The #MeToo and #NeedHerScience movements have inspired women to take a stand against sexism in health care. What I see missing from the movements are women in medicine confronting their own discrimination toward other women.
I’m an orthopedic surgery resident. It’s a male-dominated specialty — only about 15% of us are women. When I joined the ranks, I expected to have to fight hard to earn the respect of my colleagues, something everyone new to a profession must do. What surprised me was that much of the struggle for trust and respect would be with my female co-workers, especially nurses and the scrub techs who prepare, organize, and hand surgical instruments to surgeons during procedures.
The dynamic reminds me of an episode from the Showtime series “The L Word,” in which one of the women describes what happens when male lobsters get tossed into a pot of boiling water: They build a ladder to help each other escape. Female lobsters, she says, pull each other down, dragging everyone to the bottom so they can die together. I can’t speak to the veracity of the claim about lobster behavior, but the analogy rings true from my on-the-job encounters.
When I first started as a junior resident in the operating room, a sense of distrust and hostility often permeated the sterile, cold air. “Oh, you’re the ortho resident?” one of the female operating room nurses asked. “Are you cut out for this job?” she continued, eyebrows raised behind her surgical mask, scanning me from head to toe. A female orthopedics resident who is a colleague of mine shared an exchange she had with a female scrub tech who refused to pass surgical instruments to her, saying, “Female surgeons just aren’t good enough to deserve them.”
While I’d like to believe these are outlier behaviors, data about women in medicine suggest otherwise.
Researchers in Canada surveyed 543 internal medicine residents. Among the respondents, 71% of females, as compared to 35% of males, reported experiencing gender discrimination from nurses.
To bring the research closer to home, I wanted to see how women-on-women harassment played out in my own specialty. So I surveyed the women of the Ruth Jackson Orthopedic Society, an organization founded to promote the professional development of women in orthopedics that includes both females and males. Of the 180 respondents, 87% reported that they experienced more negative treatment from female floor and operating room nurses than their male colleagues did. Fewer women, 69%, reported discriminatory treatment by senior male colleagues. Most identified “being female” as the driver of this treatment. Moreover, while most (90%) of the behavior targeted interns and residents, more than half of fully trained orthopedic surgeons reported ongoing antagonism and harassment from other women in the first five years of practice.
The survey also showed that women perceived men to be better allies in orthopedic surgery than women. Among the potential candidates of support in the face of such behavior, male attending physicians received the highest percentage of votes, 26%, more than double the that of female attending surgeons, 12%.
So even as women in medicine are navigating this male-dominated profession, research underscores that we’re not always making it easier for each other. This isn’t restricted to orthopedic surgery, but extends across various branches of medicine.
There’s no question that some women uphold historical female gender norms. They can also perpetuate a kind of “benign sexism,” in which women are expected to be warm and nurturing, held to a different standard of acceptable authority and assertiveness than men. One of the respondents to my survey put it like this: “As a surgeon, I can be a boss and not a bitch, but I always have to prove myself — work harder, be faster, and be nicer.”
It is encouraging that 70% of the respondents to my survey noted that the hostility seems to mitigate over the years, though it’s hard to say whether that’s a reflection of genuine behavior change or simply getting used to it.
As more women enter the medical profession, change is clearly needed. The number of female residents in orthopedics rose from 67 in 2007 to 601 in 2019 — a more than ninefold increase in a decade. A similar trend is seen across other specialties. It’s time to acknowledge that as women in medicine take important and long-overdue steps to tackle male-on-female harassment, we’d be wise to broaden the scope to examine how women are harmed by the biases of their female colleagues.
Change starts with male and female physicians recognizing and rectifying the discriminatory behavior that has real consequences for their own well-being and that of their patients — from workflow logjams to communication errors. Inter-professional team training, systematic reporting, and zero tolerance policies around differential treatment must be implemented to help shed internal gender discrimination.
As Madeleine Albright often said, “There’s a special place in hell for women who don’t support other women.” I believe she’s right. Women in medicine need to make that “special place” much smaller for all of us.
Bonnie Y. Chien, M.D., is an orthopedic surgery resident at the Harvard Combined Orthopedic Residency Program.