A few months into medical school, my student adviser asked me how I was handling the gender gap in medicine. At the time, I hadn’t yet experienced what he meant: Over half of my new colleagues were women, and my experience of medicine was still limited to the lecture hall, where our clinician teachers were largely evenly distributed by gender.
Since then, I’ve come to see that a gender gap permeates almost all aspects of my experience as a female medical trainee. It’s reflected in the way that a patient refers to me—a resident doctor—as a “girl,” and to my male medical student colleague as “doctor.” It’s there when a colleague and I are discussing career paths, and my colleague tells me I’m more suitable for obstetrics than emergency medicine because of my “softer” nature. And I feel it when a male patient, without speaking directly to me, tells my supervising physician while I’m in the room that he should “get together” with me, because I’m “cute.”
These incidences have occurred while I’m still early in training, yet evidence suggests that gender-based disparities will also influence my career in the future. Gaps in access to leadership positions, pay, and even respect in the workplace are borne out in the literature: Women comprise only 16 percent of medical school deans and 15 percent of medical school department chairs; we are remunerated less than our male counterparts even while working in the same field; and we are more likely to have our credentials questioned and to experience sexual harassment by our patients, colleagues and supervisors.
Taken together, these numbers highlight the significant structural disadvantage women face in the workplace, with a particular spotlight of late on sexual impropriety. The #MeToo movement has served as a platform through which women have felt empowered to come forward with their experiences of sexual harassment and abuse, often by male colleagues or superiors. In medicine, this has meant an increasing recognition of the prevalence of misconduct toward women at all stages of training.
Yet #MeToo has also engendered a backlash in which men are increasingly reticent to mentor women, which, as a group of female clinician leaders recently detailed in NEJM, can have significant detrimental impacts on female physicians’ career advancement.
Medicine is a unique model of teaching and learning. As trainees, we rotate through different medical specialties, often working one-on-one with a physician preceptor whose practice style and insight significantly inform our vision of what a career in the field could look like. Consequently, our relationship with a single physician can directly influence our career choices. Common stories exchanged among my peers and colleagues are ones about specific preceptors whose teaching, research or practice have served as scaffolds on which we hope to model our careers.
And, since men occupy the majority of leadership positions in medicine, their willingness to mentor women as readily as men is pivotal in shaping female physicians’ careers, and ultimately in bridging medicine’s gender disparity.
The fear expressed about false allegations is not supported by the statistics. In fact, there is significant evidence that false accusations are the rare exception: The research shows that between two and eight percent of allegations are false reports, and this number is felt to be inflated given the spectrum of reasons why reports are ultimately dismissed.
Most recently, the number of assaults reported in Canada increased by 13 percent in 2017, perhaps demonstrating that more women who have experienced sexual assault are coming forward in the wake of #MeToo, while the rate of “unfounded” cases decreased by half, in part because allegations are now less likely to be dismissed by the authorities.
However, responding to the emerging empowerment of women by declining to mentor them threatens these gains, and suggests that women’s perceptions of men’s behaviours and intentions are hazardously unreliable.
Psychologists suggest that this reaction may be rooted in a biological aversion to a perceived threat: Despite its improbability, the fear of a false allegation is so compelling that we react disproportionately. It has also been suggested that there is a deep-seated concern over the “feminization” of medicine; the number of women enrolling in medical school has recently started to outpace that of men, and there have been suggestions—which have been disproven—that women won’t work as hard in medicine or take up as many leadership or administrative responsibilities as men.
We must recognize that the unfounded fear of false allegations perpetuates structural sexism, and proactively seek strategies for its redress. Male mentors may be more comfortable inviting male trainees to social outings, but favouring men for social meetings can also lead to favouring them for leadership or training opportunities, even if unintentionally. Instead, the mentor could invite multiple mentees to social outings, offer different environments in which to meet one-on-one, or provide opportunities for female mentees to indicate their preference for individual or group meetings as well as the settings where they will occur.
As well, formal mentorship programs exist within many institutions and facilitate universal access to mentorship with explicit expectations of what the relationship will involve. In my medical school, this took the form of randomly assigning one or two incoming medical students to senior physician mentors, with no consideration given to culture or gender. I met with my mentor every few months to review my progress and goals in the program and although we ultimately didn’t share the same clinical interest, my assigned mentor had extraordinarily valuable lessons to impart with respect to the trials of medical school, how he settled on his chosen specialty and, indeed, it was he who opened that first discussion with me on the gender gap in medicine.
And so, perhaps most importantly, mentors could also seek to have explicit conversations with their colleagues, departments, or mentees about the #MeToo movement and the importance of creating a shared understanding of mutual boundaries and expectations to ensure each party feels comfortable and secure throughout the mentorship.
As a resident physician, I stand at the beginning of my medical career. Even so, I attribute many important decisions made and milestones achieved to the support of numerous male mentors, each of whom has demonstrated the type of leadership and support I hope to emulate in future with my own mentees.
There are professional, respectful and nurturing ways in which to foster mentoring relationships in medicine. We need to use these strategies to develop a medical culture in which women are not disadvantaged by their gender.