GENDER BIAS IN THE MEDICAL SYSTEM

Michaela Page

Women have not always been treated equally, but great strides have been made throughout society in order to close the gap between men and women. Although many improvements have been made, there are still aspects of society that are affected by gender bias against women. In “6 Dismal Findings

From U.N Report on Gender Bias” Kim Elsesser writes of a study conducted by the United Nations Development Program. This study showed that an alarming number of men and women both have felt a biased attitude when it comes to women and their abilities. These numbers are 90% of men and 84% of women. Women start to notice the bias from childhood, and it follows them through school, their careers, and even through their own health care. An especially important part of our society that is majorly affected by bias against women is the medical system. The inequality between men and women affects several aspects of the medical system including medical school, women’s medical careers, and even affecting their own healthcare.

It is undeniable that women’s experience in society has improved some throughout history. It is well known that women were given the right to vote with the introduction of the nineteenth amendment in 1920, as well as given more rights to make decisions about their own lives in the next several decades. In “Women are better off Today, but Still Far from Being Equal with Men,” Nikki Van der Gaag explains how in the past few decades, increased numbers of women have begun to be employed outside the home. Van der Gaag states that in 2011, for the first time in the history of the United States, women made up a little over half the workforce. There are more women in positions of power throughout the workforce as well. Rosie Benson in “How Being a Woman has changed in 100 Years” gives an especially important example of societal improvement as well. Benson states that only just as recently as 1961 did women receive access to birth control. Prior to this, women everywhere were denied access to birth control, and many suffered because of it. The legalization of birth control was definitely a huge step forward for women’s medical rights.

Regardless of these many improvements, many women still start to notice gender bias in early childhood, which can impact their confidence as they are developing. This can affect their personality whether it is consciously or subconsciously. Adolescent boys are often encouraged to be messy, creative, and speak their minds while their female counterparts are taught to be quiet and ladylike. In “How Puberty Kills Girls’ Confidence” by Claire Shipman et al. a poll was performed showing the alarming percentage of young girls who do not feel confident. This poll surveyed over 1300 girls who were asked to rate their confidence on a 1-10 scale. Claire Shipman et al. state that, on average, these young girls only rated themselves a 6, and the average drops as the age of these young girls increases. Some of these young girls grow up and want to become medical professionals. In “How Gender Stereotypes Kill a Woman’s Self-Confidence,” Dina Gerdeman interviewed Katherine B. Coffman, an assistant professor from Harvard Business School. Gerdeman writes how Coffman believes that women’s lack of confidence causes them to undermine their own abilities and can also cause them to question their place in any male-dominated career. Dina Gerdeman quotes Coffman, “If talented women in STEM aren’t confident, they might not even look at those fields in the first place. It is all about how good we think we are, especially when we ask ourselves, ‘What does it make sense for me to pursue?” It is crucial to society that intelligent women have the confidence to express their ideas. In “The Confidence Gap”, written by Katty Kay and Claire Shipman, they explain how a lack of self-assurance can influence any woman in a male-driven career. They interviewed women from all levels of society, from athletes to CEOs, and the feelings were unanimous. These professionals shared that they felt they had to work ten times harder than their male coworkers in order to be successful in their field. These are prime examples of intelligent girls growing up to pursue their dreams only to let what has been ingrained in their heads get in their way.

The lack of confidence that young girls may possess directly translates to the medical system in the minds of female medical students. In the article “Female Medical Students Underestimate their Abilities and Males Tend to Overestimate Theirs,” the Indiana University discussed a study that was done by Patient Education and Counseling. According to Dr. Richard Frankel, the study’s senior author and a professor at Indiana University, third-year medical students were observed interacting with patients as well as being given non-verbal sensitivity tests. Frankel states that the female students’ superiors, as well as their patients, noticed women medical professionals have a tendency to be less sure of the medical advice they are giving. Indiana University quotes Doctor Richard Frankel, “Our finding of decreased confidence among female medical students is important because it makes it very clear that somewhere in the training of future physicians the issue of confidence needs to be addressed.” The findings in this study demonstrate how a lack of confidence can have a detrimental impact on women entering the medical field. This, in turn, makes the already stressful process of going through medical school even more so.

For medical students, there are many aspects of their education that induce stress. Female medical students experience more stress because of the gender bias that is inflicted upon them. Caitlin Bowen et al. released an article for BMC Medical Education discussing the difference in application rates of men versus women in medical scientist research programs. These studies show that although men and women often have the same qualifications, women apply for the medical scientist research programs in smaller numbers, even though they are accepted at the same rates. According to the aforementioned article, the program type that the female medical students apply to is also dictated by gender bias. The AMA Journal of Ethics quotes an article written by Kevin McMullen et al. “Nearly equal numbers of men and women graduated from U.S. medical schools in 2011 overall, but three-quarters of applicants to radiology residencies were male and four-fifths of applicants to ob./gyn programs were female.” It is fair to assume a number of these women were influenced by societal norms to choose the more feminine specialties. Lauren Barnes et al write about a survey done by the University of New Mexico Hospital of their female surgical trainees in the article “Gender Bias Experiences of Female Surgical Trainees.” Two focus groups, both containing fifteen female surgical trainees a piece, indicated through the survey that one hundred percent of them had experienced gender bias and/or discrimination while receiving their education and surgical training. When asked about their future in the medical field, many of these women confided that they have considered leaving medicine altogether because of the obvious divide in the way each gender is treated. This just goes to show that gender bias, whether it is conscious or not, impacts women in their education.

Another instance of gender bias in medical school is the harassment and mistreatment women experience during their time in college. Bethany Ao in “Medical School Can Be Emotionally and Physically Dangerous for Women and Minorities, Study Finds,” quotes the American Medical College Graduate Questionnaire, which shows that forty-one percent of female medical students have experienced some kind of mistreatment at least once versus twenty-five percent of their male peers. This mistreatment could mean anything from just being treated differently because of their gender to even sexual harassment. Sexual harassment specifically has been a long-standing issue within the medical education community. Amy Paturel in “Sexual Harassment in Medicine” writes that, according to the National Academies of Science, Engineering, and Medicine (NASEM), sexual harassment in medical education is almost double the amount than that of other science and engineering fields. Paturel quotes NASEM, “The cumulative effect of sexual harassment is a significant and costly loss of talent in academic science, engineering, and medicine, which has consequences for advancing the nation’s economic and social well-being and its overall public health.” This information tells of the negative impact this unfortunate part of many women’s education experiences can have on them personally, but also on our society.

An entirely new wave of gender bias occurs if and when these women can ignore the bias along the way and become doctors. This comes from the massive pay gap between women and male coworkers in the same field.

Anna Weiss et al. in “Assessing the Domino Effect Female Physician Industry Payments Fall Short, Parallel Gender Inequalities in Medicine,” discuss a study done for the American Journal of Surgery showing this pay gap. Data was received from the Open Payments Program Database, which was then matched with the National Provider Index. This data helped determine the gender of physicians being studied. Of the 136,845 physicians, 31,297 of those were surgeons. Male surgeons have an average payment of $131,252.00 compared to the $62,101.00 average for their female counterparts. The American Journal of Surgery also stated that there is a decreased likelihood of female physicians receiving payment for consulting, speaking, royalty, and ownership. Logically, there is only one explanation: extreme gender bias is still prevalent in the medical system today.

Although the pay gap is an important topic that highlights the gender gap in the medical system, the negative effects go deeper than just income. An interview with Megan Reynolds explains another side of the gender bias that women medical professionals experience. Megan Reynolds, who is a CT technician at Sweetwater County Memorial Hospital, was interviewed. Reynolds explained that as a medical professional she experiences gender bias often in her career from patients and superiors alike. A seemingly small instance of gender bias Megan has experienced is patients automatically assuming that she is a nurse, without ever asking for her qualifications. Although there is nothing wrong with pursuing a nursing career, this just further explains how society has a challenging time seeing women as anything but what they consider feminine. Megan also stated that patients had actually refused care from her because of her gender and requested a male CT technician. Reynolds was quoted stating, “I have several stories I could tell. I have even seen the effect it has had on my co-workers and the people around me. It’s made it really difficult at times to stay focused on the work that needs to be done when the patients don’t have faith that you know what you’re doing.” This is just one of many real-life examples of how the treatment of women medical professionals differs from that of their male colleagues.

The gender bias does not only come from being a professional in the medical field, but it is also glaringly obvious as a female patient. Duke Health quotes Emily Paulsen,

A survey conducted in early 2019 by TODAY found that more than one-half of women, compared with one-third of men, believe gender discrimination in patient care is a serious problem. One in five women says they have felt that a health care provider has ignored or dismissed their symptoms, and 17% say they feel they have been treated differently because of their gender—compared with 14% and 6% of men, respectively.

Fatalities and other health risks increase because of the bias within the medical system.

There is a difference, biologically, between men and women, and this difference affects many aspects of medical care, including symptoms and treatment. Although this is true, it is not always taken into account when treatment is being provided. Kelly Burrowes, a researcher at the University of Auckland, provided an example of this. She states that women are more likely to develop autoimmune disorders, chronic pain conditions, arthritis, Alzheimer’s, and chronic fatigue syndrome. Burrowes states that because women tend to not show “normal” symptoms of a heart attack, they often receive a late diagnosis, which can cause their heart attacks to be more fatal. The majority of heart attack research was done on male subjects by male researchers.

In the article in New Scientist magazine titled “End Medical Gender Bias” by Caroline Criado Perez, a study shows specifics of how male and female heart attacks differ. The original study was conducted on male mice and showed that a heart attack that occurs during the day was less likely to be fatal, but the revised study done on female mice showed the exact opposite results. Since heart disease is one of the top causes of death in women, more can be done by the medical community in order to lessen unnecessary deaths.

This inequality does not only occur in heart attack research, but the majority of medical research also included male subjects with the idea that the results would be the same for women. Kelly Burrowes states,

In 1977 the US Food and Drug Administration (FDA) recommended women of childbearing age be excluded from clinical research studies. This was to protect the most “vulnerable” populations unborn children.... Another reason given for excluding women in clinical studies is that, depending on where a woman is in her menstrual cycle, the variation of her hormones “complicates” the results.

The lack of focus on female-specific medical research has had detrimental effects on women’s health care.

Aside from there being a lack of medical research on women and their bodies, there also seems to be a disconnect between female patients and their doctors. A book that was written by Caroline Criado Perez called Invisible Women: Data bias in a world designed for Men outlines a specific instance of a woman’s health concerns being ignored. “Part IV: Going to The Doctor” of this book tells the story of a woman named Michelle. Michelle struggled for years with stomach pain and was consistently told nothing was physically wrong with her and that the pain was all in her head. After decades and several doctors, she was finally able to receive her diagnosis of ulcerative colitis and irritable bowel syndrome. In her book, Caroline Criado Perez states,

It’s hard to read an account like this and not feel angry with the doctors who let Michelle down so badly. But the truth is that these are not isolated rogue doctors, bad apples who should be struck off. They are the products of a medical system which, from root to tip, is systematically discriminating against women, leaving them chronically misunderstood, mistreated, and misdiagnosed.

This is one of many stories of a woman’s symptoms being ignored and dismissed. There are stories similar to Michelle’s all over the world that just go to show how the gender bias against women can have a severely negative impact on their lives.

The medical system today still needs work, regardless of the other societal improvements. The solution begins with increasing the confidence of young women. By acknowledging the faults within the medical system and working to improve them, society will benefit in many ways. Creating a safe and healthy environment for the women within the medical system is a key piece in closing the gender gap. Increased research, representation, and a better understanding of women’s health will help improve the medical system as a whole.

Works Cited

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Barnes, Lauren, et al. “Gender Bias Experiences of Female Surgical Trainees.” Journal of Surgical Education, 2019, https://www.sciencedirect.com/ science/article/abs/pii/S1931720419303058.

Benson, Rosie. “How Being a Woman Has Changed Over 100 Years.” Marie Claire, 3 Aug. 2017, https://www marieclaire.co.uk/life/woman-changed-100-years-480273.

Bowen, Caitlin, et al. “Medical School Research Ranking Is Associated with Gender Inequality in MSTP Application Rates.” BMC Medical Education, 2018, https://bmcmededuc. biomedcentral.com/articles/10.1186/s12909-018-1306-z.

Burrowes, Kelly. “Gender Bias in Medicine and Medical Research Is Still Putting Women’s Health at Risk.” The Conversation, 2021, https://theconversation.com/gender-bias-in-medicine-andmedical-research-is-still-putting-womens-health-at-risk-156495.

Criado-Perez, Caroline. “End Medical Gender Bias.” New Scientist , vol. 242, no. 3234, 15 June 2019.

Criado-Perez, Caroline. “Part IV: Going to the Doctor.” INVISIBLE WOMEN: Data Bias in a World Designed for Men, Abrams Press, New York, NY, 2019.

Elsseser, Kim. “6 Dismal Findings From U.N Report on Gender Bias.” Forbes, 2020, https://www.forbes.com/ sites/kimelsesser/2020/03/09/6-dismal-findings-fromun-report-on-gender-bias/?sh=3cee6de35d1c.

Gerdeman, Dina. “How Gender Stereotypes Kill a Woman’s Self-Confidence.” Working Knowledge, 2019, https://hbswk.hbs edu/item/how-gender-stereotypes-less-than-br-greater-thankill-a-woman-s-less-than-br-greater-than-self-confidence.

Kay, Katty, and Claire Shipman. “The Confidence Gap.” The Atlantic, 2014, https://www.theatlantic.com/magazine/ archive/2014/05/the-confidence-gap/359815/.

McMullin, Kevin, et al. “Expectation of Gender in Medical Education .” AMA Journal of Ethics, 2012, https://journalofethics.ama-assn.org/article/ expectations-gender-medical-education/2012-12.

Paturel, Amy. “Sexual Harassment in Medicine.” AAMC, 2019, https://www.aamc.org/newsinsights/sexual-harassment-medicine.

Paulsen, Emily. “Recognizing, Addressing Unintended Gender Bias in Patient Care.” Duke Health, 2020, https://physicians.dukehealth.org/articles/recognizingaddressing-unintended-gender-bias-patient-care.

Reynolds, Megan. Personal Interview. March 2022. Shipman, Claire, et al. “How Puberty Kills Girls Confidence.” The Atlantic, 2018, https://www.theatlantic.com/family/ archive/2018/09/puberty-girls-confidence/563804/.

University, Indiana. “Female Medical Students Underestimate Their Abilities and Males Tend to Overestimate Theirs.” Science Daily , 2008, https://www sciencedaily.com/releases/2008/10/081003122713 htm#:~:text=A%20literature%20survey%20by%20 the,males%20tend%20to%20overestimate%20theirs.

Weiss, Anna, et al. “Assessing the Domino Effect: Female Physician Industry Payments Fall Short, Parallel Gender Inequalities in Medicine .” The American Journal of Surgery, 2018, https://www-sciencedirect-com.ezproxy.scottsdalecc edu/science/article/pii/S0002961018300230?via%3Dihub.