As women physicians shine, glass ceilings crack

As women physicians shine,
glass ceilings crack
Sue Bornstein, MD
Growing up in Dallas in the 1950s and ’60s, my
older sister and I were fortunate to have Dr. Floyd
Norman as our pediatrician. Dr. Norman was
kind, approachable, patient, and had a good
sense of humor (great qualities for any physician
but especially a pediatrician). I remember him fondly. I also
remember that even as a young child, I was impressed that
Dr. Norman’s wife also was a physician. Little did I realize at
that tender age that Dr. Norman was married to Dr. Gladys J.
Fashena, the pioneering pediatric cardiologist.
Dr. Fashena joined the staff at Baylor University Medical
Center and became one of the first clinical faculty members
at the new Southwestern Medical College in the 1940s. She
established the pediatric cardiology practice at Children’s
Medical Center and recruited one of the first cardiothoracic
surgeons to Dallas to operate on children with congenital heart
disease. One of the six academic colleges at UT Southwestern
is named in her honor. In 1976, Dr. Fashena was the first female
president of our Dallas County Medical Society.
From my childhood until I began medical school in 1998,
I do not recall meeting another female physician, although
approximately one third of my medical school classmates at
Texas Tech were women. During my third-year clerkships in El
Paso, I met my first two women physician mentors. One of them
became the strongest role model I have encountered in my
medical career, and my experience with her helped solidify my
decision to pursue internal medicine as a specialty. Dr. Dorothy
DiNardo-Ekery was a consummate physician with a remarkable
bedside manner and an encyclopedic knowledge of medicine.
Of my residency class of nine at BUMC, six were women!
Still, BUMC had few internal medicine attendings in those
days. Later, in 2005, I was honored to be elected the first
woman president of the BUMC medical staff. Since that time,
at least five more women have served in that role. That glass
ceiling is permanently shattered!
What is known about the state of women in medicine today?
In 2015, more than one third of the active physician workforce
in the United States was female, and an estimated 46 percent
of physicians-in-training and medical students are women.
That’s the good news.
Several recent studies have documented the compensation
inequity between male and female physicians. A 2017 survey
(Grisham S. Physician compensation report. Medscape 5
April 2017) found that male primary care physicians made
$229,000 annually, compared with $197,000 for women,
a gap of 16 percent. This gap is even wider for specialists.
In academic medicine, female physicians made an average
of $227,783 annually, compared with $247,661 for male
physicians after adjustment for factors including faculty rank,
age and years since residency.
It is tempting to conclude that women physicians on the
whole work fewer hours and may choose less financially
rewarding specialties, which in part explains the pay gap.
However, researchers find these disparities even when
controlling for age, specialty, number of hours worked, and
practice characteristics.
There is another gap for women in medicine — the
leadership gap. Female physicians constitute 38 percent of
full-time medical school faculty but only 21 percent of full
professors, 15 percent of department chairs, and 16 percent
of deans. The lack of female physicians in leadership positions
traditionally has been believed to be a pipeline problem, but
because women have made up roughly half of medical school
graduates for years, more systematic factors are at play.
The situation is even more challenging for minority female
physicians. The intersection of race and gender compounds
the effects of discrimination and inequality related to
compensation and career advancement.
Women physicians face other challenges including lack of
mentors, gender bias, impostor syndrome, and the need for
better work-life integration. Female physicians are more likely
to report an environment of perceived gender bias in their
medical careers and more likely to report sexual harassment.
The recent “MeToo” movement has created more
visibility for the issues faced by women medical students,
residents and practicing physicians. Social media has
played a powerful role with the establishment of hashtags
such as #WomenInMedicine, #HeforShe, #SheforShe, and
#ILookLikeASurgeon. A weekly #WomenInMedicine online
chat has gained a lot of followers.
The American Academy of Neurology in July 2018 published
results of a study that examined the total numbers and
The author’s
favorite pastime
is fishing on the
Lower Laguna
Madre on the
Texas coast. Her
struggle to land
this 50-pound
tarpon (“all
muscle and
power”) capped
what she called
an epic fishing
day.
8 Dallas Medical Journal September 2018

SPOTLIGHT
Wendy Chung, MD, is the chief
epidemiologist for the Dallas County
Health Department and a member of the
DCMS Community Emergency Response
Committee. Julie Trivedi, MD, is medical
director of infection prevention for the
university hospitals at UT Southwestern
Medical Center. They’re part of the Dallas
Medical Operations Center, which set up
and oversaw the medical clinic at the Dallas
Convention Center during Hurricane Harvey
in 2017.
Wendy Chung, MD, and Julie Trivedi, MD
proportions of men and women physician award recipients
in their organization. Women were underrepresented among
awardees. In the most recent 10-year period, the AAN
presented 187 awards to physician recipients. One hundred
forty-six were men and 41 were women. This occurred despite
significant increases in women AAN membership. Finally,
female physicians are less likely to be properly introduced by
their titles at Internal Medicine grand rounds by their male
colleagues.
How can we address these issues and begin to close the
leadership, compensation and opportunity gaps? I encourage
you to read this position paper on achieving gender equity in
medicine that was published in the May 18 Annals of Internal
Medicine: http://annals.org/aim/fullarticle/2678630/achievinggender-equity-physician-compensation-career-advancementposition-paper-american.
The ACP, the largest medical
specialty society in the world, calls for a number of actions
including increased transparency in physician compensation,
and universal access to family and medical leave policies that
provide a minimum of six weeks paid leave. In a major move
to support these policies, the ACP recently implemented a
six-week paid leave policy for parents of newborns or newly
adopted children for ACP staff. And for the first time in its 103-
year history, the ACP’s CEO is a woman.
On the home front, the Dallas County Medical Society
established a Women Physicians Committee in 2016. Dr. Lee
Ann Pearse, then DCMS president, believed it was important
for women physicians to address in an organized way the
issues that affect them and their practices. We have had some
excellent meetings and, in a move to expand our reach, will
have our first social event for DCMS women physicians on
Sept. 13 at STIRR in Dallas.
Even more work must be done to recognize and
acknowledge the value that women physicians bring to our
patients and our profession. However, I am proud to point out
that a number of Texas woman physicians have blazed trails in
organized medicine.
• In 1997, Dr. Nancy Dickey, professor of family medicine
at Texas A&M University, was elected the first woman
president of the American Medical Association.
• Dr. Susan Rudd Bailey, a TMA past president and current
AMA speaker, is poised to be AMA president.
• Dr. Lynne Kirk, professor of internal medicine at UT
Southwestern, served as ACP president in 2006.
• Dr. Lisa Hollier, my fellow BUMC resident, is president of
the American College of Obstetrics and Gynecology.
• And Dr. Mary Dahlen Peterson, pediatric anesthesiologist
and CEO of Driscoll Children’s Health Plan, soon will serve
as president of the American Society of Anesthesiology.
Dr. Fashena would be smiling at the great strides made by
women in medicine. Let’s keep moving forward! DMJ
Sue Bornstein, MD, FACP, is a board-certified internist. Since
2008, she has been the driving force behind the nonprofit Texas
Medical Home Initiative. The vision of this practitioner-led
organization is to lay the groundwork for a medical home for
every Texan. The group’s work has included a patient-centered
medical home pilot in North Texas and, since 2013, annual
statewide conferences on Primary Care and the Health Home.
Dr. Bornstein is an ACP regent, chairs the ACP Health and
Public Policy Committee, and is a TMA trustee.
September 2018 Dallas Medical Journal 9