By Steven Clark
It was 1980, a very different time for women in medicine, when Dr. Judith Berger, a freshly minted medical school graduate waddled into a Brooklyn hospital to begin her internship. She was seven months pregnant.
“The first thing my second year resident said was, ‘Why am I so lucky that I got the pregnant one?’” Dr. Berger, director of Infectious Diseases at SBH, recalls. “We worked six days a week and I was on call every other night. It was a crazy schedule, especially for someone who was pregnant.
“After meetings, I was always the person who was expected to clean up. When there was a code or resuscitation, and I’d start pumping, with the big stomach, the others would just stand around and I’d have to say, ‘OK, feel free to jump in at any time.’ Yes, women then were treated differently.”
During her residency and fellowship, “The surgery residents, who unlike the medicine residents were mostly men, would tell off color jokes to make me uncomfortable. Later, as a young attending, I would hear the same lewd jokes. They would put their arms around me and say ‘Oh, Judy, what do you think about …’ That’s not appropriate. They weren’t doing this with the male attendings. The boundaries weren’t good. I knew mine, but I wasn’t sure they did.”
One neurosurgeon had a propensity for calling her from his office and saying “Thank you, dear” after she answered his questions regarding patients’ medication. “I would tell him, ‘I understand you don’t mean anything by it, but it’s condescending and inappropriate. You can’t call me ‘dear.’ He said ‘that’s fine’ and would remember for a while and then he’d forget again. One day, over the phone he said, ‘Thank you, dear.’ So, I said back to him, ‘No problem, sweetie pie.’ And he stopped it.”
Fast forward, nearly 40 years. In many ways, women in medicine have come a long way. Whereas one of every 10 medical students in 1965 was a woman, in 2017, for the first time, more women than men graduated from U.S. medical schools. In many hospitals, the number of women physicians is equal to or has surpassed the number of male physicians.
And it’s not just a matter of filling specialties that have been long considered “more suitable” for women because of the flexibility they offer for those raising families and seeking more of a work/life balance. In 2018, for example, a Manhattan hospital bent over backwards in applauding itself for graduating its first ever residency class of all female general surgeons.
Research suggests that female doctors achieve patient outcomes as good if not better on average than their male peers. They have slightly lower mortality and readmission rates. They are more likely to adhere to clinical guidelines and provide more frequent preventive care. They tend to use more patient-centered communications, listen to patients better, ask more questions to elicit patients’ opinions, and provide more counseling on psychosocial issues related to lifestyle, daily living activities, social relationships, coping strategies and stress. They are more likely to express empathy, concern and reassurance and are more positive in the words and voice tone they use. And, they’re more likely to engage family members who accompany patients.
“Women physicians tend to be more introspective, nurturing,” says Dr. Tina Chee, site director in internal medicine at the SBH ambulatory care clinic. “We’re more of a nurturing breed,” says Dr. Paula Amendola, a family medicine physician at SBH. “Women listen better, they follow up, their communication skills are better.”
Adds Dr. Sonata Cooper, an obstetrician/ gynecologist at SBH, “There is a certain level of empathy and emotional connection that is ingrained in women. We take the time to get to know our patients. We want to know why she didn’t come to prenatal care.”
Leadership
Only when it comes to rewarding female physicians, a bias remains. While healthcare is an industry where female consumers make 80 percent of the buying and usage decisions (compared to 46 percent in financial services and 26 percent in technical services), women account for only 18 percent of hospital CEOs and 16 percent of all deans and department chairs in the U.S., according to a report published by the management consulting firm, Oliver Wyman. They comprise approximately 30 percent of C-suite teams. [Women comprise 36 percent of SBH’s senior leadership team]. These are positions that typically direct the mission and control the resources at medical centers. It takes women on average 3 – 5 years longer to reach these positions. While the findings are similar in other industries, women of color make a small dent in leadership roles in medicine.
In the 1990s, with nearly half of all medical school graduates being women, the impression was that this newfound abundance of women in the pipeline would change these numbers. This does not seem to have happened.
According to an article in the Philadelphia Inquirer, male doctors earn as much as 25 percent more than their female counterparts in some specialties. This ranges from a salary differential of four percent among hematologists, to more than 20 percent in such fields as radiology, urology, otolaryngology and pediatric pulmonology (according to the 2019 Physician Compensation Report).
So what’s holding women back?
According to an article in the Harvard Business Review, this includes:
• Implicit gender and maternal bias. In addition to receiving lower pay, there is workplace discrimination in terms of women being disrespected by colleagues, being held to higher standards than male peers, and not being invited to give major talks. In many cases, this discrimination is seen as specific to mothers.
• System-wide policies that disadvantage women. Many medical centers have insufficient policies and programs when it comes to supporting women during child rearing, lactation and caretaking.
• Sexual harassment. The literature on workplace harassment suggests that this is more prevalent in hierarchical and male-dominated fields like medicine.
• Lack of mentorship opportunities. Women in medicine are found to have more difficulty finding mentors than male physicians.
At SBH, Dr. Janine Adjo, chair of Pediatrics, sees herself as part of the change. In addition to Dr. Adjo’s role as department chair, which she assumed earlier this year, Pediatrics’ ambulatory director (Dr. Alyson Smith) and many of its section directors are women in what was a male-dominated specialty when she first arrived at the hospital in 2002.
“I have a mix of women in my department, both with families and single, and some are equally afraid (of assuming leadership roles),” says Dr. Adjo. “Sometimes women don’t want to assume leadership positions because they have families and other things in their lives and they just can’t juggle anything else. But it may also be a fear of stepping into a realm that’ unknown. It’s different when you see patients. When you’re managing other people, many women physicians are afraid of failing or have people speak poorly of them.
“But also, sometimes, they are overlooked. It’s not that they’re not qualified or that it’s too much for them to do. They just don’t get tapped.”
She has been active in working to get mentorship and sponsorship programs off the ground for female physicians at SBH. “Men will say, ‘I’m doing x, y and z and that’s why I need more money, while women are fearful to ask because they don’t like to promote themselves,” she says.
This is a mindset, she admits, that didn’t come to her naturally. “Years ago, I asked for a raise after getting more responsibility a couple of years earlier, and I was sort of laughed at when I asked again. I spoke to my husband, who is in business, and he said, ‘Your responsibilities are increasing, why wouldn’t they give you a raise?’”
Dr. Adjo is actively involved in a national leadership group comprised of a group of 18 female physicians – diverse in terms of race, age, background, marital and family status. The group meets quarterly to discuss issues that can range from ways to get more women into leadership roles to becoming more effective negotiators.
“There’s one woman physician in Kansas City, who’s working on wellness in her institution. She found that in terms of pain control at her hospital, African-Americans don’t get the same pain treatment as other patients. When she presented this information to management, and spoke about equality, equity and racism, one person said, ‘That doesn’t happen here. We don’t treat people differently.’ They refused to believe what she presented in her data. She said she has to start off with baby steps or people get very defensive.”
One of the physicians in California spoke about how during grand rounds, she gets introduced by her first name while her subordinate, a male, is referred to as Dr. so and so. Another woman, a psychiatrist in Boston, talks of how her supervisor goes to her when he feels he needs someone to set someone straight about a matter because she’s viewed as assertive. “Why am I always the angry black woman?” she asks. “One thing I talk with my group about is fear, fear of making mistakes,” says Dr. Adjo. “I tell my doctors here that you’re going to make mistakes, it’s a part of life. It’s how you deal with these mistakes that makes the difference.
“Men are socialized to be different. They’re socialized to take over a room. We’re not socialized like that. We’re socialized to be nurturers.” She offers, as an example, a friend of hers, a male, who was recently promoted to associate dean at a college in Manhattan. “He said, ‘I have no idea what I’m doing, I’m just faking it until I learn.’ Some women say ‘I’m not going to do it, I’m not equipped, I don’t have the skill set.’ We need to understand that we can learn on the job just like our male counterparts.”
Dr. Lizica Troneci, chair of the department of Psychiatry, grew up in Romania, where three quarters of the medical students were women (the only exception being, she says, in the“adrenalin-driven” specialties like surgery and emergency medicine). She came to the United States for her residency in 1996 and quickly climbed the management ladder. “Personally, I was lucky to work with male mentors who were open-minded and recognized my qualities as a professional and a leader despite being a woman,” she says.
Yet, she remembers one male doctor in a leadership role saying, “Since there are more women leaders in the field of medicine in general, the field has lost some of its prestige.” She kept calm at the time, but years later has not forgotten it. “There is a feeling that women have to prove themselves more,” she says. “I have had instances where my leadership skills were challenged and this is when you learn how to work with non-believers.”
Women, she says, lead differently than men. In discussing herself and the other two female chairs at SBH, Dr. Adjo and Dr. Dara Rosenberg, chair of the department of Dentistry, she says, “The three of us, we’re more detail oriented by virtue of being women and mothers, more attuned to handling conflict or crisis. I don’t want to generalize, but when I look at my male counterparts, they’re more dismissive of this, not as focused on the human part of conflict or the dynamics of the interactions. Do they achieve the same results? They do, but the message comes across differently. We’re more understanding, more open to feelings and negotiate differently than men.”
Mentorship
Female physicians speak about the importance of mentors – both in working with them and providing guidance to their younger colleagues.
“Women tend to help other women,” says Dr. Chee. We tend to be supportive of each other.”
Dr. Cooper agrees. She had planned to go into emergency medicine – “I’m about immediate gratification” – until during her third year of medical school rotations a female mentor “showed me that I could be awesome (becoming an OB/gyn).” “She had been in emergency medicine and had made the switch because she missed the connection and, continuity of working with women in every aspect of their lives,” recalls Dr. Cooper. “I felt the same way. I would watch her in her office, seeing her connect to patients. She had delivered the mom, the sister, the auntie.”
Dr. Amanda Ascher, Chief Medical Officer with Bronx Partners for Healthy Communities (BPHC), the DSRIP Performing Provider System headed by SBH Health System, was singled out as a mentor by Dr. Chee. Dr. Ascher, who puts a premium on helping younger physicians, says she has been exceedingly lucky to have her own share of very supportive female bosses over her career.
“This woman had three kids of her own and had been running on the same hamster wheel the rest of us are on,” she says, discussing a past supervisor at a major NYC medical center who could identify with the challenges many of her female doctors faced. “Moms take on a lot more work than the dads at home and it’s not the dad’s unwillingness, but the mom’s feeling that that’s expected of us and we would be somehow lesser if we didn’t do it by making up for the time we’re at work. I used to have this incredible sense of pressure that everyone had to be in bed by a certain time. I had to let go of this pressure and realize, ‘Does it really matter if someone is in bed 15 minutes later?’”
Dr. Angela Regina, an emergency medicine physician and toxicologist, says she has had these talks about family vs. work with older female physicians at SBH like Dr. Marianne Haughey. “When I came to work after Shawn (her five year old son) wouldn’t let me leave the house, I spoke to her. Her children are in college. She said, ‘He’ll understand when he’s in high school.’ She’s experienced and saw the final outcome 10 years later.”
Dr. Amendola, who came to SBH in the mid-90s, first as a resident and then an attending, can point to the benefit of having positive female role models. “Judy Berger is the strongest women I know,” she says. “She doesn’t back down to anyone and is not afraid to open her mouth. It took me 10 years to get there, but I got there and that’s what’s important.”
She credits Dr. Victoria Bengualid, an infectious disease specialist and director of the internal medicine residency program at SBH, for giving her the best kind of advice: “She told me ‘Don’t ever feign to be the smartest person in the room.’ Knowing where to find that person, knowing where to send your patient to get the best treatment is more important than being the all-knowing physician. Be wary of that doctor because that person will miss something.”
But mentors, of course, don’t have to be women. “I had a fantastic boss (Dr. Nelson Eng), who understood I was always going to be a mother first,” says Dr. Amendola. “He always understood and that was the best. You can’t buy that. It’s priceless.”
Work/Life Balance
According to Dr. Ascher, achieving a perfect work/life balance for women physicians is like a discussion of Santa Claus or the tooth fairy. It’s a fantasy. “If you asked me what I would tell young women in medicine, it’s that you can have it all, but you can’t have it all at the same time,” she says. “The idea of work/life balance, that phrase should be stricken from our vocabulary. There are times when you’re working harder and neglecting home, and other times when work has to wait because home has your attention now. There are rare moments when things feel in balance.”
Virtually all of the female doctors interviewed for this article have always worked full-time. Navigating a career in medicine in general is difficult for all physicians, they admit, regardless of gender. But those female doctors who are also mothers, face conflicting pressures.
“I chose not to be a stay home mother and that means there are things that I’ve missed or been really late to,” Dr. Ascher says. “But, on the other hand I’ve had a really rewarding career. I don’t think my children (she has two teenaged daughters) have suffered for it, but I’ve heard things from them that have made me want to cry like ‘Why do you want to work? The other mothers don’t have to work,’ which is totally untrue.”
She adds, “Not saying no is how you burn out. You said, yes you can bake all the cupcakes for the kids, and you said, yes you’re going to cover someone’s evening shift. How are you actually going to do that? There are choices that are going to have to be made.”
Dr. Regina talks about her young son, who she says is now at an age when he misses his mother when she runs out the door to go to work, sometimes on weekends and sometimes at night. It’s because of this that she’s not surprised to hear that women physicians have lower satisfaction scores than their male counterparts.
“He says, ‘Mommy, don’t go to work.’ When your kid is crying and putting arms against the door to keep you from leaving, you end up leaving in tears. You want to be the perfect mom, the perfect wife, the perfect doctor, and it’s very difficult.
“I have phenomenal support at home and I chose to work at St. Barnabas (where she did her residency) because I know there is truly a family atmosphere here. Still, we second-guess ourselves when it comes to our family. I realize I’m not going to be perfect. There is no perfect.”
Having support at home is crucial, say those female physicians with families. Dr. Ascher knew she could count on her mother to cook Monday night dinners when her children were young. Dr. Regina has a similar relationship with her mother. Dr. Adjo says she was incredibly fortunate to have both her mother and mother-in-law available to provide child care for her two daughters, now 12 and 7, when they were small. Dr. David Perlstein, then her boss, she says, was very supportive in allowing her to take four months off when she was pregnant with her older daughter. She says she’s extremely pleased to see such recent innovations at SBH as the new lactation room. “I had to pump in my office between seeing patients,”
she remembers.
Even with support though, it can be difficult. “My mom lives in New Jersey and I live in Manhattan and I would take my daughter to her home every morning, go to work, then go back to New Jersey to get her, and I did this until she was four,” says Dr. Adjo. “It’s still a balancing act, you’re the primary at home and at work. You make dinner, check homework, prepare for tomorrow, and try to have a meaningful conversation with your spouse. It’s a huge balancing act.”
She speaks about how she and her husband have split their responsibilities down the middle and how he takes their daughters to school every morning. Dr. Ascher’s husband moved his office closer to home to help out when they had a family emergency.
“Girls are taught to take care of everyone else,” says Dr. Ascher. “My husband is incredibly supportive. He’ll do anything I ask. “But I still have to ask.”
Family dynamics may have changed, but only so much. Dr. Berger remembers when she was a young doctor, living in a cramped apartment in Queens with her husband, a live in nanny and three children. She and her husband were both working long hours, but she also had the primary responsibility for childcare.
“I once said to him, ‘It doesn’t have to be 50 – 50, you know, but how about 75 – 25?’ He said he would do the grocery shopping.”
