More women practice family medicine but still face gender-based challenges, says faculty members

Aug 29, 2019
While more women are practicing family medicine than ever before -the representation of women has tripled to 45.5% in the past four decades - women have yet to achieve equity in medicine. With the increased proportion of women in family medicine, we have seen numerous benefits to the profession, patient care and medical education, yet women continue to face gender-based challenges in their professional and academic careers that result in disproportionate rates of burnout and can have negative effects on their career trajectories.  

As they come to the end of the first five years of their careers in family medicine, University of Toronto Department of Family and Community Medicine faculty members Drs. Tali Bogler, Kim Lazare, and Vanessa Rambihar discuss and reflect upon the challenges that female physicians face in their early careers in an article in the Canadian Family Physician

The article highlights systemic challenges, which include overt harassment, pay inequalities, lack of women in leadership positions, and lack of comprehensive family-, caregiving-, and medical-leave policies. Female physicians are also often confronted with implicit gender biases held by their patients, learners, and colleagues, which lead them to be deemed as less capable, receive lower valuations, and be introduced as a doctor less often as a result.   

“I work in family medicine obstetrics, and I often had strangers or patients in hospital assume that I’m the nurse taking care of them and not actually the physician,” says Dr. Bogler, a family physician at St. Michael’s Hospital.  

Dr. Rambihar, a family physician at Women’s College Hospital, echoes a similar experience and explains that this lack of recognition as a physician may contribute to individual challenges with imposter syndrome.  

“Throughout my first five years in academic family practice, I have often been introduced or referenced without the title ‘Doctor’ by trainees and patients, in written communications, and on panels where colleagues have been introduced with their full titles,” she says. “Several of my mentors with similar past experiences suggested this might propagate feelings of imposter syndrome, encouraged me to ask to be referenced as my colleagues were, and suggested I question whether on a professional scale this was related to gender, seniority, or other types of implicit bias.” 

In the article, the three authors outline practical strategies in response to both systemic and individual gender-based challenges.  On a systemic level, the authors call for mandatory implicit bias training, flexible work policies and scheduling, and development of comprehensive family-, caregiving-, and medical-leave policies, among others. 

“Thinking about these leave policies and how to make scheduling more flexible – not just for women, but for everyone – will be an investment,” says Dr. Bogler. “But I think we need to invest in adequate and comprehensive policies because otherwise women will get burnt out and leave the profession.”  

Individually, the authors recommend open communication with colleagues and leaders on career goals, effective time management, proactive scheduling, outsourcing of domestic tasks, and setting boundaries as some of the adaptive strategies that women may take if they are struggling in their early careers. But most notably, reaching out to colleagues, finding mentors, and joining support groups to learn from others’ experiences on how they have navigated the situation are especially important, says Dr. Bogler.  Having these mentors to help support you through transitions or difficult times can be helpful.  

The first step towards addressing inequity is acknowledging that it exists. With this paper, the three authors hope to open a dialogue with physicians from all stages of careers and of all genders on the topic of gender inequity, and share experiences, suggestions, and propose solutions to help move the discipline of family medicine towards a more equitable future.