What It Takes for Women in Medicine to Be Seen and Heard

Dr. Julie Silver has diagnosed a problem in medicine: the low visibility and silencing of women physicians. And although the physical symptoms may not be obvious to all — that is, after all, the issue — it has lasting negative consequences. Increasingly, medical professionals are rallying in support of a cure. “There is a loud, loud roar about women being silenced and being made invisible. Women are unifying, together with many male allies, both virtually and in real life,” Silver said.

The erasure of women’s presence and voices in medicine and STEM fields generally — intentional or not — has driven Silver’s research, advocacy, and action for several years. Silver, associate chair and associate professor in the Department of Physical Medicine at Harvard Medical School and staff physician at MGH, BWH, and Spaulding Rehabilitation Hospital, has become a leading voice in the movement to increase the visible presence of women physicians both within the profession and societally.

“I decided to really show how women are being silenced,” Silver said. Her efforts gained national exposure in October 2016, when STAT published her critique of gender-based dynamics in medicine, “Invisible Women: Female Doctors and Healthcare Leaders Are Being Hidden in Plain Sight.”

The stark gender differences in physicians’ professional experiences are evident in salaries, promotions, research funding, consumer-facing marketing materials, and more. “My research with colleagues has shown that women are not recognized for their important work, and their knowledge and insights are not valued,” Silver said. “For example, in several studies, we showed that women physicians, in both surgical and non-surgical specialties, often receive none of the prestigious recognition awards given by medical societies. Women physicians are conspicuously absent as award recipients in categories such as lectureships where they would have an opportunity to speak to their peers and help shape the future of the specialty.”

A recent study Silver co-authored showed that although most pediatricians are women, women pediatricians are “underrepresented in all four high-impact pediatric journals for perspective-type articles. Silencing women physicians has had a profound and irreparably damaging effect on the healthcare workforce.”

Emerging data is also highlighting the suppression of women in grand rounds. A research letter published in JAMA in March 2017 pointed out that “women’s representation among academic grand-rounds speakers falls below the percentage of female medical students and residents, and often falls lower than faculty.” In addition, women physicians are not implicitly presented as on par with their male colleagues. “Even when women are invited as grand-rounds speakers, they’re introduced less formally and often not called ‘Doctor,’” Silver said. A 2017 study in the Journal of Women’s Healthfound that women introducing a male speaker used his formal title 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time on first reference. Fewer than 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the male introducers used women speakers’ professional titles on first reference.

Research is showing the cumulative impact of such everyday instances of bias. “In medicine, microinequities and microaggressions are often so pervasive that some people think it’s OK to be slightly disrespectful and just a bit condescending to women,” Silver said. “Actually, a culture of microinequities promotes microinequities — a culture where even more egregious behaviors, unethical and sometimes even criminal, may be fostered. Paying women less for equal work is outrageous, and increasingly illegal, as it should be.”

Silver is tackling the issue on multiple fronts. Last year, during the annual Harvard Women’s Leadership CME course, she spearheaded the Walls Do Talk Challenge. The contest was designed to highlight the implicit bias familiar in the ‘honor walls’ of many medical and academic institutions. The hallway portraits were unrepresentative of women and minorities, skewing the image of what a leader in medicine looks like, Silver pointed out. The campaign has already had an impact. In June, Harvard Medical School announced that it planned to relocate 31 portraits — all but one depicting white men — from a Brigham and Women’s Hospital amphitheater as part of its ongoing efforts to honor the increasing diversity of the profession.