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Show Me the Data: Gender Equity in Medicine

Watch an Interview with Julia Files, MD from Mayo Clinic that discusses the disparity and discredit women experience in medicine and how that is being changed and how it can continue to change.
Julia Files, MD
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Julia Files, MD, associate professor of medicine, past chair of the women's health clinic within the general internal medicine division, as well as the past associate chair of staff development in the Department of General Internal Medicine. 

ABOUT JULIA FILES, MD

I am an internist, but my area of focus interest in research is in women's health. And it transcends not just health, but women's issues. So, I have been very involved in my career in mentoring younger women and lifting up women across different specialties who encounter challenges. 

And that's where I see my focus leading as I come to the end of my career, which is getting longer and longer has my daughter because my daughter just got into medical school, so I'll be working a lot longer. 

WHAT DOES GRIT MEAN TO YOU?

JULIA FILES, MD: Well, I've been thinking about that. And I have to tell you what GRIT meant to me – when I first arrived yesterday, there was an overwhelming feeling of emotion when I walked into the room. I feel like there is a seismic shift in medicine, and we are at the brink of seeing equity happening for women. And so, I am I'm very emotional about it. I think that's that's how I would describe it. I'm thrilled and emotional about being a part of this. 

INTERVIEWERS: Well, we may share that sentiment to you. And thank you for mentoring in sponsoring and in what you've done and helping others. Right now, at this point, it’s because of leaders, role models, and mentors like you that we’re in this shift. Can you touch upon you talked about this kind of first shift and then now the second in terms of gender equity or a push towards it? 

HOW FAR WE HAVE COME AND HOW FAR WE STILL NEED TO GO

JULIA FILES, MD: Sure. Well, you know, women have come a long way since the very first woman physician, Elizabeth Blackwell, who we can never forget. And what we first encountered was overt discrimination. We were just overtly discriminated against, told we shouldn't be in the profession, told we shouldn't be doing the jobs that we were doing. And it's taken a very long time, over 100 years. 

And now we don't experience that type of overt discrimination, but we are still finding that there are areas of second generation bias, which you could also call covert discrimination – things that happen to you that you can't quite put your finger on. It makes you uncomfortable, and it's holding you back from the goals that you have articulated. 

And we have a lot of work to do because things are now packaged in small packages, microaggressions. They're very hard to address. But by using this forum to give voice to it, to describe it, and to help other women understand what's happening, we can start addressing these things. 

WOMEN ARE RECOGNIZED DIFFERENTLY IN MEDICAL PUBLICATIONS AND CONFERENCES THAN MEN

INTERVIEWERS: In one of those things that specifically you talked about today, and you've published on, is how we address speakers. My first name or by using the professional title. Can you tell us about the story when you went to publish the paper? 

JULIA FILES, MD: I'm happy to do that. So, many of us have experienced things, but we don't take the time to prove that it's happened. And this was one of those crazy instances where everything came together. 

I was speaking at a meeting, and I was the only female faculty. And at the end of the meeting, the moderator stood up and said, “Please join me in thanking our presenters for a wonderful afternoon. I'd like to thank doctors X, Y, Z and Julia for a wonderful presentation.” That was the Sentinel event that caused us to think about this differently.

A STUDY IN GENDER BIAS AND PHYSICIAN RECOGNITION

And so, we constructed a study where we studied speaker introductions at internal medicine, grand rounds in Rochester, in Arizona, on the Mayo campuses. And we chose that because Internal Medicine Grand Rounds is a formal conference that is given by physicians and is for physicians. And so it should be a place of respect and use of professional title. 

And what we discovered is that when women do introductions, greater than 95 percent of the time, they use professional titles. It's gender neutral, but when men introduce, they're less formal. About 72 percent of the time, they'll address their male colleagues as doctor because there's an in-group dynamic there, where they know each other and it's not as important and it's kind of a club. 

But when men introduce women, the woman can expect to be called doctor less than 50 percent of the time – about 49 percent of the time. And that is a statistically significant difference. And we were very excited about that finding. So, when we went to published the paper, we got some pushback on publishing it. 

THEIR STUDY IN THE DISPARITY OF RECOGNIZATION FOR GENDER WAS REJECTED MULTIPLE TIMES

We went to a journal that we thought would accepted because it was a Mayo Clinic finding, and we were rejected. We were rejected at another journal. And then the Journal of Women's Health took a risk and published our paper. And it became one of the most popular papers that they had ever published. Because it touched a chord. Women have been experiencing this. And it gave voice to it. Now, what's most gratifying to me is that there have been two studies since at least that have reproduced our readers our results in other settings at national meetings. And so, it certainly is a thing.

INTERVIEWERS: You really prove that in that with more than 90 percent of our audience in the room, when you pose that question and a roll call, if it had happened and we had greater than 90 percent of our audience standing. So, it is a thing.

JULIA FILES, MD: It is a thing. And what was so interesting is our article published online first before it hit the paper version of the Journal on a Friday. And that Monday, I was contacted by a reporter from the TIME of London. And it just spiraled from there. 

We we heard from NPR, we heard from TIME magazine. We heard from The New York Times. And what was really gratifying about the whole thing is the American College of Physicians referenced our paper in a position statement on women in medicine, and career and gender equity. And so, it was very powerful, very unexpected because this study was unfunded. Everyone was a volunteer. In fact, I made my daughter participate because I needed a worker at MIT. 

INTERVIEWERS: I actually recruited one of our fellows to participate in the study because she did data. So, I feel like a part of the study that indirectly. 

This is incredibly important work. And I loved how you use the Sentinel event. It truly was what triggered and catalyzed your passion and do a scholarly project to prove you also shared data around choices women make within medicine for special election. And we loved how you correlated that to, I wouldn't say inequity, but pay differences by specialty. Could you speak about it?

WOMEN IN MEDICINE AND HOW THEY STRUCTURE THEIR LIVES

JULIA FILES, MD: Sure. I was surprised. You know, every time you put a presentation together, you learn things and. And so it's interesting. Women have historically been attracted to specialties that are more in primary care. But what was interesting is when you look at the choices that women are making, they tend to be in specialties that don't have the same remuneration. They're the lower level incomes compared to male colleagues. And men tend to populate specialties that have higher payback. 

For example, neurosurgery, thoracic surgery, orthopedic surgery, those are historically inconsistently, currently, predominantly male. 

INTERVIEWERS: Recently, there was an article, and I think it was in the Wall Street Journal, that talked about how medicine is becoming a better fit or more accommodating for women. And within that, it spoke about how women intentionally choose the specialties that can offer more flexibility. 

And there was commentary, and this has kind of been in the Twitter-sphere on women disagreeing, first of all, and saying that, “No, women are choosing that, or they choose to work part time or less, get paid less.” But it's about the system, and and how can we get women in the system and these specialties to drive women towards some of those? 

I think it was an interesting article because the way it presented how medicine is family-friendly, and it's friendly for women because they can work part-time. It almost was. I think there were there's a lot of dimensions to how one can look around this, but there was disagreement, clearly. So, I'm interested on your kind of thoughts on how can we continue to encourage women in one to follow their passion. But if surgery or a surgical subspecialty or something is their passion, how can we address the imbalance? 

WHY THERE IS GENDER AND RACE DISPARITY IN MEDICINE – SIMILARITIES OUTWEIGH DIVERSITY IN THE HOSPITAL

JULIA FILES, MD: Such a timely question. I just came back from lunch, and I was meeting with a group of women. We're working on a program for medical students through the American Medical Women's Association to talk about topics that are not traditionally covered in a medical curriculum, and one of the women at lunch suggested that a topic that we address is a career in a traditionally male dominated specialty. 

What we need is to expose women to other women who are in the specialty. They are the pioneers who have, so to speak, plowed the road. And we need to let younger women students know the good, the bad, and the ugly about each of these specialties. Because, if that is their passion, they should be able to do it. 

But many of these traditionally male dominated specialties are difficult to navigate. They're difficult to gain acceptance into it. They're difficult to get into residency programs. And, you know, people like to be with people that they understand in certain surgical fields, see someone that looks like them. And that's a choice as opposed to someone that doesn't look like them. And this this transcends gender. It's about diversity and about socioeconomics. And it's so many factors. And it's in-group, out-group dynamics that influence a lot of this. So, we have a lot of work to do. But I think getting our medical students the opportunity to explore these specialties with support might be a first step. 

WHY MED STUDENTS OF ALL TYPES NEED ROLE MODELS

INTERVIEWERS: I think that's so true. And to piggyback on that, there is a new mentoring program at the Mayo Clinic Rochester program to address the diversity and the inclusion needs for students who are seeking role models to make choices and to inform themselves. 

And really, they need role models. They don't make choices just by fact that we throw on them. They really want to walk that walk that they see people who think like them look like them. So, I couldn't agree more with you. 

JULIA FILES, MD: And especially for women. Women need to know that you can be a surgeon, and you can be a mother. It is doable. They have this feeling that they just can't do it. I'm not saying it's easy, but it can happen. 

INTERVIEWERS: Yeah, it's not mutually exclusive. You actually had great data on that today in your talk. I mean, your talk was rich of data, and it was so juicy and engrossing. How you did that with data was just fascinating. But you shared data around motherhood. 

WOMEN IN MEDICINE BEING MOTHERS – IT’S POSSIBLE!

JULIA FILES, MD: I found this very interesting. It was my favorite statistic because my talk today was about statistics, which can be dry. But the the fund's statistic about women in medicine dating back to 1922, done with survey research, 80 percent of women in medicine are mothers, whether they choose it or it happens. We don't have that data, but they are mothers. 

And so it is something we have to acknowledge and support, because we also know from recent studies that women still carry the majority of the home burden, which is child care, home keeping, elder care, and extended family relations. And it leads to a lot of role conflict. When I was going through it, I didn't know what I was experiencing. And when I started to become interested in the research around this, I found the term role conflict, which really does describe what we experience as women in medicine. 

INTERVIEWERS: So, with that, and I love that notion of more conflict in the do need we have. Do you how do you use that information when you're mentoring women at the different levels of the career? And certainly they may be thinking about motherhood.

WHY WE NEED TO EDUCATION WOMEN IN AND OUTSIDE OF MEDICINE ON IF THEY WANT CHILDREN AND WHEN THEY WILL NEED TO COMMIT

JULIA FILES, MD: Oh, sure. Well, I think one of our failings in medicine is that we don't give education to young women about reproductive life planning. Women have an abstract concept that someday they will choose motherhood, but they think they have all the time in the world. And a lot of that is influenced by Hollywood because women are having children later and later. They're not mentioning that they're using egg donation and reproductive technologies because their academic career and biologic timeline are synchronous, and you have a limited amount of time.

 And so I like to just open the topic and ask women, have you ever thought about it? And if you haven't thought about it, why don't we look at your risk tolerance for your last pregnancy? Like, how old do you think you can be? And then, I challenge them. How many kids do you think you would like to have? Why don't you think about Thanksgiving at age 45? Who's around the table? And then we work backwards, and we look at inter-pregnancy interval, and we help them construct a personal plan. 

And we're doing that now with medical students through the American Medical Women's Association. I’m very passionate about that because I think everyone should be able to decide and not let biology time them out for motherhood,

INTERVIEWERS: That’s incredibly important and kudos to your team for doing that. Much needed. Well, we could go on and on, and we are. Well, what are your top three takeaways for our listeners today? 

CONCLUSION

JULIA FILES, MD: Well, I think the most exciting statistic that I explored today is the fact that, for the last two years, the number of female medical students exceeds the number of male medical students. Again, there's a seismic shift. 

The other takeaway is that numerical parity does not equal gender equity. So, we have a lot of work to do. We may be having good numbers, but we still have a lot of work to do. And lastly, there is no more noble calling than motherhood. And 80 percent of us are mothers. And we need to support each other at each phase of motherhood because it has its own challenges.

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