BCMS 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 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

Women aged 45 years or less found combining parenthood and work more of a challenge compared to those older than 45 years. Compensation, gender equity and age discrimination were more challenging for the older group. 94% of those surveyed said they made a personal life trade-off because of work obligations. Society’s view of women as caretakers is powerful and many surveyed felt they needed to choose a specialty that allowed for flexible hours in order to be the primary caretaker at home. Although 71% of the women surveyed felt very confident about taking a leadership role, more than half were not in a leadership role. Only one quarter of healthcare organizations provide classes, seminars, mentorship programs or other activities aimed to support and encourage women physicians as leaders. Addressing these barriers is essential and is the first step for system-wide reforms for the betterment of our communities. Just an FYI, our Bexar County Medical Society does provide a course on leadership open to all members.

Being a physician is challenging enough, but being a female physician comes with distinct challenges that are unique and perhaps all too often overlooked. Despite these challenges, women physicians have been contributing to medicine since the first woman received her medical degree. I’ve compiled a list of women physicians who have made important contributions to medicine.

• Ann Preston MD (1813-1872) – First female dean of a US-based medical school, who also trained the first black and Native American female doctors and created social programs meant to educate poor women about hygiene and physiology.

• Rebecca Lee Crumpler MD (1831-1895) – First black woman to earn an MD; tireless activist that practiced alongside other black doctors to treat freed slaves.

• Mary Edwards Walker MD (1832-1919) – First female surgeon and first female surgeon in the US Army; active during the Civil

War and was captured and imprisoned. She later won the congressional Medal of Honor in 1865.

• Susan L. Flesche Picotte MD (1865-1915) – first Native American woman to receive a medical degree, pursued medicine after she witnessed an Indian patient die because a white doctor refused to provide care; cared for >1300 patients on her 450-square mile territory; before her death, a hospital was built in her honor.

• Gerty Cori (1896-1957) – The first women to earn a Nobel Prize in Physiology and Medicine for her work identifying the enzyme that converts glycogen into glucose.

• Helen Brooke Taussig MD (1898-1986) – first female president of the American Heart Association; helped establish the specialty of pediatric cardiology. Together with Drs. Blalock and Thomas, created the Blalock-Taussig-Thomas shunt to prolong the lives of children born with tetralogy of Fallot.

• Helen Flanders Dunbar MD, PhD (1902-1959) – considered the

“mother of holistic medicine” and founded the American Psychosomatic Society and its journal Psychosomatic Medicine.

• Virginia Apgar MD (1909-1974) – Created the Apgar score, the first standardized tool to evaluate the newborn; a pioneer in the new field of anesthesiology.

• Elizabeth Kubler-Ross MD (1926-2004) – A pioneer in the study of death, dying, and grief. Her book, On Death and Dying, published in 1969, became a standard text for those caring for the terminally ill and to help improve end of life care.

• Audrey Evans MD (1925-) - a pioneer in the treatment of childhood cancer, instrumental in the creation of the Ronald McDonald house (1974), a place for families of sick children with cancer to stay while receiving their treatment.

• Patricia Bath MD (1942-) – Founded the discipline of community ophthalmology, was the first female chair of an ophthalmology residency program in the US in 1977, and co-founded the American institute for the Prevention of Blindness.

• Antonia Novello MD (1944-) – First woman and the first person of Hispanic origin to become the Surgeon General of the United

States; played an important part influencing policy aiding children and later became a special representative to the United Nations

Children’s Fund.

• Nancy Dickey MD (1950-) – The first female president of the

American Medical Association and, as president, proposed the patient’s bill of rights. She is an active member of the American and

Texas Academy of Family Physicians.

I would keep listing more women physicians who have notably contributed to the field of medicine if I had more space; however, I wish to end by recognizing and congratulating all our female colleagues, both present and future, who are contributing to healthcare in a very positive manner and on multiple levels. Thank you for continuing to inspire and save lives every day.

Rodolfo (Rudy) Molina, MD, MACR, FACP is a Practicing Rheumatologist and 2021 President of the Bexar County Medical Society.