Another 138 years?
As I was nearing the end of my four years at Harvard Medical School in 2009, I was faced with the crucial decision of every medical student. What specialty would I go into? I was very interested in orthopedic surgery and even did two sub-internships in this specialty. I love the musculoskeletal system and being able to fix things with my hands. So what turned me away?
During my rotation, I met twice with my clerkship director, who happened to be a white male surgeon. As we were chatting in his office, I glanced at his roster of the different classes of residents. I couldn't help but remark, "I don't see any women in the intern class!" Dr. Hale (name changed) simply replied, "We would have loved to match a woman, but we didn't have any qualified candidates."
He then went on to point out that in the second and third year classes, there was one woman in each class of 12 residents. He indicated a petite young woman who was in the fifth year class. "The problem is, some people don't look like doctors. Like Sarah, she's so small that when she puts on her white coat, she practically disappears. She looks like a kid playing dress up. One time we were doing a hip replacement on a bigger patient, and she was really struggling to hold his leg up."
At the conclusion of my meeting with Dr. Hale, I asked if he would be willing to write me a letter of recommendation for my application in orthopedics. For a competitive specialty such as ortho, it is imperative to get a letter from your clerkship director. Not having such a letter would have been an absolute no in being able to match for residency. In essence, he was the gatekeeper.
Dr. Hale paused for a moment before answering. "Why don't you do one more rotation in ortho. And if you still really like it, then come back to me and ask me again." I felt confused and conflicted, not understanding why he had said no. I had worked hard during my rotation and had earned solid Step Exam scores. But I listened to Dr. Hale and did a second rotation in orthopedics where I was dismayed by the amount of sexist banter in the operating room. I wanted to be tough, but I knew there was no way I could handle training in this type of environment for five years. I never went back to ask Dr. Hale if he would write me that letter after all.
Was my experience an outlier? It would seem not.
According to this new study on The Gender Gap in Surgical Residencies by Bennett, et al, 138 years is how it will take until the number of women in orthopedic residencies equals the number of men, if things continue at the current rate of change. At a time when there are now more female than male medical students, this study points to there being a strong and active discriminating factor against women going into orthopedics and other exclusive specialties, such as neurosurgery and urology. Is it surprising that these are the same specialties with the highest compensation in the field of medicine?
No one explicitly told me, "Don't apply in orthopedics." I never heard an attending say, "Women shouldn't be surgeons." But I do wonder - if I had been a man, would Dr. Hale have questioned my sincerity in wanting to become an orthopedic surgeon? Or denied my request for a letter of recommendation? I've wondered about which implicit messages are told to women and people of color in medicine. How many of these messages are old scripts handed down generation through generation by those who held all the power and wished to keep it that way?
As I was nearing the end of this blog, I expected to finish it on a somber note. Instead, I am surprised and thrilled! Out of curiosity of how things are now, I checked out the Harvard Combined Orthopedic Residency website. The third through fifth year resident classes are exactly like I remembered with 0-1 women per class of 12. But the first and second year classes tell a dramatically different story with one class even having a majority of women. It's incredible that the number of women has risen from 0% to 58% in the last few years. The number of POC residents has also surged.
While the majority of this country's surgical residency programs are lagging in accepting women, this one has turned things around 180 degrees. This shows that change is not easy, but it is possible. I can't be certain if this is related, but the residency director is now Dr. George Dyer, who is a Black orthopedic surgeon. Being a minority in a white dominated field, I would suspect, makes Dr. Dyer a less biased gatekeeper in the evaluation of residency applicants. I'm doubtful that it was a dearth of qualified candidates that kept prior years' numbers of women low rather than the barriers in applying and being chosen in a field that is overwhelmingly run by men.
Progress is intentional. It does not happen by accident. But with having intentional goals and being aware of each person's biases, we can change the landscape of medicine. It does not need to take another 138 years.
Time that it will take for women to equal men in surgical residencies, by specialty:
Plastics: 7 years
ENT: 19 years
Neurosurgery: 47 years
Urology: 71 years
Orthopedic surgery: 138 years
Paper cited: https://jamanetwork.com/journals/jamasurgery/article-abstract/2768489
And if you wondering whether women surgeons measure up in the quality of care they provide for patients post residency - it turns out they actually do better.