December 14, 2017

Why residency is 'worse for women than men,' according to research

Daily Briefing

    While "it's no secret that medical training is grueling," research suggests that the experience is "worse for women than men"—and that the disparity largely centers around work-family conflict, Dhruv Khullar, a physician and researcher, writes in the New York Times' "The Upshot."

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    Khullar cites a new study in JAMA Internal Medicine that found that while men and women, who had equal levels of depression before residency, both saw an increase in depression scores six months into residency, "the effect was much more pronounced for women." According to the study, more than one-third of the disparity could be attributed to work-family conflict.

    Khullar explains that the findings reflect broader disparities in the medical field: While women make up more than one-third of practicing physicians and about half of physicians in training, the structure of medical training has remained relatively unchanged since the 1960s,"when almost all residents were men with few household duties." Meanwhile, "the division of domestic labor" has not "shifted to reflect the rise of women in the" field today, Khullar states.

    In turn, it's more common for female physicians than male physicians "to cut back professionally to accommodate household responsibilities," Khullar writes. For instance, a study of young academic physicians found women spend nine more hours per week than men on domestic activities, while another study into dual-physician households found that women with children work 11 fewer hours outside of the home each week than women without children—but there was no difference among men.

    And while medical training might "crystalliz[e]" this disparity, the "gender bias within hospitals—both subtle and overt, from patients and colleagues—may be just as pernicious," Khullar writes. He points out that female doctors often struggle to get patients and colleagues to address them as a physician. For instance, one study found that female doctors nearly always referred to a speaker during Grand Rounds as "'doctor,'" while male speakers "used the formal title only two-thirds of the time—and were much more likely to use 'doctor' for men than women,'" Khullar writes.

    Moreover, "biases can bleed into the way we do business," Khullar continues. According to a working paper by Harvard University Ph.D. candidate Heather Sarsons, physicians are considerably less likely to refer a patient to a female surgeon after a patient death—even though they "barely change their referrals to a male surgeon" in the same situation.

    The effect on female physician careers—and wellness 

    According to Khullar, research suggests these disparities are negatively affecting women's medical careers and overall wellbeing. For instance, research suggests that female physicians:

    • Are more than two times as likely to die by suicide, when compared to the general population;
    • Earn "significantly less" than men who are physicians;
    • Are "less likely to advance to full professorships," even when accounting for productivity; and
    • Comprise just one-sixth of medical school deans and department chairs.

    But it doesn't have to be this way, Khullar writes. He spotlights a pilot program at Stanford Hospital that could help physicians with household responsibilities as one way to improve experiences for female—and male—residents. Under the program, physicians can use hours they spend mentoring or serving on committees as credits for child care, ready-made meals, housekeeping, and other services. The program has been linked to "increased job satisfaction, improved work-life balance, and reduced turnover," Khullar writes, and similar efforts over time "could be evaluated to see not only if they improve physician well-being, but also if they promote career advancement, cut medical errors, or improve patient satisfaction."

    Ultimately, however, the disparities between male and female physicians demand that we "examine our own biases," Khullar writes. After all, as he concludes, "disparities don't close on their own. They close because we close them" (Khullar, "The Upshot," New York Times, 12/7).

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