Women in medicine: The Henry Higgins problem

In a commentary in this issue of Respirology, Smallwood and Rees review the history of women in medicine and then focus on the status of women in pulmonology, raising several important issues that may help to solve disparities in opportunities, leadership positions and job satisfaction. They note that mentorship and sponsorship, focused grant and fellowship opportunities specifically for women and the use of current electronic communication opportunities that allow for flexibility, plus consideration of prorated benefits for part-time work (rather than foregoing them), would be helpful. And they suggest that encouraging and openly discussing the issues of disparity should aid in finding solutions. It is a useful and timely article, yet does this and other pieces that have appeared in various general and specialty publications in medicine go far enough in suggesting remedies? The most recent Association of American Medical Colleges (AAMC) data (2018) indicate that 25% of full professors are women, 18% of department chairs and 16% of deans—numbers that have not increased much in a decade, despite the number of women now in the pipeline. These numbers are higher than a decade prior, but the gains are seen as less than optimal. Substantial data have exposed examples of bias—judging male and female medical students differently, making assumptions about whether a woman as opposed to a man would be interested in certain positions, and ruling out certain opportunities by rendering them time-dependent, making it difficult for women who have taken time out to have children qualify, among others. As rightly noted by Smallwood and Rees, there is good evidence that women physicians provide patient outcomes equivalent or superior to those of men, possibly owing to more focus on the patient, better communication with patient and family and more time spent per patient. And surgical outcomes are also reported as equivalent. Not stated is the fact that women, in general, are naturally driven to share, to communicate and to listen—which, I would suggest, means that they may gather data and reflect, perhaps getting to the core of those symptoms that form an accurate diagnosis while providing comfort and confidence to the patient. Medicine offers a multiplicity of career choices—the well-known triumvirate of practice, teaching and research, plus other options such as medical ethics, administration, business and consulting, and medical writing. Beyond that, it is feasible to shift from one area of medicine to another during a career. Given the breadth of the field, all areas might be recast to reflect female traits that would improve every aspect of medicine. After more than 50 years in academic medicine, during which I have experienced a variety of actual and perceived prejudices and disappointments but overall, a modicum of success, I would proffer that many of the qualities we women physicians and scientists possess can be employed positively to enhance the practice of medicine and the performance of scientific studies. To imbue these fields and subfields with our positive feminine attributes, there must also be reassessment about those qualities considered desirable in men, but negative in women. A good example is the negative perception of ‘alpha women’ as compared to the positive opinions of ‘alpha men’. How do we feminize medicine and science? In a recent article, Bots et al. make several relevant recommendations that would encourage more ‘femalefriendly selection procedures’ in science—educating selection committees about overt and covert bias through gender champions, that is, persons who have expertise on hiring practices and the role of gender; using coaching and sponsoring for specific jobs to provide similar opportunities for women and men; and considering whether measures of success that presently value output volume should focus more on quality. Bots et al. also suggest that the use of artificial intelligence may identify traits and techniques that would facilitate gender bias-free hiring and promoting free of a priori judgement. A growing literature documents and offers personal observations and suggestions about ‘breaking the glass ceiling’ and engendering an end to disparities (see Refs). In 2006, the four female deputy editors (of whom I am one) at the New England Journal of Medicine wrote an editorial in which we commented about a research article by Jagsi et al. that reported persistent inequities in academic medicine. Among several points, we suggested that beyond the publication of further state-of-practice and tracking studies, it would be important to embark on qualitative studies that would evaluate the personal and professional aspirations of both women and men in academic medicine. We still have too few of such studies. In the 1964 Lerner and Loewe musical, My Fair Lady, Henry Higgins famously sings, ‘why can’t a woman be more like a man’, a catchy ‘number’ that encapsulates a vision underlying both of lack of understanding between and about women and men. Beyond the popular musical, this particular song applies to many situations and is relevant to those of us in medicine and science worldwide and to many observed professional disparities. Men have shaped medicine for centuries, but the time is now ripe for women, presently accounting for over 50% of those graduating from