As women physicians shine, glass ceilings crack

suescher

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

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