“When are you going to give birth?”: How does sexism prevent you from building a career in medicine
In medicine, sexism is often encountered not only patients, but also female doctors — and for those who are not involved in this sphere, this may sound unexpected, because the majority of medical professionals are women. We understand who divides medical specialties into "female" and "male", how many doctors and nurses are faced with harassment, and what can be done about it.
Text: Evdokia Tsvetkova, endocrinologist
"Shameless asexual creatures"
In antiquity, care for the sick and many household medical manipulations were a female prerogative - but as soon as the development of medicine as a profession began, men declared a monopoly on it. Since antiquity, only men were allowed to learn the art of healing. The names of women who have become exceptions - Merit-Ptah, Aspasia, Trotula - can be counted on the fingers, and they are known exclusively as gynecologists. If their scientific interests affected something other than obstetric aid, the story did not preserve this data. Until the end of the XIX century, women did not have the opportunity to get higher medical education and apply for something more than the position of sister of mercy or midwife. The knowledge of obstetrics and caring for the sick was passed on to women in religious communities.
They began to break the tradition relatively recently - a couple of hundred years ago, and not always openly. So, nee Margaret Ann Balkley lived a long life, graduated from the University of Edinburgh and practiced as a military surgeon under the name of James Barry. The secret hidden by the woman was revealed only after her death. Under her present name, she received the first Elizabeth Blackwell medical diploma in 1849. The rector of the Geneva College gave the decision to enter the university at the mercy of the students, with the condition that if at least one out of one hundred and fifty people voted against, the woman would not be accepted - and everyone voted for.
In 1850, the world's first Women's Medical College, Boston, was founded. Its founder, Samuel Gregory, considered obstetric care too simple for male doctors and created a women's college to rid men of this occupation. True, the program of the educational institution did not provide for full qualification and admission of female students to clinical practice - and without it a full-fledged medical education would not be obtained; the college was soon disbanded. Fallen banner picked up the Pennsylvania Women's Medical College, where women from all over the world began to come. XIX century newspapers described women receiving medical education as "asexual, shameless creatures, by their very appearance discrediting the noble title of lady," but the process was unstoppable.
In 2019, experts compared the characteristics of gender discrimination in 187 countries over the past ten years, and in the overall ranking Russia ranked 121st
The first Russian woman doctor was Nadezhda Prokofievna Suslova. Because of the government ban on women attending lectures, even as volunteers, she left Russia and entered the medical faculty of the University of Zurich. A year after graduation, Nadezhda returned to her homeland to work as an obstetrician-gynecologist. Varvara Andreyevna Kashevarova-Rudneva became the first woman to receive a higher medical education in Russia, and not abroad, in 1863. She in 1876 became the first woman in the country to defend her dissertation. However, she was never allowed to practice and only helped her husband-doctor in his work. After the death of her husband, Varvara Andreevna was subjected to public persecution - newspapers published mocking cartoons and published angry articles, after which she moved from the capital and worked as a rural doctor until the end of her life.
In our country, the first women's medical courses ("A special female course for the education of midwifery scientists") opened in 1872 in St. Petersburg, and in 1897 the first St. Petersburg Women's Medical Institute was established. In 1917, after the change of power, the system of training medical personnel changed, and only then women became commonplace in medical schools.
Of course, this was not the end of gender discrimination in the labor sphere (including medicine), which still exists today. In 2019, experts compared the characteristics of gender discrimination in 187 countries over the past ten years, and in the overall ranking Russia took the 121st place. The rating was compiled taking into account thirty-five criteria in various fields: labor, property and family law. Gender inequality was found in a quarter of the countries studied. The average global rating was 74.71 out of 100 maximum points. Russia received 73.13 points in the rating and is adjacent to Morocco and Uganda. According to the World Bank, the problems associated with wages and the beginning of a career.
"Surgery is not for girls"
Already during her studies at a medical college, students are being pressured in matters of their future specialty. “Surgery is not for girls,” “How will you lead a family with an unregulated schedule?”, “A pregnant woman should look only at the beautiful — which forensic scientist ?!”, “Girls need to learn from pediatricians in order to treat their children” - all these phrases Many have heard more than once during their studies. According to endocrinologist Anna S. (the names of the heroines are changed at their request. - Note ed.), who wanted to become an operating gynecologist and actively attended circles on topographic anatomy, under pressure from teachers, she chose another — more “female” specialization. There are those who manage to ignore insults, although it is not easy. Her experience was shared by a surgeon-coloproctologist Eugenia T.: the doctor tells how on duty in the surgical department and the general surgery internship she was constantly subjected to misconceptions and jokes in the spirit of "How will you stand at the table [operating room], take care of your legs - on them no one wants to look, "" Place women at the kitchen table, not surgical, "and the like.
Unfortunately, in the view of many, including doctors, the specialties are divided into "female" and "male." According to the results of a sociological study of Marina Kovaleva, while writing a thesis on the “Gender Status of Women in Modern Medicine”, it turned out that female doctors have more difficulty in mastering a profession than men. The reasons for this are seen both in the polyfunctionality of the “female” social role (unpaid domestic work) and in the social prejudices that exist in society. For 2017, women accounted for only 19.2% of surgeons in the United States.
In addition to the possible difficulties in training, women doctors in Russia often face a denial of employment due to the presence of children or the likelihood of their occurrence. Specific data are not given here: statistics, unfortunately, are not kept. But often during a job interview, the second question after "What did you graduate from?" becomes "When do you plan to give birth?". According to the doctor Alexandra K., she even had a situation when she was denied employment, arguing that she was a young woman, of course, she plans to acquire a husband and children in the near future, which means: “Well, why are you ? "
Glass ceiling
In 1991, the US Congress found that, despite the increased number of female workers, they were still under-represented in leadership positions. The commission that studied this phenomenon, in a report from 1995, confirmed the artificiality of the erected barriers that prevent women from reaching managerial positions. These barriers include social (associated with gender prejudice and stereotypes), managerial (associated with insufficient consistent government control over the observance of the rights of citizens of the country), internal and structural (due to personnel policies of the institution). The commission also found that even women in leadership positions had lower pay than their male counterparts. In addition, the findings of the commission showed that women's leadership positions were mainly represented in the areas of personnel management and accounting (in Russia in 2018 the situation is exactly the same).
The gap in the wages of men and women, according to data for 1983-2000, was 21% in the United States. According to the data of the Ministry of Labor for 2018, the wages of women in the world are on average 16–22% lower than men’s. In Russia, this figure is 28%. However, in recent years, the gap has narrowed - in 2001, men received an average of 37% more women. Deputy Prime Minister Olga Golodets at the opening of the forum “The Role of Women in the Development of Industrial Regions” stated that the average wage of women in Russia is 70% of the salary of men. Golodets tried to explain the inequality by saying that "women do not achieve the same level of education and career growth as men".
With regard to the medical field, the level of education among workers is the same - and the difference in salary may be due to gender discrimination in the workplace or discrimination in relation to which profession or position women can occupy. Research results also show that working mothers face an additional pay gap compared with women who do not have children (about 7%).
Although women make up almost 78% of the health workforce, there is a gender gap in senior management
According to the American College of Health Managers (ACHE) for 1995, although women make up almost 78% of the health workforce, there is a significant gender gap in senior management and executive management (in the health care manual, 11% of women compared to 25% of men, 46 % and 62% respectively). Moreover, women managers are usually represented in specialized areas, such as nursing care, planning, marketing and quality control, which do not belong to the usual career paths to leadership positions. ACHE also reports the wage gap between men and women in senior positions. With an equal level of education and work experience in 2000, the gap in average annual wages of women and men was 19%.
In a subsequent report from ACHE in 2006, there was a shift of women to the highest levels of hospital management (44% of women and 57% of men). But the wage gap continued to exist, and women as a whole earned 18% less.
Epidemic harassment
The difficulties of working in the men's team are faced not only by representatives of traditionally "male" specialties. Mischievous jokes among colleagues and management, according to medical experts, are frequent. According to sociological studies, the general attitude of the team and leader is important for the formation of the atmosphere. So, when joining a social group where such behavior is considered acceptable, even those who were not prone to sexism perceived a local standard of tolerance for discrimination. Especially sad is the evidence that sexist jokes contribute to the formation of prejudice and the adoption of stereotypes in women working in a team.
Sexism on the part of patients towards women of traditionally "male" specialties is, for example, a request to change the surgeon from a woman to a man. According to general surgeon Catherine P., once such a thing happened to her at the very beginning of her career, but, unfortunately, no one leads statistics in Russia, so it is impossible to reliably argue about the frequency of such cases. There is practically no talk of harassment in medical institutions in our country either, although in other countries we are already talking about a "harassment epidemic in hospitals."
A 1995 study showed that 52% of women in medicine were sexually harassed at least once. According to a 2016 study that included 1,719 women, 62% of them were harassed (of which 30% were sexually motivated). Of the sexually harassed (150 people), 40% describe its severe forms, and 59% noted the negative consequences of what happened in their professional activities. Inna S., an ophthalmologist, says that she was forced to change her residency since the head of the department locked her in her office, refusing to let her go until she agreed to have sex.
A 1995 study showed that 52% of women in medicine were sexually harassed at least once.
According to the #MeToo movement, medical sisters and women doctors are often harassed not only by colleagues (often occupying a higher position - managers, teachers), but also by patients. It may include persistent invitations to meet in an informal setting, attempts to give expensive things with persuasion for subsequent relationships, attempts at physical contact, a proposal to fund research in exchange for sex. Christina P., endocrinologist, recalls how a patient once learned her address and was on duty at the door with flowers; Psychiatrist Alexandra K. tells about the patient's harassment from the patient. Medical nurses and residents of the clinic shared stories about how they were solicited in single rooms, cutting off the way to the exit; Nurse Love N. told how once on duty a patient in her underwear came to her with a request to sleep in nursing with her.
In this regard, the video of the Med2Med medical channel is very revealing, full of strategies for “avoiding harassment”: instead of publicizing the actions of the aggressor, it is proposed to behave “non-defiantly”, avoid the aggressor, and not be alone with him. According to a 2018 study, gender discrimination and harassment at work reliably affects the mental and physical health of women.
Discrimination in science
Doctors are not only practitioners, but also scientists, and can work not only in hospitals, but also in university departments. According to the UNESCO Statistical Instrument, in 2018, the share of women in world science was 28.8%. In Russia, according to Rosstat, in 2016, 370,379 researchers worked in science, 40% of women. Until now, in the view of many, the division of science into "female" and "male" specializations is preserved. The overall picture of women's employment in research and development has remained stable over the past twenty years, although on the whole a shift towards the "maturing" of science is still being noted. Thus, in 1995, the share of female researchers was 48.4%, and in 2016 it decreased to 40%.
Among the disciplines united in the English-speaking environment into the group STEMM (science, technology, engineering, mathematics and medicine - science, technology, engineering, mathematics and medicine), men still noticeably prevail. In the new work, researchers from the University of Melbourne in Australia analyzed 9.7 million articles from the PubMed and arXiv databases. In the automatic mode, it was possible to determine the gender of 1.18 million authors of 538,688 articles published since 1991. Of the 115 disciplines reviewed in 87, the proportion of women was less than 45%.
Women working in science receive an average salary of 26% less than men (data for 2015). In teaching, men earn an average of 16.3% more than women. There are a clear minority in the posts of managers in the science and education of women: 13.3% among the rectors of universities of the Ministry of Health. The average income of women directors of institutes is 66.9% of men's salaries, and of rectors - 89.2%.
What can be done
The state program implemented in the USA allows to gradually reduce the wage gap between men and women. And in China, they recently banned women from asking about family and children when hiring and removed a pregnancy test from the list of mandatory tests for medical examinations. We don’t have to talk about help from the state, but we can do something - for example, not to support mischievous jokes and the sexist atmosphere in the team and publicize cases of harassment.
When trying to discriminate when applying for a job, you can refuse to discuss personal issues (about family, marriage, having children or plans to start them), record interviews on a dictaphone (warning you to make a recording, because during the discussion personal data or information that may appear) state or commercial secret), carefully examine the employment contract and, if necessary, discuss the introduction of changes. The employer can be held accountable in court because of unlawful refusal of employment. And perhaps the most important thing is to talk about the problem. It's like with health - if we hide our "complaints", then we will not wait for "diagnostics" with "treatment".
Photo: Piman Khrutmuang - stock.adobe.com, Joytasa - stock.adobe.com, New Africa - stock.adobe.com
