The courageous social media movement #ILookLikeaSurgeon, led by a female surgery resident from my home state of North Carolina, is shedding light on stereotypes of male and female roles in medicine. According to the American Academy of Medical Colleges (AAMC) the composition of medical school graduates in terms of gender, race, and overall diversity has drastically changed. The statistical data indicates that the graduating classes of 1965-1966 were comprised of 6.9% female medical students. Fast forward to the most recent data from 2013-2014 and females are nearly half of the graduating medical school class at a whopping 47.5%. There are many reasons for this explosion of female providers; women have responded to the diversity of patients in medicine and have actively pursued equal rights through feminist movements such as the women’s suffrage. Women have advanced quite a bit in medicine but some things unfortunately have not changed since 1965. Women often share in equal professional roles, legal liability, and overall expertise when compared to their male counterparts in medicine; however, they may disproportionately suffer the stresses of gender discrimination, disrespect by medical staff or patients, and less recognition by healthcare administration. The extraordinary increase of female physicians suggests that doctoring is no longer solely a male sport. Despite the increased representation of competent women in medicine, the ghosts of the historically male dominated medical field still haunt us today.

Interview any female physician and I am willing to wager that she has tales of being mistaken for the clinical support staff, the nurse, or the assistant. I have been referred to as “the nurse” even after introducing myself as “the doctor”! Depending on the field of medicine this awkward display of gender polarity may be magnified. According to a 2015 report from the AAMC, women tend to be most represented in fields such as pediatrics, obstetrics and gynecology, psychiatry, and family medicine. Women are less represented in the surgical subspecialties in comparison to other disciplines within medicine. Women in surgery are outnumbered by men more than any other area of medicine. Although the field is exponentially growing in the volume of female providers, there are still several nuisances. For example, women in surgery have been reported to have a harder time fitting into the predominantly male culture, are sometimes embraced less by male attending physicians, and are not as highly regarded by nursing staff.

One of the most intriguing small sample size studies on gender differences involved feedback from female medical students. In 2009, female students shared with study investigators in New England that they found themselves behaving in “stereotypical female roles” during their clerkships. This included offering extra help to nursing and support staff, apologizing excessively, and intentionally appearing to be insecure with their skill level. A stark contrast was drawn with male students who seemed to seek opportunities to spend more time with attending physicians, take advantage of more learning opportunities, and assert their positions as future physicians. The surveyed female students admitted that their behaviors had a negative impact and perpetuated stereotypes of women being less confident and somewhat inferior in medicine; however, the advantage to the behaviors was that it allowed the female students to appear non-threatening and comforting to medical staff.

There is no doubt that the most compelling argument for gender inequality in medicine is salary. When men and women are matched for specialty, level of experience, clinical complexity of services, and hours worked, women on average take home a jaw dropping $20,000 less than male physicians. One factor that may contribute to this is the overall higher reimbursements for male physicians by insurers such as Medicare. According to the Journal of the American Medical Association (JAMA) June 2012 issue men received higher reimbursement from Medicare due to higher billing and more clinical procedures. This of course is not the only explanation for the gap in salary, which has appeared to only widen over the years. There are several theories as to what else may be at play in assessing the salary difference related to gender. Do men receive higher wages due to the gender roles in society as the financial provider for the family? Are women poorer negotiators? Do women fail to ask for promotions when necessary? Are women disadvantaged due to the potential for maternity leave? All of these speculations may have some small impact on gender inequality in wages in medicine but I suspect that this is merely scratching the surface.

Equality in medicine mirrors society and it will perhaps never be fair. Male medical students are often rejected from gynecological procedures due to female patient preference. Male nurses are commonly mistaken for the doctor or expected to work in high acuity areas such as the emergency room or intensive care units.  Young physicians are told that they don’t have enough experience to be good doctors while elderly physicians may be considered out of date or too old to adequately provide good medical care. And the list goes on. So, when confronted with protecting femininity in medicine, what’s a girl to do? As a female physician I am not proposing to adopt the victim mentality or go about our day’s work with a chip on our shoulders. It is our job to be educated about the obstacles that we are faced with and work from the inside out to do something about it. We have to be cognoscente that gender differences in medicine will never change if we are not willing to involve ourselves with the issue. We have to get involved in professional groups that cater to the needs and concerns of female medical professionals while maintaining our other prospective memberships. We have to mentor young female physicians and serve as positive role models. We have to be aggressive about getting what we deserve in terms of monetary compensation, promotion, and respect. Most importantly, we have to support and uplift each other and never forget how far we have come in medicine.

#ILookLikeaDoctor. I am feminine, competent, outspoken, and fearless. And I am proud of it.