By Dr. Dagny Zhu
In my 13+ year-long journey to becoming an eye surgeon, I worked and lived everyday believing that gender inequality in medicine was a relic of the past. I trained during a time when more women than men were graduating from medical school. In my ophthalmology residency class, five out of six of us were women. In my cornea and refractive surgery fellowship at the number one eye hospital in the country, three out of four of us were women. Throughout my training, I had access to prominent female attendings and mentors who showed me that it was possible to “have it all.” I was convinced there was nothing a male physician could do that a woman physician couldn’t.
But that all changed once I graduated and entered the real world practice of medicine.
At one of my very first job interviews, the senior male surgeon asked me swiftly and bluntly,
“When are you planning to get pregnant?”
I was shocked and had no idea how to respond except to tell him what I knew he wanted to hear.
“Not anytime soon,” I replied.
It was at that point that I realized that the medical training, surgical skillset, and work ethic I had acquired over the past decade were not enough. My suitability for the job was overshadowed by my gender and the inherent biases that came with it—reduced productivity and a lack of commitment. Unlike the safe haven of academic training, the real world of medicine was all about the bottom line, and I was a walking (soon-to-be pregnant) financial liability.
I never took that job nor the other job offers from the predominantly senior male practice owners I encountered (women make up only 8% of refractive surgeons and a quarter of practicing ophthalmologists). I decided to buy a practice down the street, and in 2020, after having a baby in the middle of a pandemic, I achieved a record year in production while balancing motherhood as a new mom.
As the sole surgeon at the practice, I rushed back to the OR after only 5 weeks of maternity leave and found ways to pump discreetly at work, all while balancing a needy newborn at home and double the surgical load. It wasn’t easy, but it reaffirmed my assertion that doctor moms were resilient, multi-tasking, problem-solvers, and far from the liability that some employers believed us to be.
Gender bias in medicine is an ongoing, problematic occurrence today. But because it is largely unconscious, it is both ubiquitous and difficult to discern. When I was asked about my pregnancy plans at my first job interview, I was taken aback, but couldn’t quite pinpoint exactly why it made me feel so uneasy at the time. I now know that what he did was a form of gender and maternal discrimination and 100% illegal according to the Pregnancy Discrimination Act (PDA) of 1978 (an amendment to the 1964 Civil Rights Act).
While women physicians have made huge strides since Elizabeth Blackwell, the first female physician in the United States, graduated from medical school in 1849, women still make only $0.66 to $0.75 for every $1 a male physician makes. And while there are more female leaders in medicine today than ever before, women make up only a tiny portion of department chairs, hospital CEOs, and practice owners. The reasons for the gender pay gap in medicine are complex, multi-factorial, and in fact, not always related to gender bias.
However, some have gone as far as to call it a myth:
Women simply choose to enter lower paying specialties, perform less lucrative procedures, see fewer patients, and bill less overall—they say. But with the majority of physician-mothers carrying the burden of family responsibilities over physician-fathers at home, it becomes clear that those decisions are not always by choice.
We are also learning more and more that women physicians are being paid less for the same work done. A recent study published in Ophthalmology revealed that female ophthalmologists earn significantly less (~$33,000) than their male colleagues in their first year out of training despite controlling for demographic, educational, and practice type variables including workdays and OR time. While the reasons for this discrepancy remain unclear, it begs the question of whether employers are (unconsciously or not) viewing and treating female physicians differently from their male colleagues in regard to compensation.
Indeed, a well-known ophthalmic consultant on a healthcare podcast recently attributed the lack of well-trained “gonzo workaholic” surgeons to the new generation of physicians who strive for a “balanced lifestyle” and young female surgeons who “naturally want to be forming a family” and work only part-time. In those few words, female physicians were characterized as less driven and less productive than their male counterparts, thereby reinforcing hackneyed stereotypes that further perpetuate gender inequality in medicine.
One thing we know for certain is that the pay gap between male and female physicians is not a reflection of the quality of patient care provided. Studies have shown that women primary care physicians spend more time on average with each of their patients during office visits.
In a highly publicized 2017 study, patients of female surgeons had fewer surgical complications, lower hospital readmission rates, and an overall lower risk of dying in the first 30-days compared to their male counterparts. Regardless of gender, the fight to reform physicians’ pay to more accurately reflect the quality of care provided remains an ongoing battle in medicine today.
The good news is that we’ve come a long way, but there is still much to do. Just like the reasons for the gender pay gap in medicine are complex, the solutions to the problem are multi-fold. We need to encourage shared delegation of family responsibilities at home, provide more support for working moms in the workplace, facilitate career advancement for women, and increase compensation transparency in medicine. Most importantly, we need to acknowledge the problem and put an end to the implicit gender biases that we all have.
Keeping an open dialogue and engaging in difficult conversations like this one go a long way towards making gender inequality a true remnant of the past for the next generation of physicians.
Dr. Dagny Zhu is a Harvard-educated, board-certified ophthalmologist who specializes in cornea, cataract, and laser refractive surgery. She was born in Shanghai, China and immigrated to the United States with her working-class parents at the age of 3. Dr. Zhu received her M.D. from Harvard Medical School where she discovered her love for ophthalmology and performed cutting-edge research on corneal immunology at Harvard’s Massachusetts Eye and Ear Infirmary. As a medical student, she co-founded the Medical Mandarin course for doctors-in-training and embarked on a medical mission with Operation Burns in Mumbai, India where she worked alongside plastic surgeons to treat burn victims with debilitating skin and eyelid contractures. Dr. Zhu then returned to her home in Southern California to complete her ophthalmology residency at the prestigious Doheny Eye Institute/University of Southern California (USC) + Los Angeles County Medical Center, where she served a predominantly Latino community and cared for the sickest patients at one of the largest public hospitals in the country. She has also completed a fellowship training in cornea and refractive surgery at Bascom Palmer Eye Institute, the #1 eye hospital in the world.
