For Women Physicians, the More Things Change...

When psychiatrist Diane Shrier, M.D., went to Yale medical school in the early 1960s, she was one of only six women in a graduating class of 80 due to a then-common policy restricting the number of women permitted to enroll in each class.

“This was a low point for women in medicine,” she told Psychiatric News. “In the 1950s and 60s, women were supposed to get married, have children, and stay home to raise them. The myth was women would abandon their medical studies” to fulfill these roles.

Things have changed since those days. Women and men now enter medical school in equal numbers and are expected to combine career and family.

But faster than anyone can say, “we've come a long way,” Shrier acknowledges that women entering medicine today are encountering some of the same problems—sexual harassment and inability to advance professionally due to gender discrimination, for instance—at the same rates as their forbears did.

And she has the data to support her observations.

In a study appearing in the July Journal of Women's Health, Shrier, of the departments of Psychiatry and Pediatrics at George Washington University Medical Center, reported finding that among 136 mother-daughter physician pairs, there were no significant differences in the proportion who reported ever having experienced sexual harassment at work or during training (44 percent of mothers versus 51 percent of daughters). She conducted the study with her daughter, pediatrician Lydia Shrier, M.D., M.P.H., an adolescent medicine specialist at Children's Hospital in Boston.

The mean age of the mothers in the study was 65, with 84 percent graduating medical school prior to 1970; the mean age of the physician daughters was 35, with 89 percent graduating after 1979. The Shriers recruited the mother-daughter pairs from state and county medical societies and through alumnae associations and word of mouth.

In addition, about 28 percent of mother physicians and 23 percent of their daughter physicians reported experiencing gender-related biases or obstacles to success or satisfaction in the work environment.

In some cases, the daughters, who graduated from medical school decades after the 1965 passage of the Civil Rights Act, part of which prohibited discrimination in the workplace based on gender and race/ethnicity, fared worse than their mothers did.

For instance, a higher proportion of daughter physicians reported being sexually harassed in medical school (34 percent) than did their mothers years before (23 percent). In addition, Shrier found that daughters who were sexually harassed or experienced gender bias reported more stress at home and at work and less career satisfaction than did mothers with similar experiences.

A higher percentage of mothers said they were denied opportunities for advancement due to gender than did their daughter physicians (37 percent vs. 22 percent, respectively) and due to race or ethnicity (18 percent vs. 6 percent, respectively).

Shrier said she was disappointed by the findings. “We expected the daughters to do better,” she noted. She had expected to find that the physician daughters, “having access to maternal role models and mentors and entering medicine at a time when gender and racial/ethnic discrimination and harassment were illegal, would have fewer and less severe experiences with these issues.”

In an article in the February Pediatrics, the two Shriers and colleagues noted that “women physicians are less likely to be adequately mentored and to hold leadership positions” in medicine and that outdated assumptions persist among leaders in medicine even in specialties in which a majority of practitioners are women.

Such misconceptions include the notion that medical careers are all-consuming of time and energy at the expense of family and personal life and that a “high-achieving career in academia and in research must be linear and uninterrupted,” they said.

According to APA President-elect Nada Stotland, M.D., M.P.H., who participated in the Shriers' study with her own daughter, an obstetrician/gynecologist, little has been done to discourage discriminatory attitudes and behaviors in the medical field, which are ubiquitous yet not always obvious. “Careers can be made or destroyed behind closed doors,” she observed.

Stotland also said that many in medicine assumed, falsely as it turns out, that the mere increase in the percentage of women entering medicine would reverse gender discrimination. She suggested that the influx of women into medicine may, in fact, have had a “paradoxical effect” in that“ some men may feel threatened by the shift in gender balance.”

Although many medical institutions have policies that prohibit discrimination and instruct employees on how to report harassment, Stotland observed that those who come forth with claims of gender discrimination or sexual harassment may experience retaliation from the perpetrators or others in power. “The likelihood is that a complaint will ruin a career as well,” she said.

Creating a nondiscriminatory and harassment-free environment for women physicians “requires commitment from the top down,” Shrier said. That is, medical leadership must establish an environment in which discrimination and harassment are recognized, related attitudes and behaviors are discouraged and punished, and people feel comfortable identifying and discussing instances of harassment, she noted.

“This is not just a women's issue as medicine is continuing to lose substantial numbers of potential leaders and researchers, especially in academic medicine,” she emphasized.

Transforming medicine into a more family-friendly career would also be helpful, Shrier acknowledged. In an ideal work environment, she said, there would be a phase during which men and women work less when they are in their 30s and 40s, a time when many physicians peak in their respective careers but also a time when many are raising children, and dedicate more of their time toward careers in their 50s and 60s.

According to psychiatrist Leah Dickstein, M.D., leaders in medicine must establish a “community of respect” in which all physicians and trainees are treated respectfully and equally, she told Psychiatric News. The future of the field rests in the hands of men and women“ of good conscience,” who actively promote deserving women to positions of leadership.

Dickstein entered medical school at the University of Louisville in 1966, after years of working as a grade-school teacher to support her husband while he attended medical school. She eventually had three children and managed to balance her career as an academic psychiatrist with family life, despite attempts by some to dissuade her from such a course.

In her past position as professor of psychiatry and associate dean for faculty and student advocacy at the University of Louisville, Dickstein helped others learn how to balance family and career while focusing on individual well-being through the Health Awareness Workshop program at the university.

She is now professor emerita of psychiatry and behavioral sciences at the university.

In her previous positions, she also encouraged students and residents to come forward if they had experienced discrimination or sexual harassment.“ We must stand together for what is right,” Dickstein said.

An abstract of “Generation to Generation: Discrimination and Harassment Experiences of Physician Mothers and Their Physician Daughters” is posted at<www.liebertonline.com/toc/jwh/16/6>.▪