There’s some pretty good evidence out there that women physicians provide really good medical care—in some cases, better than their male counterparts. For instance, a 2017 study showed that hospitalized Medicare patients under the care of a female doctor had lower rates of 30-day mortality and readmission to the hospital than those cared for by a male doctor. A study in Canada in 2016 found that patients of female doctors were more likely to receive routine cancer screening and comprehensive diabetes management than patients of male doctors. Women physicians are also more likely to see patients with complicated psychosocial problems. Other studies suggest that female doctors spend more time with their patients and are more likely to build a partnership with patients than male doctors do.
I think we women want to be that doctor who has a great rapport with our patients. We want to provide comprehensive care. We get it that patients want warmth, kindness, competence, and completeness and that patients don’t want to walk away from a visit feeling that their concerns have not been thoroughly addressed. Many (maybe most) of us are self-critical perfectionists who put our all into every patient encounter, and our patients benefit from that. We can feel good about being great doctors, but sadly, women physicians also pay a high price for doing what’s right.
There is a dark side to our extra efforts:
1. Women in medicine are paid considerably less than men, even controlling for hours worked, academic titles, seniority, and the number of patients seen.
2. Patients expect more empathic care from women and criticize the perceived lack of empathy in women much more harshly than the perceived lack of empathy in men.
3. Women spend more time outside of work hours on documentation than men, likely because they spend more time with each patient.
4. Women doctors get less help from support staff than men do and are perceived poorly when they ask staff for more assistance. Women are also interrupted by staff more frequently during quiet work time than men are.
Really unfair, right? Of course, it is! The higher expectations of women, the increased time spent on documentation, the lower pay, and the lack of clinical and administrative support. It all adds up to a perfect storm of stress and burnout. It’s no wonder that women physicians are struggling with depression, insomnia, and burnout at record rates. So what can we, as women physicians, do about this situation? Should we give less to our patients? Downgrade the care they get? I don’t see that as any solution. We can organize and advocate for women physicians as a group. Join ACP, join AMWA, and get involved. Still, systemic change takes time, and organizing won’t lead to results in time to prevent our personal burnout. But we aren’t without agency. There are steps we can take to help ourselves and our female colleagues. Awareness of the realities of the inequities is a first step for individual women physicians, health care institutions, and the health care system as a whole. We can then begin to examine which of the issues in our particular work lives contribute to negative experiences and feelings, identify one or two areas to focus on, and formulate the best way to advocate for change.
This is where you might be wondering, “How can I pick my battles when there are so many stressors?” And, “even if I could identify a stressor to work on, nobody will listen to me! They’ll say I’m a complainer, or they’ll ignore my asks.”
I’ve come up against those same questions. I think now that I would have had a much easier time advocating for my own needs in medical practice if I’d had a coach the last time I struggled in my work environment. A coach who could help with self-awareness in the areas of personal and professional values, priorities, and communication. And more specifically, a coach who knew the health care system and the medical culture. Someone who had been in my shoes.
In training to be a physician coach, I am learning how women physicians can sort out their stressors and find answers that work. We can’t change everything that makes life as a female doctor particularly challenging. But we can begin to chip away at the stressors when we see them clearly and develop strategies that others can buy into. I also see the value of simply talking about the stress with someone who understands and doesn’t judge. We all need that connection, but it’s sometimes hard to talk to friends and colleagues about work stresses. We fear being misunderstood, for one thing. And talking to another stressed physician can sometimes exacerbate our own stress.
Women physicians are strong, smart, and resourceful. A lot of the answers are already there, hidden inside. Sometimes we need someone to help us pull them out. That’s what a coach can do.
Rosalind Kaplan is an internal medicine physician who blogs at her self-titled site, Dr. Rosalind Kaplan.
