PRESIDENT’S MESSAGE
Women in Medicine: Accomplishments and Challenges By Rodolfo “Rudy” Molina, MD, MACR, FACP, 2021 BCMS President
March 1st marks the beginning of a month dedicated to the history of women. I thought the center piece of this article should explore and compare the challenges and accomplishments of the first woman to graduate from medical school in America, Elizabeth Blackwell, to our present-day female physicians. Now, more than half of the entering medical school class is female. So, what new challenges are women in medicine facing since Dr. Blackwell received her degree 170 years ago? Full disclosure, my wife is a physician and I also have two daughters in medicine: a second-year internal medicine resident and a fourth-year medical student. Let me begin with a brief narrative of Elizabeth Blackwell’s story. In 1849, British-born Elizabeth Blackwell became the first woman to earn a medical degree in the United States. After being rejected from a multitude of medical schools, she was finally admitted to the Geneva Medical School in New York. Originally, the dean opted to also reject her application, however, he decided her acceptance would be contingent upon the 100% approval of an entirely all-male student body. They unanimously voted yes (reportedly as a joke), but she was soon met with new challenges. From the town women shunning her to the professors not treating her as an equal to her male counterparts, Dr. Blackwell learned to not shy away from adversity. One of the professors even requested she leave the classroom during a “sensitive” male reproductive lecture. She refused and with the support of her male colleagues, she stayed. After graduating, she focused her efforts on establishing her career in New York, but was not allowed to practice in any hospitals. Unfortunately, Blackwell struggled to dispel the negative basis of dealing with a female physician. Being a female physician was thought by some to be code for abortionist. Because she was not allowed to practice in hospitals, she was urged by friends to go to Paris for further training. The French were not any different from the Americans about allowing her to continue training at one of their hospitals, but eventually she was allowed to work at a maternity hospital alongside mid-wives. Eventually, through family influence, she was given a place at St. Bartholomew, a prestigious London hospital. In 1859, Blackwell succeeded in becoming the first woman to be included in the newly formed British Medical Register. She befriended several women along the way who became prominent figures in the history of medicine including Florence Nightingale. Eventually they parted ways and Nightingale later gained notoriety for her service during the Crimean War. Dr. Blackwell returned to America and tried to establish herself in New York City. She struggled finding paying patients. In the face of adversity and with her tenacity, she founded the New York Infirmary 8
SAN ANTONIO MEDICINE • March 2021
for Indigent Women and Children for the purpose of caring for those in need. At the outbreak of the American Civil War, she hoped the American military would welcome the contributions of female physicians. To her surprise, she was relegated to be under the supervision of a head nurse with the duties of recruiting suitable nurses to help the war effort. In 1869, Blackwell returned to London and later taught at the London School of Medicine for Women, established in 1874. Due to health reasons, she moved to a country side house in 1879 where she continued to write numerous lectures, articles and books until her death in 1910. Her obituary in the London Times stated, “She was in the fullest sense a pioneer who, like all pioneers (when discouraged) heard but did not listen.” What about now? Societal mores, in particular those embedded with gender biases or expectations, are deeply rooted and not easily erased from memory or tradition. While female physicians today are not openly shunned like Elizbeth Blackwell, there is a level of unconscious bias working against female physicians in the workplace that exists today. A large review of the literature covering multiple countries regarding the female nurse-physician relationship was published by the Mayo Clinic Proceedings in May 2020. It concluded that many women physicians perceived gender inequity and did not receive the same level of respect from female nurses as their male counterparts. This dynamic is in evolution and, as more women become medical doctors, will likely (hopefully) change. However, today women physicians still face other challenges. Here is a summary of a 2020 survey published in Medscape 15 July 2020. A panel of women physicians developed the questions used in this survey which included over 3000 participants. The Women Physicians responded to the issue of what was the most challenging problem: • 64% - work-life balance • 19% - gender equity • 6% - age discrimination • 43% - compensation • 16% - career development • 1% - sexual harassment • 30% - combining parenthood with work • 16% - relationship with colleagues and staff
