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On the cutting edge?

A look at the “medical” gender gap for women surgeons

by Alison Dahl Crossley on Monday, November 16, 2015 - 12:12pm

Claudia MuellerWomen surgeons face intense pressure, challenges and empowerment—much like surgery itself. They also face the obstacles of dealing in what is primarily a male-dominated field. Claudia Mueller, M.D., assistant professor of surgery at Stanford University and former Clayman Institute faculty research fellow, offers insight into the “medical” gender gap through the publication rates of female and male physicians. From publishing to history to mentorship, Mueller provides a perspective to better understand the experiences of women’s involvement in medicine in order to craft workable solutions to advance women in the field.

The ongoing gender gap of physicians

In order to understand the “medical” gender gap, Mueller conducted original research examining the publication rates of female and male physicians in surgery departments at Stanford, Johns Hopkins and the University of California, San Francisco. She analyzed two variables: the number of works published and their calculated scholarly impact.

 “Men published significantly more than women,” she found, “and had significantly higher scholarly impact.” This was absent any difference in academic rank or the number of years since completion of training. Why? Mueller suspects the explanation goes beyond just underrepresentation in surgical leadership ranks.

Scholarly impact is calculated by the h-index, a complex algorithm analyzing scholars’ productivity and citation frequency. According to Mueller, a large 2014 study found that men are more likely to cite their own work, while women are reluctant to cite themselves for fear of appearing self-serving. Self-citations can significantly raise an individual’s h-index, and there appears to be a gender discrepancy in self-citations.

Another explanation for the gender gap in publishing is that women surgeons have more competing demands than do men. Mueller cites research that found while 90 percent of women academic physicians have spouses who work, only 55 percent of men do. Despite similar work pressures, women physicians still spend twice as many hours as their male counterparts on parenting, according to self-reported data. Mueller believes the fact that women physicians have less help with home and caretaking duties that take time and energy away from their professional commitments may also explain variations in publishing frequency.

How women have historically experienced “difference” in medicine

Elizabeth BlackwellAs early as 1500 B.C., Egyptian women were enrolled at medical school in Heliopolis. While women are known to have practiced both medicine and surgery throughout ancient and early modern history, it was the societal values from A.D. 1400-1800, which emphasized being kind to the poor and charity work, that encouraged women to participate in medicine.

In the 1800s, sisters Elizabeth and Emily Blackwell became the first women to attend medical school in the United States. Although in 1863, Mary Edwards Walker was the first woman to become a surgeon in the U.S., it wasn’t until over a century later, in 1987 that Olga Jonasson became the first woman to chair an academic surgery department in the U.S.

Emily BlackwellIn 2011, according to Mueller, a record 47 percent of first time applicants to medical school were women. Prior year statistics showed that women represented 35 percent of all those students who applied for general surgery programs. However, these female applicants were entering institutions still primarily run by male faculty: 41 percent of assistant professors were women, 29 percent of associate professors and only 17 percent of full professors.

Research has found that both women and men are motivated to specialize in surgery by the same factors, Mueller notes: its intellectual challenges and the faculty in the field whom they admire. Yet, while motivated by the same career goals, women in surgical trainee programs reported very different experiences than their male counterparts, particularly in terms of discrimination and harassment. “Women were more likely than men to be deterred by the masculine surgical personality and the perception of an old boys club,” says Mueller.

Agents of change: Inclusivity, mentorship and more

Given the near equal numbers of men and women entering medical school today, Mueller is optimistic that change is possible. She has recommendations for spurring change in the field. “It is important for women to identify mentors and role models,” she advises. Mentorship and sponsorship are also invaluable in creating research opportunities and ensuring workplace success more generally. Mueller cites research that found women physicians experience less mentoring and fewer networking opportunities than men. This deficiency negatively effects women’s ability to advance in the medical field.

Departments, as well, can work toward creating more inclusive workplaces. Like the School of Medicine’s ABCC pilot, small changes can greatly shift the burden of demanding surgical careers. Mueller continues to look at ways to narrow the medical gender gap in collaboration with fellow Stanford surgeons Sabine Girod, Cindy Kin and Dyani Gaudillière. “Greater inclusivity, increased opportunities for networking and increased dialogue will inevitably benefit everyone,” Mueller says. “Women’s position in medicine has changed dramatically over time, so too can it change in the future.”

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For more information on the experiences of women surgeons, see Cindy Kin's article.

 

Claudia Mueller
Assistant Professor (MCL) of Pediatric Surgery

Claudia Mueller received her AB from Harvard College in 1992 and a PhD in Social/Personality Psychology from Columbia University in 1997 (Dissertation: Praise for Intelligence Can Undermine Children’s Motivation and Performance).  She then attended NYU School of Medicine where she obtained her MD in 2001 and completed a residency in General Surgery in 2006.  She completed her specialty training with a fellowship in...

Alison Crossley
Associate Director

Alison Dahl Crossley is the Associate Director of Stanford's Clayman Institute for Gender Research. She leads the Institute's strategic focus, operations, and academic and community relations, including the Institute’s fellowship programs and programming. She co-organized the Institute's Online Feminism Conference, drawing a diverse group of scholars and activists from across the country to discuss the challenges and...