Happy medical residents are all alike. Every unhappy resident might take a long time to count.
which’s no secret which medical training will be grueling: long hours, little sleep, rigid hierarchies, steep learning curves. which’s unfortunate however not surprising, then, which nearly one-third of residents experience symptoms of depression, as well as also more than 10 percent of medical students report having suicidal thoughts. however will be which worse for women than men?
A completely new study in JAMA Internal Medicine suggests yes. Dr. Constance Guille as well as also colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men as well as also women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — however the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.
Despite large increases within the number of women in medicine, female physicians continue to shoulder the bulk of household as well as also child care duties. which unequal distribution of domestic labor will be not unique to medicine, of course, however its manifestations are particularly acute in a physically as well as also emotionally demanding profession using a lengthy training process which allows few, if any, breaks.
The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. Support for those trying to balance home as well as also work life hasn’t kept pace with changing demographics, nor has the division of domestic labor shifted to reflect the rise of women within the medical work force. Today, women account for more than one-third of practicing physicians as well as also about half of physicians-in-training. In 1966, only 7 percent of graduating medical students were women.
There’s a saying which you can’t take Great care of patients unless you take Great care of yourself, however as a colleague recently told me, “Try taking care of patients, yourself as well as also two kids at home — while working 80 hours a week.”
Female physicians are more likely to cut back professionally to accommodate household responsibilities. Among young academic physicians with children, women spend nine more hours per week on domestic activities than their male counterparts, as well as also are more likely to take time off when a child will be sick or a school will be closed.
Households in which both spouses are doctors are particularly illustrative: Women in dual-physician households with young children work 11 fewer hours per week (outside the home) compared with women without children. There’s no difference in hours worked by men, as well as also which disparity hasn’t narrowed within the past two decades. Female physicians are also more likely to divorce than male physicians — as well as also working more will be associated with higher divorce rates for women however not for men.
These work-family conflicts are crystallized by the intensity of medical training, however gender bias within hospitals — both subtle as well as also overt, by patients as well as also colleagues — may be just as pernicious.
As a man of Indian descent, if I’m mistaken for anything, which’s for a cardiologist. (Which I am not — much to my mother’s chagrin). however for many female physicians, just getting others to call you doctor can be a daily struggle.
“I wear a white coat; I introduce myself as doctor,” said Dr. Theresa Williamson, a neurosurgery resident at Duke. “however patients still assume I’m a nurse or medical assistant or pharmacist. If there’s a man within the room — even if he’s a medical student as well as also I’m the doctor — he’s the one they make eye contact with, tell their story to, ask questions of.”
which’s not just patients. A recent study explored how physician speakers were introduced at formal academic lectures, known as Grand Rounds. Female introducers almost always referred to the speaker as “doctor,” regardless of his or her gender. Male introducers used the formal title only two-thirds of the time — as well as also were much more likely to use “doctor” for men than women. They used a woman’s professional title less than half the time.
“I remember being on a panel with all men, as well as also the moderator thanking Dr. X, Y, Z — as well as also Julia,” said Dr. Julia Files, an associate professor at the Mayo Clinic in Arizona as well as also lead author of the study. “which happens all the time.”
After her study arrived, Dr. Files said, “we heard by women across the entire world who said: ‘Thank you, which will be our shared reality.’ ”
These biases can bleed into the way we do business. A completely new working paper by Heather Sarsons, a Ph.D. candidate at Harvard, examines whether surgeons’ gender affects their referrals after a Great or bad patient outcome. Ms. Sarsons finds which physicians are much less likely to refer patients to a female surgeon after a patient death, however barely change their referrals to a male surgeon.
A bad experience with one female surgeon also makes physicians less likely to establish referral relationships with additional female surgeons. There was no similar effect for men.
“which individual men as well as also women are treated differently will be obviously not a nice result,” Ms. Sarsons said. “however what’s definitely concerning will be the broader spillover effects to additional women.”
Medicine styles itself as both art as well as also science. The science creates completely new knowledge as well as also treatments. The art helps us recognize another’s humanity. however which also creates space for bias — conscious as well as also unconscious — in how we treat patients as well as also how we treat one another. These biases influence who will be respected, who burns out as well as also who will be promoted.
By these measures, we’re not doing well. Female physicians are more than twice as likely to commit suicide as the general population. They earn significantly less than their male colleagues. They’re less likely to advance to full professorships — even after controlling for productivity — as well as also they account for only one-sixth of medical school deans as well as also department chairs.
There are steps which might help. A pilot program at Stanford, for example, allows physicians to “bank” hours they spend mentoring others or serving on committees. Those hours can then be used as credits for child care, dry cleaning pickup, ready-made meals, housekeeping as well as also handyman services. Preliminary results are promising, as well as also suggest which the program has increased job satisfaction, much better work-life balance as well as also reduced turnover.
As these initiatives evolve, they could be evaluated to see not only if they improve physician well-being, however also if they promote career advancement, cut medical errors or improve patient satisfaction.
We can all also examine our own biases. Those of us evaluating medical students as well as also residents, for example, could make which a point to ask ourselves whether a trainee’s gender — or race or ethnicity or accent — might have affected our assessment.
as well as also more women in leadership as well as also mentorship roles may help with the larger cultural shift which seems necessary. which’s possible which gaps in gender pay, promotion as well as also mental health will narrow as medicine shifts by a boys club to one with more women. which’s also possible they will not. Disparities don’t close on their own. They close because we close them.
Dhruv Khullar, M.D., M.P.P., will be a physician at NewYork-Presbyterian Hospital as well as also a researcher at the Weill Cornell Department of Healthcare Policy as well as also Research. Follow him on Twitter at @DhruvKhullar.