Each day seems to bring a new story of sexual harassment or abuse of power in workplaces across sectors: Government, entertainment and tech. With a glaring physician pay gap, and countless examples of unconscious bias, health care cannot claim immunity from this disturbing trend. Healthforce Center at UCSF Director Sunita Mutha, MD, FACP, recently shared her thoughts on this issue.
Q: How would you characterize gender discrimination in the health care workforce? What does it look like?
This is a problem about both power and proximity, and it is exacerbated in health care by high-stress, hierarchical environments. There are so many examples from my own experiences and from colleagues and pupils. Not all examples are glaring instances of discrimination or abuse in and of themselves, but they add up to perpetuate an imbalance of power. Female physicians, for example, are often held to a standard that is both confusing and unrealistic. Women are expected to be friendly, smiling and warm, and whenever we deviate from that expectation we are viewed as cold, unkind or ruthless.
Microagressions also appear in interactions with patients. The other day I introduced myself to a patient, an older man who proceeded to call me “honey” and “sweetheart.” I thought to myself: “You wouldn’t talk this way to a guy.” He certainly didn't talk that way to the male resident I was working with! I mentally started to make excuses for him because he’s older and from a different generation, but at the end of the day this behavior is unacceptable.
Q: Female physicians earn, on average 74 cents for every dollar a man makes, according to a report by Doximity. What do you make of this? Why is this happening?
As a young faculty member, I remember learning that a colleague with similar credentials earned a higher salary than me. When I confronted my boss about this, his rationale was that my colleague had a family and served as a head of household, but I was a single woman who only supported myself. There are still structural issues that prevent women from asking for a raise or earning more, especially when the options for additional pay are tied to incentives at odds with caregiving and other family roles. We need more women at the table developing policies and creating cultures to close this unconscionable gap.
Q: Do you think there are issues unique to physician burnout among female physicians?
A: Many women do a large share of the caregiving in their families, including those in the "sandwich generation" who care for both elderly parents and young children. My own patients who are nurses or physicians tend to prioritize the needs of their partners, children and other family members before their own needs or commitments to self care.
Q: What practices or initiatives could help close the pay gap, and end discrimination, for physicians and other health care workers?
A: I wish I could identify a single intervention that could solve this problem, but unfortunately there is no silver bullet. Public dialogue, such as the #MeToo movement, helps shine a light on these issues. At the end of the day, I think we need more women and minorities to be leaders and decision-makers. As I’ve written in the past, narrow definitions of leadership are detrimental to the health workforce and the patients we serve. I’m ready for change—are you?
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Sunita Mutha, MD, FACP, is the director of Healthforce Center at UCSF. For over a decade, she has been engaged in transformational leadership in healthcare with a special focus on emerging leaders and inter-professional training.