bonus ep. Women’s Work: a candid conversation about specialty prestige

When you think of careers like being a teacher, firefighter, secretary or engineer, what gender do you envision those people? Many careers are associated with particular genders, and the same goes for medicine. We explore this idea in our first ever live show, where we sit down with two highly specialized female-identifying physicians and have an honest conversation about a recently published academic paper titled ‘When a Specialty Becomes “Women’s Work”: Trends in and Implications of Specialty Gender Segregation in Medicine.’ During this talk, we explore shifts in gender predominance among medical specialities and wage as well as prestige gaps that have followed. We also get some incredible insights from our guests about their personal hardships, past experiences, and advice on mentorship, advocating for yourself regardless of career, and more. This, plus the thoughtful questions from our audience, make this episode unlike any other!

Q & A with Dr. Erin McKean

-How would you suggest holding leaders accountable in healthcare systems, or rather bring to light what they may not see or consider given their power position?

This is tricky, but I suggest being confident, informed, organized, respectful and prepared. It is ok to respectfully state an opinion and share your perspective. We need more of that- civil dialogue, empathy and awareness. It is also good to actively protest and speak out against injustices. I just want to state that at baseline about bringing issues to light. That said, within the healthcare system, it is even more powerful to bring data and have an understanding of the power structure and how the system functions. If you can bring data, along with a compelling story (a key component of effective communication), through the right channels confidently, you are more likely to see action taken on your ideas. Good mentors can help guide you through navigating the system.


-As young female residents/in your early years as attendings, did you ever encounter lack of respect from patients based on your age and gender? If so, how did you navigate that?

I try to approach patients, who tend to be the ones in the vulnerable situation, with understanding and grace. I have become aware of things that trigger me and offend me. Most of the time, I deflect the problem and move on, noting the disrespect says more about the other person than it does about me. A quick, assertive statement is usually enough to redirect. While I try to handle things with grace, I don’t tolerate abuse. With respectful confidence, I have called out inappropriate comments when it crosses my ‘line’. I have also fired a patient before (long story, but this is possible in certain circumstances).   


-Since you have children, do you have any advice for balancing your specialties/work with starting a family?

#1 – Take everyone’s advice with a grain of salt… no one knows your situation and needs like you do.

#2 – Have broad mentorship and get many pieces of advice/wisdom to be able to better apply that to your own situation.

#3 – You can have it all, but you can’t have it all at once. You will have to determine priorities and where you choose to spend your time. This never gets easy!


-You have discussed how prestige has declined for medical specialties that have tipped and are now women dominated. At the same time, we are entering an era in medicine where we are actively working to deconstruct power differentials between patients and providers to facilitate open communication and shared decision making. As women physicians, how do you navigate that complex landscape?

This could be another hour long talk on its own.  I’m running to the OR but I’ll try to send more thoughts later. I could write a book on this!

Listen to the episode, think on these questions, and follow up with us if you want to!

Show Notes:

  • Female physicians and physician researchers have heavier home and family workloads, experience more harassment and assault, and are less likely to move up in the ranks to leadership positions
  • Uneven distribution of female physicians in specialties: 60% of pediatricians → 5% orthopedic surgeons

Gender Segregation in the general U.S. workforce

  • Tipping: once a significant number of women enter a previously male-dominated profession, that profession experiences a rapid sing to female predominance
  • The highest pay gap is among workers with advanced degrees
    • A high-skilled occupation that is 100% female is expected to generate 54% of the average income of a 100% male occupation
  • Even more telling of this gap is that among trans folx after their transitions, the average earnings for trans men increased slightly while those of trans women declined by nearly ⅓

Specialty segregation in Medicine

  • In the 1970s there was a mild decrease in specialty gender segregation but no more integration occurred in the past 40 years
  • Stereotypical beliefs about the skills, attributes and values of men and women subtly shape career “choices”
    • Women are seen often, by themselves and others, as better suited for specialties aligned with female-gendered attributes like being nurturing and valuing relationships
  • As the presence of female physicians in a specialty increase, the salary of the specialty has an overall decrease
    • 64% of the variation in salary of medical specialties was found to be explained by gender
  • The most female-predominant specialty, pediatrics
    • Earned 93% of the average physician salary in 1975 when 22% female
    • Earned only 71% of the average salary in 2017 when 63% female
  • The most male-predominant specialty, orthopedic surgery
    • Earned 160% of the average physician salary in the mid-1980s with 2% female
    • Earned 180% of the average physician salary in 2017 at 5% female

MORE comparisons

  • OB-GYN 
    • Earned 20-25% higher than the average physician salary in mid-70s when 8% female
    • Earned the average physician salary in 2017 when 57% female
  • Urology
    • Earned 123% the average physician salary in the mid-80s when 1% female
    • Continue to earn 125% the average physician salary when 

Sources:

Pelley E, Carnes M. When a Specialty Becomes “Women’s Work”: Trends in and Implications of Specialty Gender Segregation in Medicine. Acad Med. 2020 Oct;95(10):1499-1506. doi: 10.1097/ACM.0000000000003555. PMID: 32590470; PMCID: PMC7541620.

Like the episode? Send us your thoughts and questions!

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