The longstanding hierarchy in medicine — mostly male doctors at the top of the heap and mostly female nurses below them — often gets in the way of patient care. We need to change that structure for the good of the profession and our patients.
Emerging trends in medicine and nursing may lead to “flattening the hierarchy” as women move into traditionally male roles, sociologist Anne V. Bell recently told attendees at Rosalind Franklin University’s second annual symposium on the gender divide in health care professions. But despite these gains, women still struggle to establish themselves as equals in health care professions.
A reminder of this divide tore through social media recently when a Florida anesthesiologist with ties to a major medical school posted demeaning and inflammatory comments about nurse practitioners.
“Nurse practitioners are not, I repeat, not physicians. They lack the education, IQ and clinical experience. There is no depth of understanding. They are useful but only as minions,” Dr. David Glener ranted on Doximity, a medical social media network. His comments were posted to Twitter, where many people reacted swiftly, calling for physicians to take a team-based approach and promote unity among health care professionals.
Nurses have long realized that membership in a female-dominant profession means having their competence questioned despite extensive training. The comments by Glener, who is on the board of Florida State University, as well as one by Dr. Wendell Perry, an emergency physician, speak to a broader issue of disparity in the health care professions that is connected to gender and the hierarchy of medicine.
As policymakers work to reform health care, aided by professionals who provide patient care, the Glener rant provides a well-timed reminder of the ethical obligations of physicians and nurses to build collegial relationships with each other and with all health care professionals.
The American Medical Association prioritizes the importance of this inter-professional relationship. In a chapter of its code of ethics, these efforts are described as part of a “common commitment to patient well-being” which “should be based on mutual respect and trust.”
With looming physician and nursing shortages, predicted to produce up to 104,000 and 1.2 million vacancies in the coming decades, this trust and commitment will be put to the test. The health of the public depends on its success.
Improving inter-professional relationships is one approach to help advance gender parity in health care. Women in STEM fields have been historically undervalued. As Angela Saini points out in her recent book, “Inferior: How Science Got Women Wrong — and the New Research That’s Rewriting the Story,” researchers such as Charles Darwin have made claims deeming women inferior in science and medicine dating back to at least 1881. This could not be farther from the truth.
As IQ scores have risen over the past 100 years, women’s gains have outpaced men’s. Furthermore, in a test of abstract, logical reasoning women again matched or exceeded scores of male counterparts of equal educational level.
Yet despite overwhelming evidence of the contributions women make in advancing science, women in academia experience persistent gender bias. Men have often received credit for women’s work, a phenomenon that has become known as “The Matilda Effect.” One study, for example, showed that the same research abstract was rated higher in scientific quality if the author was a man rather than a woman. Such bias and other gender differences, such as women contributing more time to teaching and mentoring colleagues, mean that women publish less frequently than men, limiting this as a gateway to career advancement and promotion.
Economic disparities persist as well. Despite accounting for 91 percent of the nursing profession, women still experience a gender pay gap, earning between $4,000 to $17,000 less per year than men, depending on specialty area.
Similarly, though the percentage of female physicians has grown to account for 50 percent of the profession, on average they earn 8 percent less (about $20,000) than their male colleagues.
These gaps will not shrink overnight. The onus will be on higher education to deconstruct the hierarchy of science and medicine. It must do this by recruiting a diverse faculty and student body that mirrors the U.S. population by gender, race, beliefs, sexual orientation, and socioeconomic backgrounds. It must also cultivate a culture of respect for the contributions of these diverse bodies.
Faculty members of every discipline will be asked to model behaviors that foster inter-professional collaboration. One essential component of their approach must be to equally value the contributions of all health care providers — and the providers themselves — and not see one group as superior to others
In my experience as a nurse, patients usually don’t prioritize a health care provider’s gender, title, or degree. They want to know you are competent. And that you care.
With all of the controversy in health care, we need to put emphasis back on the caring. Flattening the hierarchy is an important way to do this.
Melissa D. Kalensky is an assistant professor in the College of Nursing at Rush University, a family nurse practitioner, and a Public Voices Fellow through The OpEd Project.