Subliminal Sexism in Medicine

For the most part, the sexism in medicine is not subliminal at all.  It’s quite overt.  However, unless you’re a female physician, you probably are unaware that it’s still an ever-present reality for us.  I do want to note that there are very good men out there who are trying their best to be advocates for equality in our field even though they can not fully appreciate the female physician plight.  My father is one.  My husband, an Anesthesiologist, is one.  The male physician-entrepreneur I met with last week to discuss a partnership in my new solo practice with his clinic system is one.  These men are the “He’s for She’s” of medicine.  And yet, the hurdles are massive even once we women have finally made it to attending status.

Examples of overt sexism abound.  As this article notes, the pay discrepancy for the exact same job and hours worked is blatant (>$100,000 difference).  Physicians in specialties such as ER and Anesthesia may not appreciate this, as their shifts might be salaried per hour.  However in fields that require a lot of non face-to-face patient care and fields which weigh “productivity” aka patient face-to-face volume and turnover heavily in the pay, women are often paid significantly less.  I’d contend it’s because in many non-procedural fields females more often take the time necessary for patients despite the sacrifice to their productivity earnings.  We women, frankly, tend to care more about the patient than our paycheck.  And yes, there is evidence to back this up.  A Harvard study released in JAMA this year showed conclusively that elderly patients admitted to the hospital had lower death rates and readmission rates when treated by female internists compared to their male counterparts.  While the numbers are overt, the subliminal sexism is written into the RVU methods of physician reimbursement.  Those who care enough to take the time to do the job well inevitably get punished financially.

Let’s forget about numbers.  There is overt sexism we women experience daily in how we are addressed and spoken to.  Frankly, a man would never tolerate without a complete fit the words and tones I have had to take from coworkers, bosses, and patients alike.  Last week I had a meeting with a hospital system in my town who has been trying to get me to agree to work for them for months without retainer.  We finally met and I told them about starting my own solo-practice instead of employment, but also to discuss how I’d be happy to assist with medical directorship for their SNFist program and inpatient Geriatric care improvements.  The female care manager told me how she didn’t think what I could offer was necessary from a physician and the male physician said,”I just don’t think you’re going to get anyone to pay for your care out of pocket when it’s something medicare covers” (I’m opting out of medicare).  I don’t think they’re aware of how this came off.  What they were trying to communicate is that they aren’t looking for a medical director at this time and they are concerned for my financial viability solo.  That’s what they would have said to me if I were a man.  Never would they have insinuated that my expertise as a physician and Geriatrician, something unique to this community, were not wanted or needed (it actually very much is), or that my care was comparable to the the care provided by the non-physician providers who go to the nursing homes and assisted living facilities here (it’s not comparable, my care is better because I am trained at a much higher level to care for this vulnerable population).  No, Medicare doesn’t actually cover the quality of care I provide.  So this is blatant.  This kind of thing also happens routinely to female physicians of every specialty.

Let’s get to the truly subliminal content.

My husband opened my American Academy of Family Physicians CME advertisement in the mail and brought to my attention the fascinating pictures.  Here are 6 of the 8 pictures, including all of the pictures featuring women.

I guess I don’t know if these truly are subliminal because it was my husband who pointed out to me how sexist this seemed.  He’s not one to catch subtlety.  The pamphlet has a ratio of men to women pics of 6:2.  So the numbers already don’t reflect the reality of family medicine.  However, in the entire pamphlet, there are only pictures showing men as smiling, engaging physicians/leaders/teachers.  The women pictured are either facing away or with an expression that says, “I am a passive recipient, incapable of worthwhile thoughts of my own or engaging discussion.”  Then there is the woman staring at the painful computer CME module with the pen in her mouth.  Is she a secretary enthralled by data entry?  Why is there not a single picture that depicts a woman physician smiling, engaged, like someone you would want to talk with, or care for you, or capable of teaching you?  And this is not a testosterone driven surgical specialty.  This is family medicine people!  Where women are actually more prevalent in the field!  Also, it’s not like the pictures are showcasing the keynote speakers (although that is something that is also far too male-dominated).  It’s advertising how the AAFP envisions its audience.  Even the AAFP does not view women as equally capable of being physicians, leaders, and teachers.  Their marketing tells us so.

Still today in medicine, even in the fields full of women, the message sent is that men lead in education, discussion, and patient care.  But truly, it’s the women making the most impact in time-based fields and giving our heart and souls to do so.  We are just as capable, just as engaging, and it’s time to demand that our fields recognize this before we continue to break our backs in the trenches.



An Open Letter to the self-proclaimed “Professional Truth Sayer”, Matt Walsh

Dear Matt Walsh, Professional Truth Sayer,

I’m a devout Catholic.  Based on everything I read of yours recently I feel like I have to qualify that (because your writing style routinely starts with false labels and generalizations and when people point this out you only then clarify the very specific audience you are apparently speaking to).  My unabashedly liberal sister called me randomly, knowing that I had at one time (I think when you first started) liked a post or 2 of yours, and  wondered if I’d read anything of yours recently and also wondered if I’d consider writing to you on behalf of moderation (she knows we don’t agree on a lot, she also knows I’m an Independent).  My initial gut-feeling was……it’s not worth my time, nothing I write will change the mind of the self-professed professional truth sayer.  Then I got into a disagreement with my sister regarding some of the things that I disagree with on the “liberal” side (like the emphasis on transgender issues and treating two different issues (sexuality and gender) as one issue).  I realized something:  This likely won’t change you or your mind.  However, extremes drive extremes, and it is high time moderates, independents, people who are open to other viewpoints and capable of empathy for someone even different from themselves, and who are good at seeing the bigger picture start speaking out and louder than the extremists.  So here it is, read if you’d like.

I’m still debating how to approach addressing you.  Should I take the loving stance and appeal to reason, shared values, and shared Faith?  Or should I take the approach that is my instinct after reading your words that are clearly meant to ignite rage, fear, bitterness and just pick a fight?  I get the sense you like a good quarrel, but I will do my best to stick with the first approach.  I will probably fail.

The recent post which brought your blog back to my attention by my liberal sister was the one about Trump’s refugee and immigration policies and Christians.  This one..  Indeed, your writing style and choice of words implies that to be against the recent Executive Order banning even already vetted refugee and immigrants from 7 predominantly Muslim countries (and fascinatingly not any of the countries who bred the most horrific terror attacks on US soil to date in which Trump likely has business dealings wsj article) is to be a secular liberal Instalogian who views the Bible only in terms of childish fairy tales until they want to use it against you and all conservatives like you.  It’s obviously been pointed out to you that many Christians and Catholics (including many of the Bishops of the US) also believe that this particular policy on immigration (to clarify for you Matt, they are not saying ALL immigration laws are inherently immoral as you suggest they claim in your blog) is antithetical, even as policy for a nation, to Christ’s teachings.  Still, you continue to write in a way that is clearly meant to spread false-information while also making fellow conservative Christians feel victimized by everyone.  Have you really heard that your faith requires you to “advocate for the immediate admission of illegal aliens and un-vetted refugees from terror hot spots?”  I get the sense you fudged the wording a tad because not even my Trump-voting friends here in Lubbock TX think those of us who opposed the ban are saying that.  Most realize that those who are allowed in as refugees already go through an extreme-vetting process to get here (yup, there are already laws in place that do not single out predominantly Muslim countries meant to stringently vet immigrants and refugees in order to protect our country and its borders).  And those who oppose the wall don’t all feel we should open our borders to everyone, but rather that we should explore other options of handling undocumented immigrants who manage to survive the exodus from their own country to get here.  I get the sense your words are intentionally misleading.  Oh and I have literally NEVER heard anyone, left, right or middle, suggest, “You can’t be a real Christian unless you’re an advocate for open borders and unfettered immigration. National security and sovereignty are heresies!”  Even the blog post you linked was not saying that.  That may have been what you in your primed for outrage stance heard, but it hasn’t been said by anyone ever as an argument or even a cry of outrage because it’s nuts.  So why suggest that it has?  What are you hoping to achieve?  I’d say almost every American who cares that America as a whole (and not just the white Christian sect of the country) succeeds for the sake of everyone having equal dignity in life agrees that immigration is an issue, we do need to protect ourselves (hence why we don’t just let anyone in), our open Southern border makes things complicated, and there may be a multitude of ways for us, as a Nation, to reach our common goals while still upholding our Constitution in it’s entirety, promoting Religious Liberty and protecting our Democratic (I mean as a democracy, not “Liberal”) ideals.

Ok so that was to address the inflammatory and compassionless tone of your writing.  This would be far too long to address every single scriptural argument you proceeded to write in your blog.  I’ll focus on a few that stood out and then quote a true theologian.  Also, I’m only going to address concepts you use that are from the Gospels because ultimately those are the most accurate accounts of what Jesus wanted to impart upon us (can we agree on that?).  First, I don’t agree completely with the uber-literal interpretation that Jesus wanted us to only focus on those in our immediate land based proximity.  Technically if He did though, Mexico shares a land border with us so you could understand then how Mexicans in the north are in the proximity and true neighbors of Americans in the south?  With technology today, the internet, etc we see things and know things about what goes on in our shared world and know that every person is within our vicinity as humans.  Even so, many Christians (and Muslims, and seculars, and every other type of persons) here in the USA have professions that give them the honor but also the reality in working one on one with the least of us in our proximity, and then recognize that policy is one of the most effective ways to help them, and vote accordingly.  The majority I know who feel compelled to do something about the refugee crisis not only donate to the causes to help, but also offer their homes and clothes to help…….problem is, with the recent EO the already vetted refugees can’t get to our homes.  You pretty much accused people who vote for social policies of lacking personal charity with your clothing analogy.  Is this how you spread the truth of the Gospels in love?  The majority of people I know who advocate for better social policies due so, not for clothing assistance, but for basic healthcare needs (excluding abortion obviously……again feel like I have to clarify because you’ll find any way to attack possible) met for all Americans.  Even though I’m a physician and bleed my time and love for my patients, I can’t treat everyone nor can I give enough away in my own resources to really make a dent in the care for those who most need it.  However, I can petition legislatures for a basic single-payer state funded healthcare system knowing full well that the heaviest taxes will fall on my shoulders to support that (wouldn’t those be considered my own resources?) and that is another way of giving to promote human dignity for my fellow Americans.

Ok Matt, I’ll wrap it up.  Are you still reading?  I can understand if you’ve stopped, I had a really hard time getting through your stuff of late.  You ended your blog post with this, “And if you feel that Scripture compels conservatives to adopt a left wing approach to this issue — even as you openly deny the validity of Scripture and mock those who read it — I would suggest you find a better argument entirely.”  No Matt, most people, Christians and non-Christians alike, who oppose the recent Executive Order do not mock Scripture or those who read it.  Rather they oppose the Executive Order based on it’s shortcomings and their shared understanding of the founding principles of our country and its Constitution, Democracy, Religious Freedom, and desire to have our policy as a Nation to the best of it’s ability reflect the Golden rule of “Do unto other as you would have them do unto you.” (paraphrasing Matthew 7:12 and Luke 6:31).  Yes there is a vocal minority who oppose it and are secular and are now very excited to point out what on face appears to be the glaring hypocrisies of the professed Christians who support anything President Trump does, despite what effect it has on life outside the womb.  I’m sure you’ll argue that they were your audience.  However, you know better don’t you?  You know darn well your audience is the Conservative Religious who want you to feed their outrage and self-justification with demonizing paraphrasing of the intentions of people you clearly don’t really know nor care to get to know.

Pope Francis said these words in October 2016 “It’s hypocrisy to call yourself a Christian and chase away a refugee or someone seeking help, someone who is hungry or thirsty, toss out someone who is in need of my help.”  Matt, I don’t think either of us is a Theologian.  Can we agree that Pope Francis is?  A policy targeting refugees (and even immigrants here legally) specifically directed at whose who hold passports from 7  predominantly Muslim countries, one of which is in the middle of one of the greatest humanitarian crises due to war, seems like a pretty blatant case of singling out and tossing out those who need us most.  I know our Pope has not said anything specifically directed at recent events.  He doesn’t need to.  And you know what, I just realized, what the heck am I doing?  You have proclaimed yourself a professional truth sayer, as if you have the monopoly on truth and are the sole authority on Scripture, our Political system, the Constitution, and what protecting our nation entails.  Nothing I could ever write could possibly counter the professional truth sayer.  Like you say, it’s your profession.  There’s probably no point in pointing out to you the hypocrisy in your extremism, is there?

And with that, I’ll forgo editing this for time’s sake and get back to my real jobs.