In 1917, Clara Hillesheim became the first woman to earn an MD from the School of Medicine at the University of Pennsylvania. After graduation, she moved back to her native Minnesota, spending two years performing autopsies at the Mayo Clinic before transitioning careers to become a beloved high school teacher, then a caregiver for her aged parents and two brothers, and later an avid traveler.1 Despite her successes, Dr. Hillesheim was never licensed to practice medicine in Minnesota. A year after Dr. Hillesheim graduated from Penn, the school graduated two more women: Dr. Alberta Peltz and Dr. Gladys Girardeau. Dr. Girardeau served as the art editor of the medical school yearbook and would go on to become a pathologist.2,3 Dr. Pelz became a well-regarded obstetrician and fellow of the American College of Surgeons.
As with many other institutional changes, Penn’s move to accept women into the medical school came gradually, as the culmination of many decades of progress, setbacks, and backlash.4 Though the School of Medicine first began allowing women to attend lectures in 1869, it took almost 50 years before women were formally admitted. This delay was in part due to protest from male students who felt having women classmates violated the day’s views on modesty. Financial concerns also posed a barrier: admitting women students meant expanding the class size, an initiative for which the school lacked funding. Despite these barriers, the national women’s suffrage movement brought to light a growing demand for women’s medical education, pushing medical schools throughout the nation to accept female students. Progress was slow: by 1950, women made up a mere 6% of the physician workforce.5 Today, women make up 36% of the physician workforce and about 50% of medical school enrollees.6 Considering these statistics, women have made many gains in medicine. At the same time, challenges remain: here, several women physician leaders at Penn Med reflect on their experiences as women in medicine.
Dr. Cindy Christian initially aspired to be a veterinarian but, after finding the application process daunting, decided to apply into medicine. Currently, she is a child abuse pediatrician, professor, and Assistant Dean for Community Engagement at the Perelman School of Medicine. When Dr. Christian began her pediatrics residency at CHOP in 1985, women made up about half of the 23 residents in her cohort. Over the years, however, she has noticed fewer men and more women going into pediatrics. In fact, among all specialties currently, pediatrics has the highest percentage of active physicians who are female at over 60% (orthopedic surgery has the lowest percentage of women at around 5%, followed closely by thoracic surgery).7 Throughout her training Dr. Christian noticed small instances of gender bias: on occasion her superiors gave her assignments without asking for her input, something they did not do with her male co-residents.
Like Dr. Christian, many of the other physicians I spoke to described minor instances of bias directly related to their gender. As a member of an all-female team on her oncology rotation during residency, Dr. Jennifer Kogan, an internist and Associate Dean for Student Success and Professional Development was often mistaken for nutrition support. Similarly, Dr. Rachel Kelz, an endocrine surgeon and Associate Program Director of the General Surgery residency program, recalled an instance during residency where she was made acutely aware of being a woman. “During the second year of my residency an attending made a very vulgar remark which he would not have said had I been a man. Then I suffered silently—I was in shock. Later, on an ICU rotation, a similar thing happened. It became apparent to me that not everyone saw me simply as a surgical resident, a small but significant subset of people saw me as a woman surgical resident. It was shocking. [That second time], I spoke directly about it with the fellow who made the comment.”
At the same time, several of the physicians I spoke to noted that they were able to make the most out of the challenges they faced as women. For Dr. Kelz, being seen as a “woman surgeon” was not always a bad thing. “In my training I had many allies and champions who saw me as a woman surgeon, but thought it was exciting and a welcome change. They gave me and my female coresidents a feeling of belonging. They made the process easier and substantially less threatening.”
When Dr. Suzi Rose, Senior Vice Dean for Medical Education, was training in the 1980s she was one of a few women in her medical school class and one of even fewer women in her Gastroenterology fellowship. By the time she graduated as an attending, only 4% of practicing gastroenterologists were women. Though it had its challenges, the experience was not always isolating: “About thirty years ago, I was at a Program Directors’ meeting. There was only one other woman in the audience. We looked at each other across the room and met later in the bathroom, while all of the men had to wait in line. We spent the evening together, having dinner and then shopping and now we meet yearly at our national meeting. It’s great to have someone to rely on and to be a friend, sharing professional and personal milestones and being a source of support.”
Over the course of her career, Dr. Rose has seen more women enter the field and more diversity overall. At national meetings she no longer sees “clearly sexist” slides. In addition, the gender imbalance in clinical trials has improved over time. These changes have been made in part because of women’s advocacy. Dr. Rose insists that despite the challenges, “being a woman in medicine is an amazing experience. There can be challenges with balancing and prioritizing choices, but the opportunities are immense and will lead to a fulfilling life and career, helping others and making a difference.”
Despite these opportunities, data shows that barriers for women in medicine remain significant. A 2019 study published in JAMA Network Open sampling 486 physicians from multiple specialties found that women physicians were 7.8 times more likely to report not working full time compared to their male counterparts.8 Six years after residency almost 40% of female study participants were no longer working full time compared to none of the male study participants. Despite investing more than a decade into the profession, many women walk away from medicine early in their careers. Part of this is because household responsibilities still tend to fall more heavily on women than on men. The vast majority (78%) of women physicians who were not working full time cited family as the key factor that influenced their decision to reduce their work hours or drop out of the workforce. For instance, even among academic physicians, women spent eight and a half more hours per week on domestic activities than male academic physicians.9
Several of the physicians I worked with mentioned that they at one point had concerns about balancing work and a personal or family life. For some physicians, they were able to find a balance by pursuing satisfaction in their career. Dr. Kelz remarked, “In medical school I saw that role models who had children were more prevalent in non-procedural specialties. So, I did some internal assessment on whether there were true barriers. I found that the same issues with work and personal life were there in other professions and came to understand that the issue was not isolated to medicine…The happier I was with my chosen specialty, the happier I would be in my personal life.”
For other physicians, the support from family, friends, and colleagues was key. Dr. Kogan recalled a particularly revelatory conversation she had that changed how she viewed the balance between work and home. “One of the most transformative moments for me, as I navigated frequent guilt trying to integrate my work and home life, was when my mother told me that I could do both well. That my then-6-year-old twin daughters knew that they were important and number one, even when my work was also important. That simple affirmation lifted a huge weight off my shoulders.”
Structurally, bridging the gap between institutional policy and practice might help prevent women from leaving medicine due to family responsibilities. Dr. Meghan Lane-Fall, an anesthesiologist and Co-director of the Center for Perioperative Outcomes Research and Transformation, notes that while there are initiatives the institution has taken to address challenges women face related to career flexibility, salary reviews, mentoring, and other issues, there is a gap between policy and lived experiences. For instance, while there are parental leave policies, she and her colleagues have been made to feel guilty for taking leave or have had their work schedules changed without their prior agreement.
Discrimination based on maternal status is unfortunately not an uncommon experience in medicine. One study found that nearly a third of physician mothers have experienced discrimination related to their maternity.10 During residency, Dr. Suzi Rose recalls an instance where she was written off when she suggested to a supervisor that rather than go to grand rounds in the morning, she wanted to see her infant son after a 28-hour work day. A culture change is needed, but is complicated not only by gender, but by the realities of being in a multigenerational workplace where there are varying expectations of work-life balance in medicine. However, many speakers noted that work life balance is not only a women’s issue: men also face challenges balancing family life with medicine as well. The fact that men are also demanding for a workplace that is more accommodating to family is a good thing; that men are speaking up as well makes it more likely for the field to change.
Several other factors pose barriers to the success of women in medicine, such as pay disparities and difficulties with re-entrance into the field, but leadership is one final theme frequently mentioned. Dr. Lane-Fall describes one reason women are underrepresented in leadership roles: “Even at Penn, when a leadership position opens, it may be more easily filled through word of mouth rather than a formal call for applications. Relying on word of mouth makes it more likely that successors are chosen based on prior relationships. It is easier to choose underrepresented minorities and women in a more formal application process where selection is based on who is most qualified.”
To obtain her current leadership roles, Dr. Lane-Fall asked for them directly, though she notes that she should not have needed to ask for them. Perception poses another barrier women may face in attaining leadership positions. Dr. Lane-Fall notes that women physicians are more subject to critiques of their physical appearance and voice level compared to their male colleagues. Simply put, a woman may not be seen as leadership material because of the way she dresses or sounds. Similarly, Dr. Rose remarked that certain personality characteristics may be viewed more negatively in women than in men. Though a broader culture change is needed, this is something that leaders can work at consciously, by avoiding comparisons and biased critiques.
Most of the physicians I spoke with credited their success, especially in the face of challenges they may face as women, to a strong support system. Though Dr. Nadia Bennett is currently a hospitalist, professor, and Associate Dean of Clinical and Health Systems Sciences at Penn, her decision to go into medicine was occasionally met with discouragement and doubt. Despite the opposition Dr. Bennett faced in her decisions to pursue a medical education, she has received tremendous support from her parents, sister, friends, and mentors. She especially credits her hospitalist group as a great model of a supportive environment for women and men. Working in a department where people are used to seeing women in leadership positions also helps.
Likewise, Dr. Christian has a job she loves. The first in her family to go into medicine, Dr. Christian credits some of her career success to her mentors. “Many of my role models in medicine were women who started their careers in the mid-20th century, when there were few women in medicine. Before I got to know them, they were intimidating. But they turned out to be generous, giving, smart, tough cookies, who taught me much about science, determination and generosity.” Despite the challenges and overwork, Dr. Rose has positive memories of her residency years—in part due to support, taking great vacations, and not thinking much about it. “You can have it all. But you can’t do it alone. Being a woman in medicine requires support and mentorship from other women as well as from men.”
Today, Dr. Bennett believes the greatest challenges facing medicine today are related to physician well-being (specifically burnout and depression), the electronic medical record, and health system issues such as reimbursements and insurance. Dr. Christian describes the greatest challenges facing medicine today as related to our ability to manage the amazing breakthroughs in scientific advancement with the reality that many basic things—like immunizing children and health access—haven’t been satisfied. On a positive note, Dr. Lane-Fall notes that over the years, medicine has seen improvements in the role of women in the workforce. Though it is still difficult to be a mother and a woman in medicine, it is not a question anymore whether having women in the workforce is good or if women should be paid equally. Parental leave and lactation spaces are no longer novel. As previously mentioned, men are also more involved in family life and are demanding more of a work-life balance in the field. Several initiatives exist to address challenges women face in medicine at Penn. FOCUS, an initiative to advance women’s leadership in medicine, is one prominent organization.11 Though there is still some room for growth, there is plenty to celebrate.
1. Correspondence with City of Sleepy Eye, Minnesota government office
2. Women in Medicine. Perelman School of Medicine University of Pennsylvania Alumni. https://www.alumni.upenn.edu/s/1587/psom/index.aspx?sid=1587&gid=2&pgid=27680
3. Dr. Alberta Peltz Wills Bulk of Estate to Two. December 11, 1952 (page 22 of 48). (1952, Dec 11). The Philadelphia Inquirer Public Ledger (1934-1969)
4. Corner G.W., Two Centuries of Medicine: A History of the School of Medicine, University of Pennsylvania.
5. “Timeline of Women in Medicine.” American Medical Association, 25 Sept. 2018, www.ama-assn.org/practice-management/physician-diversity/timeline-women-medicine.
6. “Total Enrollment by U.S. Medical School and Sex, 2015-2016 through 2019-2020.” American Medical Association, 2019, www.aamc.org/system/files/2019-11/2019_FACTS_Table_B-1.2.pdf.
7. “2018 Physician Specialty Report Data Highlights.” AAMC, www.aamc.org/data-reports/workforce/interactive-data/2018-physician-specialty-report-data-highlights.
8. Frank, Elena et al. “Gender Disparities in Work and Parental Status Among Early Career Physicians.” JAMA network open. 2.8 n. pag. Web.
9. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344–353. doi:10.7326/M13-0974
10. Adesoye T, Mangurian C, Choo EK, et al. Perceived Discrimination Experienced by Physician Mothers and Desired Workplace Changes: A Cross-sectional Survey. JAMA Intern Med. 2017;177(7):1033–1036. doi:10.1001/jamainternmed.2017.1394
11. https://www.med.upenn.edu/focus/
Faith Arimoro is an MS1 at the Perelman School of Medicine. Faith can be reached by email at [email protected].
