Female physicians and the fiberglass ceiling

A male physician — one who sits on multiple committees at a large hospital in Dallas — was recently quoted in the Dallas Medical Journal, that female physicians earn less, and they “choose to or they simply don’t want to be rushed.” Adding, “most of the time, their priority is something else … family, social, whatever.”

I should be astounded that a colleague, in 2018, who appears to be about my age, would think so concretely, let alone state it publicly as though he’s commenting on a breed of dogs ( “… the female Yorkies tend to shy away from true terrier traits, they are not as hard-working”).

Why am I not shocked? Well, because he stating what every female physician already knows. Medicine doesn’t have a glass ceiling. It has a fiberglass one. You will break your neck trying to shatter it. So, we go around it, through any crevice we can find, and try not to get noticed on the way.

As a female physician, I have made it this far mostly by downplaying any aspect of being a woman. I wore bigger and bigger scrubs as a third-year medical student, hoping to keep my pregnancy a non-topic while on rotations. (Once the cat was out of the bag, I’d typically hear the ubiquitous, “Wow. How’s that going to work?” which nobody asked my husband, also a medical student.) I returned two weeks post a C-section. (There is no FMLA in medical school and even if there was, extending your education even by a month raises a red flag on your residency applications where everyone will now know you have a baby — a little live ticking time bomb that will at some point suck you away from your 80-hour a week duties. Best if that is not mentioned anywhere on your applications. So, two weeks it is.)

I chuckle when I’m asked if I breastfed my kids. “You mean, like did I pump on my CCU rotation postpartum?” Um. No. I never mentioned I had just given birth to the all-male team, let alone ask if I could take breaks from the cath lab to pump. I’ll never forget what my attending said on the last day on my rotation: “You are an excellent medical student. You worked hard, you kept up, and you never complained. It is as though you didn’t even just give birth. No different. You will make excellent physician. I am happy to write you a letter of reference.”

I was honored by this of course; I passed as one of the male team members. See? We’re no different. But now, twelve years later, I cringe when I recall that exchange. What was lost in between his assessment and my performance was exactly equal to the twenty-five percent less female physicians earn for every dollar their male counterpart earns.

The gap is accounted for by what we female physicians do to squeeze in motherhood. We are twice as likely to work a non-traditional schedule (i.e., a condensed schedule like 3 ten-hour days or “part-time” at 32 hours). Except those are merely the hours we are on site and most likely engaged in face to face time with patients. We know from studies that for every hour of face to face patient care, a physician spends two hours on EMR (electronic medical record). While our male counterparts are more likely to work a traditional 40 hr schedule and still have difficulty squeezing what they can into those hours, we chart on what is known as “pajama time,” after the kids are asleep, and without pay for those hours.

For two years, I worked a “condensed” schedule at 32 hours a week, but realized that my patient load was not quite 20 percent less than those working 40 hours. Not even close. I did not complain. I was not going to draw attention to being “different.” (See. We’re just like the guys.) I felt grateful for the opportunity to even be able to work such a schedule although I knew I was ultimately performing 40 hours of work at 80 percent pay.

Perhaps the biggest loss isn’t even the 25 percent pay gap. It is something that is priceless. Leadership opportunities. A condensed schedule almost always disqualifies you from any physician leadership position, even if in reality you are working about 80 hours a week, multi-tasking multiple children’s schedules with a demanding job. I hardly believe that we’re not as qualified as those staying on site 8 hours longer a week.

And sadly, without female physicians at the big boy table, this inequity will continue to replay, one female physician at a time, like a sped-up YouTube video. I don’t think it is by coincidence that the main physician Facebook groups, which seem to be mobilizing and empowering physicians in new ways, were started by female physicians. Unable to the penetrate fiberglass ceiling, we seem to have found a way around it toward leadership.

I wonder what I would say today to that attending from medical school today?

“Thank you. It was difficult to leave my baby so soon, and he is asleep when I leave and get home. So I bond with him by staying up with him at night. So, I guess I’m actually different than the others on the team. I have two jobs. One, however is invisible.”

Torie Sepah is a board-certified psychiatrist specializing in interventional psychiatry. She is the founder and medical director of Pasadena Neuropsychiatry & TMS Center, a multidisciplinary clinic that provides novel, evidence-based treatments—including TMS, esketamine (Spravato), and medication-assisted treatment (MAT)—for individuals with treatment-resistant depression, OCD, schizophrenia, dementia, and for those in the peripartum and perimenopausal stages.