Piling on the unconscious bias against female doctors By: Dr. Kathleen Brush

Some languages, like English, are androcentric. The he pronoun can refer to he and she or just he. The word doctors refer to male doctors, or male and female doctors. You can probably see the problem here: androcentric languages fuel bias by making the male gender the de facto gender. In the case of a doctor, sight unseen the assumption is they are male.

A patient is waiting for the doctor. In comes Doctor Smith. It would not be uncommon for the patient to think, wait a second, I want to see a doctor, not a nurse. When the patient finds out this is the doctor, he or she unconsciously decrements her competence but increases expectations that the doctor will be warm and friendly.

Most languages distinguish between male and female professions. The male version of a word refers to males or males and females, and there is a special word for female professionals, for example, in Italian il dottoreand la dottoressa,respectively. But this may not help perceptions of competence for female professionals, like doctors. Studies in Poland and Italy have shown that when women use the feminine form of their occupation, like la dottoressa in Italy, their patients decrement their perceived competence in advance of an appointment. If instead, they used the male and sometimes androgynous word, their situation resembles Dr. Smith’s common mistaken identity as a nurse and a competence downgrade. They do receive a consolation prize in the form of an unconscious increase in perceived warmth. That is a crummy tradeoff; the primary criteria used to select a doctor is perceived competence.

Whether a female doctor uses a gender-neutral doctor title or not, mistaken professional identities should not be occurring with the frequency they do. In some countries, people unconsciously assuming a doctor is a man would be wrong more than right. In Estonia, Germany, Latvia, Spain, and the United Kingdom, there are more female doctors than male. (I’m sure there are many other countries too.) In the United States, there are almost as many women doctors as men, and data on medical students indicates that women doctors will soon be a majority.

Some researchers have inferred that when women dominate male professions, unconscious bias and all the discriminatory outcomes, like decrementing competence that accompany bias will decrease. This may be optimistic. Patriarchal societies have existed forever, and men are not going to relinquish power easily.

Challenges for female doctors do not appear to be decreasing. A survey conducted by InCrowdfound that the number of female doctors that said being treated respectfully was a problem surged from 10 percent in 2018 to 36 percent in 2019. Their sense of inequality in the profession rose from 8 percent in 2018 to 34 percent in 2019. And in spite of near equality in numbers, the belief that medicine was male dominated rose from 4 percent to 15 percent. These are outcomes of increasing not decreasing bias.

Even though female doctors are ubiquitous in the United States, look at how unconscious biases are working in medicine to preserve the status quo. Arecent studyfound that while women introduced male and female doctors using their title 96.2 percent of the time, when men introduced female doctors, they were more likely to use their first name. If a man was introducing a male doctor, 72 percent of the time they introduced Doctor Male Name.

What’s in a name, right? Turns out a lot for female doctors. Honorifics, like Dr. Somebody confer confidence, competence and respect that Didi does not. In medicine the title doctor confers a high-status position, Didi broadcasts a subordinate. The Dr. Didi Smiths of the world already faces a host of women-specific challenges working in a traditionally male-dominated profession. This includes bias against her competence, sexual harassment, and more difficult marriages. Add to this a bias that results in being introduced as a woman in a white lab coat, while a bias against her male nurse results in being mistaken for a doctor.

In spite of some evidence indicating female doctors deliver higher quality care, female doctors have been unable to escape biased assessments of their competency, and the unconscious bias that assumes they are distracted by domestic responsibilities even when working equivalent hours to their male colleagues. These biases have been shown to influence pay and promotions. Female doctors are on average paid less – a lot less. According to a Medscape survey conducted from October 2018 to February 2019, female doctors on average worked 8-9 percent fewer hours than male doctors, but compensation for female general and specialty practitioners was 25 and 33 percent less. Another survey by Merritt Hawkins in 2018 found that on an hourly basis female doctors were paid about 40 percent less.

When it comes to who gets promoted, the situation is strikingly unequal. Even though women make up 80 percent of the workforce in medicine, they have only 20 percent of key leadership positions. Compared to Germany where women make up 11 percent of leadership positions in medicine, the United States seems progressive. It’s not. It would be progressive if it was 80 percent – certainly at least 50 percent. Imagine if this were the case. Women would be dying less frequently because treatments and prescriptions they received would probably be devised for women, rather than men. A 2019 study published by the Medical Journal of Australia said that: “Historically and consistently across a broad range of health domains, data have been collected from men and generalized to women.” Dr Janine Austin Clayton for the US National Institutes of Health said: “We literally know less about every aspect of female biology compared to male biology.”

It’s known that women in male-dominated professions face more unconscious bias than in other professions, but when women face more bias in formerlymale-dominated professions this is one more sign that patriarchal societies that subordinate women are not going down without an unconscious fight. This will include diminishing a woman’s professional confidence and competence by calling her Didi when she is Doctor Diane Smith.

“First they ignore you. Then they ridicule you. Then they fight you, and then you win.” Mahatma Gandhi.

BUY HER BOOK: The Power of One: You're the BOSS