It’s National Women Physicians Day 2020, but women still face barriers in medicine

Happy National Women Physicians Day 2020! Launched in 2016, National Women Physicians Day is celebrated on the birthday of Elizabeth Blackwell, the first woman physician and a champion for the inclusion of women in the medical profession in the 1840s and 50s. Rejected everywhere else, she was finally admitted into medical school at Geneva College in New York. Her admission was intended as a practical joke. Imagine their surprise when she graduated in 1849, first in her class.

In many ways, the odds have always been stacked against women interested in studying medicine. Unfortunately, we’ve still got a long way to go to achieve gender equality in medicine. Here are just a few of the latest numbers on medicine’s gender disparities:

This week, to celebrate National Women Physicians Day 2020, we’re sitting down with Lightning Bolt Advisory Board Member, internal medicine physician, and leader in the lifestyle medicine movement, Dr. Hemalee Patel, to get her take on the barriers women face in medicine.

Dr. Hemalee Patel on lifestyle medicine, burnout and uplifting women physicians

Were you aware of those statistics?

Dr. Hemalee Patel in her white coat.

Yes, I was. I spoke to a few female physician colleagues of mine and gave them the stats to hear their thoughts and they were equally surprised. We all have an understanding that maybe it’s a little bit less but after seeing the stats you realize how significant it is. It’s disappointing. We are doing the exact same work, so why the discrepancy?

Despite the fact that women are beginning to outnumber men in medical school, there are still barriers women face during training and beyond. What are those key issues in your experience?

It’s likely multifactorial, but from my personal observations, it stems from traditional desires of starting a family, spending time with kids, being there for other family members, etc. As a mentor to medical students, residents and other aspiring physicians a common response I hear is “my life will start at  X time, after training”  It’s a shame because you shouldn’t feel like your life needs to start after training.

 Physicians are planners. We’re very empathic to wanting to help others, at the expense of our own well-being. It’s a definite barrier that is put on us by ourselves, the rigors of training and the rigors of work.  I’ve certainly gone through similar experiences where certain parts of your personal life are sacrificed in order to succeed professionally. I’ve had attendings say medicine has to be number one and if prioritizing anything else, implies you’re less of a doctor.

Hearing a sentiment like that can be deflating and also make you feel isolated. Does it make me less of a doctor if I need to be there for my family, if I need to be there for my friends? If anything I believe having a full life outside of medicine humanizes you and can enhance the provider-patient relationship.  Often times I hear aspiring physicians and those in training being told to pick a less rigorous specialty if they want to have a life outside of medicine. This is unfortunate. Yes, certain specialties are more demanding than others but at the same time becoming a physician takes a lot of hard work and dedication. At the end of the day, we should be able to choose the path we want without having to worry about the impact it has on our personal lives. Unfortunately, however, this is a current reality that does impact us.

Did those factors impact what you chose to study?

Well, I’ve always had an interest in nutrition and knew I wanted to go into medicine from a preventative standpoint, to help other people reverse chronic disease by lifestyle. It was largely based on frustrations in seeing how my family members were being treated from a chronic disease standpoint, that really prompted me to go to medical school and practice from a lifestyle standpoint.  

 I had a really naive view and came to medical school thinking that all physicians must take care of themselves by eating well, working out, etc. I realized it was anything but, and it can actually be a really unhealthy lifestyle. It fosters a little bit of that work hard, play hard mentality, which for some works well but didn’t really work for me and if I didn’t take care of myself I probably wouldn’t have survived training.  I also don’t want to be a walking contradiction to the people that I’m trying to support in lifestyle medicine.

How did you overcome those obstacles? What advice would you give to women physicians in residency or medical school? 

During training I had an attending tell me that I had to live and breathe medicine and if I prioritized anything else I wasn’t dedicated to my profession.  I walked out thinking, what am I doing here? At that moment,  I bumped into my cardiology attending who’s literally part of the walls of the hospital, and he asked, “Why do you look so upset? ” I began to tell him, I wasn’t sure if I was cut out for this and he replied, “Hemalee, I promise you, don’t sacrifice important people and moments in your life over medicine. You won’t regret it and it will make you a better doctor.” He went on to tell me this very poignant story about how he felt he did sacrifice his personal life for medicine and it cost him his most personal relationships. He said he regretted it to this day. 

My best advice for all physicians in training and beyond is to find mentors male or female who you want to emulate. Who have found a balance between enjoying and practicing the art of medicine while still taking care of themselves and making time to explore their own personal interests. Write down your core values. What are your mainstays? Have those boundaries and set up what is really important to you and define that very early on. Don’t lose your hobbies. If there’s something enjoyable, try and pursue it as much as you can. If that means reading a Vogue in the middle of your lunch break do it.

Women physicians experience much higher rates of burnout compared to male physicians. Why do you think that is?

I think  there probably are more external responsibilities for women to deal with stemming from internal and external pressure to “have it all.” You’re probably thinking about a bunch of other things in your personal life that we’ve been kind of trained to think about—family planning, marriage, or maternity leave on top of striving for professional success in our careers.

There’s data that shows that female physicians take better care of their patients and I wonder if there’s a little bit more empathy or compassion fatigue in women or not having that ability necessarily or that space to really turn off in the same way that our counterparts do. You feel you’re giving in all these different directions and trying to keep up, while also having other responsibilities you are not able to account for.

You’re a leader in the lifestyle medicine movement. Could you tell us a little bit about its mission? Are there connections between its tenets and fighting burnout?

Lifestyle medicine is a fairly new term. People with chronic diseases, diabetes, high blood pressure, or high cholesterol, a lot of that is caused by environmental factors. It’s what we’re doing to ourselves or what’s around us that is causing a lot of these things to occur. So, I look at nutrition, fitness, mindfulness, sleep, and socialization, all of those things that kind of encompass lifestyle medicine, and ask how do you optimize all of those things so that you can prevent, reverse, and cure chronic disease?

In terms of its application to burnout, lifestyle medicine for physicians means the exact same thing. It’s similar to putting on your oxygen mask before you put on your child’s. I know that when I have exercised and gotten an adequate amount of sleep, my patients are in better hands because I’m fully present.  There are a lot of takeaways to lifestyle medicine as it pertains to preventing physician burnout. At the crux of it, it’s taking care of yourself so that you can better take care of others.

The latest numbers on the gender pay gap in medicine show that women physicians earn about $20K less than male physicians. What are the key factors contributing to this disparity?

I had a female colleague ask me to advise her regarding negotiating her salary at her new job. She was told at this particular place that there was no negotiation of salary, but she was coming in with a good amount of experience. 

It just so happened that a male colleague was in the room and overheard our conversation. And he said, “Oh yeah when I worked there, I was able to negotiate 25% more than what they had initially offered.” And he said it like it was no big deal. And we both looked at him and we were like, wait, how? He said, “I just told them, I come with this expertise. I told them exactly what I wanted, and if they couldn’t match that, I was happy to go somewhere else.” And he said it so confidently and so definitely.

In terms of what steps we can take in order to end that disparity, know your data, talk about your compensation with colleagues and your hospital, and discuss them widely. It’s not something to be embarrassed about. You should ask for what you feel like you’re worth. You’re interviewing them as much as they’re interviewing you, so if they come back and it’s a hard no, I actually would be very careful about taking a job where they don’t even try and think about ways to come up with a solution and meet you halfway because they won’t recognize your value.

Women are woefully underrepresented in healthcare leadership. What changes need to happen across the industry to foster more women in leadership?

Creating more visibility of women currently residing in healthcare leadership and continuing to identify, build and develop opportunities for female physicians to lead. We are beginning to see pathways for women to get more involved and it’s exciting! I’ve had amazing male and female mentors who have helped support and direct my career. There are more seats at the table than we think. I’m a huge optimist, and I’m seeing the changes slowly occur which is encouraging.

How are you going to celebrate National Women Physicians Day 2020?

I co-created with a friend and colleague of mine a fun Instagram handle, @beneaththewhitecoat, celebrating physician creativity and lifestyle. We are more than just our white coats! So we’ll definitely feature something on there. I’ll probably also get a bunch of female physician girlfriends together and go out.

Celebrate National Women Physician’s Day by sharing your story. Use the hashtags #NationalWomenPhysiciansDay, #NWPD, and #IAmBlackwell on social media.

Dr. Hemalee Patel is board-certified in Internal Medicine and currently practices in San Francisco, CA. She speaks frequently on lifestyle medicine and population health topics that empower and educate individuals and healthcare organizations using the latest technology and scientific advances in health and wellness to prevent and control the development of chronic disease. Dr. Patel served on the board of the Physician Wellness Committee at Stanford and is an advocate for provider self-care who has conducted research on provider resilience and prevention of burnout. Her passion for physician wellness led her to develop workshops for medical students and residents on provider well-being, including navigating life after medical training and sustaining longevity and joy in medicine.