The attrition of women in medicine

A well-meaning colleague once said to me, “You probably wouldn’t want to do this since you just had a baby.”

“So this is it how begins,” I thought. “The attrition of women in medicine.”

Even though men and women enter medical school at roughly the same rate, more women are leaving medicine.

I believe this attrition is associated with factors such as being treated differently than their male counterparts and a lack of economic, professional, or personal support.  In fact, 66% of female physicians report gender and maternal discrimination at work, citing issues such as disrespect from support staff, lack of maternity leave or breastfeeding policies, and unequal pay.

In Houston, the gender wage gap translates to female physicians making about $106,000 less than male physicians annually, despite controlling for specialty, medical school, hours worked, etc. Even though the Equal Pay Act was passed in 1963, the law has limited enforcement so many women must sue for equal pay.

Working women face unique challenges in academic medicine 

I was fortunate to win the lottery when it comes to supportive spouses. My husband joyfully washes pump parts every evening, purees food for the baby, and cooks dinner, all while whistling a tune from the Brandenburg Concertos or the Beatles’ “Yellow Submarine” (both favorites of our daughter.)

I realize many aren’t as fortunate; female physicians are still bearing a significant burden of parenting and spend an average of 8.5 more hours per week on domestic activities.

Although physicians are technically eligible for a 12-week unpaid leave per FMLA, many residency programs don’t have an actual maternity leave policy. The programs often don’t support leave, as they are not policy bound to extend the residency duration. This is being addressed in other fields, as four states have mandated publicly funded maternity leave and the U.S. military recently increased paid maternity leave to 12 weeks.

As a result, many female physicians are delaying childbearing and subsequently almost 25% are struggling with infertility, compared with 10% of the general population. This takes a toll on both a professional and personal level. Female physicians have significantly higher rates of job dissatisfaction, depression, and burnout, in addition to higher suicide rates than their male counterparts.

Supporting female talent in medicine requires dedicated systems-based solutions

Deloitte is an example of a company that solved the retention problem for women. In 1992, they realized only 5% of the partners and directors were women and retention among women was poor. So they developed a task force to investigate retention and advancement of women.

Leaders believed that women were leaving to have families and stay at home, while workshops and reviews found women dissatisfied with the culture and getting poor assignments. They changed policies to ensure women received their share of premium assignments and promoted work-life balance for both men and women, including 16 weeks of paid family leave for both men and women.

As a result, the gender gap in turnover was eliminated by 1999, allowing Deloitte to grow faster than any other consulting firm.

Progress is possible and each of us can make a difference 

I recently had the opportunity to meet one of my personal heroes, Dr. Reshma Jagsi, an expert in the field of gender equality in academic medicine and a well-published radiation oncologist. I was hoping to run into her at our specialty’s annual conference and discuss collaborating on a project about women in academic radiation oncology.

Unfortunately, due to post-labor complications, I was unable to attend the conference. As I nursed my daughter while following the conference proceedings on my phone I thought, “…So this is how it begins.”

Addendum:  Turns out Dr. Jagsi wasn’t at the conference – she was attending the Executive Leadership in Academic Medicine course that seeks to promote women’s leadership. We recently connected by phone, and we already have a project planned. Dr. Jagsi says that if we succeed, our work together will help those who follow rewrite those beginnings.

-By Michelle S. Ludwig, M.D., M.P.H., Ph.D., associate professor of radiation oncology, Baylor College of Medicine, and adjunct assistant professor, division of epidemiology, human genetics and environmental sciences, UT School of Public Health