Researchers study career challenges facing women physicians who first entered medical school after Title IX
June 04, 2018
By Kristi Birch
“Medicine is so broad a field, so closely interwoven with general interests…that it must be regarded as one of those great departments of work in which the cooperation of men and women is needed to fulfill all its requirements.” — Dr. Elizabeth Blackwell, 1821-1910, the first woman to receive a degree from an American medical school
Last year, for the first time ever, the number of women entering medical school in the United States surpassed the number of incoming men. Compare that to 1970, when barely 5 percent of American doctors were women. It's easy to conclude from this headline-making news that women have reached full equality in the profession, but medical school matriculation is only the beginning of the story.
Just ask Kim Templeton, M.D., professor of orthopedic surgery at the University of Kansas Medical Center, who was the first woman to enter the residency program in orthopedics at the Rush-Presbyterian St. Luke's Medical Center in Chicago. Three decades later, Templeton is part of the still scant 5 percent of practicing orthopedic surgeons who are women. Not only do women doctors remain under-represented in high-paying specialties such as orthopedics and cardiology, they also tend not to progress to the top ranks of academic medicine. By Templeton's count, she is just the sixteenth American woman ever to become a tenured professor of orthopedic surgery in the United States. Moreover, female physicians suffer from higher rates of burnout than men.
Templeton has spent much of her career outside the operating room addressing the issues of woman physicians as well as sex and gender differences in health and disease. Last year, she spoke at United Nations' Empowering Women and Girls Summit about the impact of sex on chronic health conditions and thus on the ability of women around the world to lead productive lives. She also worked with the American Medical Association to expand their definition of women's health to include all conditions for which there are differences between women and men. Spurred by her interest in sex- and gender-based differences in chronic pain, Templeton is now also looking at ways to address the country's opioid crisis.
A former president of the American Medical Women's Association and of the Ruth Jackson Orthopaedic Society, Templeton has addressed the United Nation's Commission on the Status of Women about increasing the numbers of women in traditionally male medical fields and is currently leading a group within the National Academy of Medicine studying gender differences affecting physician burnout.
And now, she and Anne Walling, M.D., professor emerita in University of Kansas School of Medicine-Wichita — with a grant by the Joan F. Giambalvo Fund for the Advancement of Women administered by the American Medical Association — are researching an under-studied group of American physicians who radically changed the face of medicine: women doctors now over 60 years of age. "There's a lot of focus on younger women physicians and that's important, but you don't see any focus on older physicians," said Templeton. "These women, by and large, don't have a previous generation of women physicians to go to for advice on how to navigate the later phases of their careers. In addition, as we are looking at health care provider shortages — are women leaving medicine for reasons we could address?"
These physicians are the women who were the first to enter medical school after the 1972 passage of Title IX, which outlawed gender discrimination in education, and found that even though the doors were finally open, the environment could still be hostile. These are the doctors who remember people saying they should stay home and raise their children instead of apply to medical school. These are the doctors who remember having to wear multiple layers of clothing and duck into a closet to strip down to their surgical scrubs because there was no changing room for women like there was for men. These are the women who still are often addressed professionally by their first names, instead of "Dr. [last name]."
Today, these women find themselves with another part of the trail to blaze. As the first generation of female physicians to reach retirement age, they have no role models for navigating the latter part of their professional lives. Moreover, they stand in a blind spot: In addition to most studies on gender bias focusing on younger female physicians, the information about retirement and financial issues for doctors is designed by and for men, points out Templeton, and focuses almost exclusively on financial issues.
Templeton and Walling are looking to change that. Their study will examine the career issues that senior women physicians face. "This is something that impacts not only physicians and their satisfaction with their career and their risk of burnout, but it also helps medicine in general. If we can keep these women happy in their work, then that's another way we can address the health care provider shortage," Templeton said.
Identifying the issues
Templeton noted that while some issues may not vary between men and women doctors, others do. For example, burnout is more common for women physicians; the question is why. Last year, Templeton and Walling decided to hold focus groups with KU doctors in Kansas City and Wichita to begin exploring these issues.
Many of the women in the focus sessions talked about being the caretakers of elderly parents or other relatives, a job that seems to fall to women more than men. When they were young women, HR policies were in place if they had children. But what about now, when they find themselves caring for older relatives and sometimes grandchildren? "They were really struggling with being part of the sandwich generation," said Kari Nilsen, Ph.D., an assistant professor in Family and Community Medicine at the KU School of Medicine-Wichita who designed and ran the focus group sessions.
Walling remembers being one of those caretakers. "I used FMLA to care for my parents," she said. "Then I got sick, but I'd already used up all my sick leave."
Of course, caretaking issues affect older women regardless of profession, but Templeton, who gets to work usually by 6:30 a.m. so that she can be ready for patients, noted that it can be even more complicated for women in medicine: "If you're in the business world, the further you go up the food chain, the more control you have over your time," she said. "As a physician, your time is dictated by needing to see your patients; you might need to be the doctor who is there for 24 hours straight. And then there's being on call — you can get called in no matter where you are."
Finances were also cited as a significant concern. As physicians, the women were generally well paid, but they did not necessarily know how much they needed to retire, how to invest for retirement, or how to sign up for Medicare. Some had left these issues up to their significant others. "We were surprised by that, but these were doctors in an academic setting," said Templeton. "We will be looking next at physicians in private practice and see if the response is any different."
Remaining relevant and respected in their field and keeping up with technology were other common concerns. "You have to stay up to date clinically, and then there's the technology — electronic medical records, apps, and so forth," said Walling. "People are always wondering if you're up to date and if you can cut it, and that's harder if you are also taking care of your aging mother."
Taking it statewide and national
The researchers plan to use what they learn from focus groups to devise questions to send electronically to female physicians age 60 and over in the Kansas Medical Society database. The questions will cover caretaking issues, financial matters, the impact of personal health on their practice, how their career affects their health, their confidence in navigating retirement, how they interact with younger colleagues, disrespect from younger colleagues, the impact of changes in health care bureaucracy and technology, and feelings of isolation, stress and other indicators of burnout.
They then hope to take their survey national, using perhaps the AMA or the AMWA database and presenting their findings at meetings and through publications.
Ultimately, the researchers want to build a framework to develop educational materials — seminars, webinars, publications — designed for women to help them navigate the latter part of their careers.
"One of those poignant moments of the focus sessions was when someone said, 'This is the first time in my life I have ever felt vulnerable,'" said Templeton. "She was trying to decide whether to retire, and she didn't know what she was supposed to do next. There wasn't a path to follow or a preceding generation to show her what retirement looked like. There wasn't ready access to resources. We are hoping to help change all that."