of the participants reported having to work “twice as hard” to earn the respect their male counterparts automatically receive from nurses and patients (Brown, 2021).
Differences between male and female practitioners have been well established; female practitioners are more likely to follow guidelines, use more patient-centered communication, provide psychosocial counselling and preventive care more often than male counterparts (BDJ, 2017). A study investigating mortality rates in women with acute myocardial infarction found that there were higher mortality rates in women treated by male doctors than in the group of females treated by female doctors. Also, several studies have shown that patients treated by female physicians have lower rates of complications, ER department visits, lower rates of morbidity and mortality, stating that gender is an important asset in healthcare, and these differences found between male and female physicians should be investigated to replicate positive behaviour that leads to better outcomes in patient care, medical training, etc. (Tsugawa, 2017)
It is important to mention that many individuals, men and women; including those in power or leadership positions don´t consider this to be an ongoing issue in the residency training programmes or a problem worth improving, yet in a study including 7 surgical programmes in Calgary, 55% of women and 40% of men agreed that it is an issue in residency training programmes. Identification of gender-biased behaviours is the first step towards its eradication (Brown, 2021).
In the article “Nevertheless they persisted: how women experience gender-based discrimination during postgraduate surgical training”, Brown suggests that women become desensitized to gendered-biased behaviours by using coping strategies involving denial and minimization of these experiences which leads to underreporting the frequency and severity of discrimination contrary to the one experienced by men that tends to be more memorable due to its infrequency. Immediate action, such as the continuous investigation on the topic, promoting collection of empirical and objective data, the promotion of institutional-level discussions between teachers and administrators, examining the local culture and climate for students and faculty members, as well as allyship and anti-oppression training in the core curriculum is needed.
Identifying, dismantling and restructuring the system along with increasing the number of women in medicine will change the environment, given that an imbalance in sex representation promotes a culture where women are unlikely to pursue academic and personal goals, damaging well-being, medical training and ultimately healthcare.
Reflecting on strategies to promote change, medical schools and training hospitals could benefit from examining their local culture and climate as well as student, teachers, and faculty members’ perspectives. All individuals must be encouraged to be allies who continuously advocate for an inclusive environment and zero tolerance against gender discrimination and harassment policies. It is crucial that implemented strategies allow the report of inappropriate behaviour with confidence and without fear of consequences, and that those will be adequately addressed. This is an era of gender reckoning, challenging and changing times, there is no doubt that gender equality is a human right. Gender equality in healthcare and science holds the promise and potential to lead to economic, scientific, and social transformation.
Brown, A., Bonneville, G., & Glaze, S. (2021). Nevertheless, they persisted: How women experience gender-based discrimination during postgraduate surgical training. Journal of Surgical Education, 78(1), 17–34. https://doi.org/10.1016/j.jsurg.2020.06.027
Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. (2017). British Dental Journal, 222(3), 170–170. https://doi.org/10.1038/sj.bdj.2017.116
Hoffman, A., Grant, W., McCormick, M., Jezewski, E., Matemavi, P., & Langnas, A. (2019). Gendered differences in letters of recommendation for transplant surgery fellowship applicants. Journal of Surgical Education, 76(2), 427–432. https://doi.org/10.1016/j.jsurg.2018.08.021
Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria. (n.d.).
Jena, A. B., Olenski, A. R., & Blumenthal, D. M. (2016). Sex differences in physician salary in US public medical schools. JAMA Internal Medicine, 176(9), 1294. https://doi.org/10.1001/jamainternmed.2016.3284
Kowalski, A. (2020). The impacts of gender disparity in residency matching. JAMA Network Open, 3(11), e2028161. https://doi.org/10.1001/jamanetworkopen.2020.28161
Kuo, L. E., Lyu, H. G., Jarman, M. P., Melnitchouk, N., Doherty, G. M., Smink, D. S., & Cho, N. L. (2020). Gender disparity in awards in general surgery residency programs. JAMA Surgery. https://doi.org/10.1001/jamasurg.2020.3518
Ruzycki, S. M., Freeman, G., Bharwani, A., & Brown, A. (2019). Association of physician characteristics with perceptions and experiences of gender equity in an academic internal medicine department. JAMA Network Open, 2(11), e1915165. https://doi.org/10.1001/jamanetworkopen.2019.15165
Shannon, G., Jansen, M., Williams, K., Cáceres, C., Motta, A., Odhiambo, A., Eleveld, A., & Mannell, J. (2019). Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet, 393(10171), 560–569. https://doi.org/10.1016/S0140-6736(18)33135-0
Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2017). Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Internal Medicine, 177(2), 206–213. https://doi.org/10.1001/jamainternmed.2016.7875