From Today’s Christian Doctor – Summer 2012:

In 1975, the Christian Medical Society Journal published an article titled “The Physician and Her Husband” by Merville O. Vincent. Many of us were just children pretending to play doctor during recess at school when this article was written. At that time, Harvard Medical School had only been admitting female students for 30 years. So it’s easy to say that many of the questions raised in this historical article and many of the problems women in medicine faced at that time are now obsolete and outdated for today. And yet, its subject matter remains troublingly pertinent to many of the professional struggles female physicians face today. It’s shocking to realize how relevant the topic is almost 40 years later. The world tells us we’ve come a long way since 1975; on one level, this is hard to dispute. The statistics have certainly changed. At that time, medical schools were composed of 20 percent women and the physician workforce was 10 percent women, compared to 50 percent and 33 percent, respectively, today.¹ But when you consider the questions the author poses, it highlights just how stagnant we have been in the areas mattering most. For example, Dr. Vincent states, “Female physicians have received comparatively little attention (in research on physician well-being), and their husbands have been virtually ignored.” This has not changed since this was originally written. More importantly, Dr. Vincent addresses one central question, “Do women physicians have unique problems that are not experienced by other working women, or if married, by other working wives?” That query remains a critical question today. Christian women physicians feel they have been called by the Lord into medicine, and yet these unique problems remain unresolved and are a source of unending angst. Foremost among the unique problems faced by women in medicine is an ongoing crisis of professional identity. Though women are now generally accepted as professional and intellectual equals in the workplace, they remain subject to a different set of expectations from those governing their male counterparts. For example, though women and men are expected to carry the same workload in a medical practice, women physicians have been shown to have patients with more complex psychosocial issues, requiring 21 percent more time per patient.² Additionally, women are approached differently by their patients who expect more nurturing behavior and more time from women physicians as compared to men.³ In addition, women continue to experience gender discrimination in the workplace.⁴ They are frequently treated with less respect by staff as compared to their male colleagues.^5,6,7 For example, staff members often fail to address women as “doctor,” leading to patient confusion and misunderstanding. Furthermore, the practice of medicine has been shown to be more emotionally exhausting for women than for men. Studies in physician burnout show that men offer cognitive empathy to patients, while women offer emotive empathy which takes a bigger personal toll.⁸ Consequently, a woman with the same patient volume ends a day more depleted than her male counterpart. That burnout is expounded upon by other circumstances. GE Robinson reports that women may be professionally accepted by their male colleagues, but they remain isolated in terms of social events and career networking.⁹ As a result of the lack of clarity in their professional identities, women physicians experience twice as much burnout as their male counterparts.¹⁰ More significant are the findings that women in medicine sustain 2.5 percent more stress than male physicians. This is lessened by 45 percent when receiving help from home and 50 percent support from colleagues.¹¹ This rate of burnout can be mitigated by the presence of a senior female physician serving as a mentor.¹² However, the very same struggles of professional identity and the incumbent schedule stressors make these mentors less available to invest time shepherding others. The struggles continue outside of work as women physicians battle with traditional gender role expectations in their marriages, families and churches. Even when they work the same number of hours as their male colleagues, women perform 50 to 75 percent of the housework and childcare.^13,14,15 This creates “role strain” in trying to do too much, to the detriment of marriages and personal time. Barnett, Garieis and Carr reported that women who worked their preferred number of hours achieved the best work and family outcomes.¹⁶ When a woman physician feels pressure from her workplace to put in more hours, she feels further divided between her calling at home and her calling as a physician. That is why receiving support from both colleagues at work and family at home is critical to preventing burnout and keeping women in practice.¹⁷ However, women in medicine are often the primary income earners in their families, adding even further psychological stress. When husbands are unemployed or underemployed, the wives can feel pressure to perform, while the husbands feel marginalized.¹⁸ In Christian circles, this critical issue is often condemned rather than addressed, leaving these couples without tools to resolve the problem. The feeling of being torn between two worlds is magnified when a women is of child-bearing age.¹⁹ Dr. Vincent wrote that “pregnancy does differentiate men from women. Women in medicine should not have to ask for special consideration for this fact. Rather, the medical system should take this difference into consideration.” That statement remains true today as the system continues to treat pregnancy as it did in 1975. Women in medicine are often demeaned by their partners, fellow residents, supervisors and others during pregnancy.²⁰ Women can be shamed when taking time off related to pregnancy, with comments such as “This is singularly poor timing,” in response to preeclampsia and emergent induction. Similarly, motherhood and childcare responsibilities are often met with disapproval when women are criticized for taking time away from work, even when their children are ill. When it comes to the church, women physicians often feel like an anomaly as Christian women are criticized for taking time away from their children at all. However, church teaching typically addresses the needs of women who are functioning in traditional gender roles, not acknowledging the additional and unique needs professional women experience. These women are then left with solutions that don’t apply to them, and their needs remain unmet. Often women physicians report they are excluded from the community of women in their church when the other women learn about their careers. This only increases the isolation they feel. One woman physician summarized this dynamic, “It is easier to be a Christian in the healthcare marketplace than to be a professional woman in the church.” It is not just those women who are married with children who encounter struggles as single professional women often face added pressure as well. They can be targets for extra responsibilities at work. They are volunteered for committees and extra projects more freely since they “don’t have other obligations.” The church can also impose a similar burden, not realizing the overall workload being pushed on the individual. Church leaders sometimes compound this isolation by questioning the woman’s calling into medicine, stating it will decrease her prospects of marriage.²¹ In addition, single women in medicine regularly report difficulty in dating relationships as some men are intimidated by their careers or schedules. Men married to female physicians also find a void in the church where they feel isolated from the other men. As physicians, their wives “tend to be industrious, ambitious, aggressive, independent, and individualistic. These traits seldom fit society’s mold for the ideal woman”—and fit even less within the church’s mold.²² Therefore, husbands of physicians feel that much of the church’s teaching on marriage does not apply to the specifics of life with their physician wives. They feel marginalized in the church and do not know where else to go for the tools they need in their medical marriages. These are just a few examples of the challenges Christian women physicians experience together with their husbands and families. Their careers follow a far different path than their colleagues. Their patients expect more out of them. Their marriage endures distinctive conflicts. Their parenting style is unique due to their professional responsibilities. Their time is spent in vastly different ways than others. The list goes on. So what can each individual woman who experiences her own set of unique challenges and struggles do to remain committed to her calling in medicine? These individual experiences are so varied from one another that simple and standardized solutions for a group are rarely helpful to us as individuals. Although constructive support from colleagues, families and the Christian community can be helpful, it is up to the woman physician herself to examine and address her own assumptions and expectations regarding her roles. To help in this introspection, we can offer a few suggestions we’ve gained from both research findings and personal experience that we hope can be helpful:

• Recognize that a successful career in medicine is more like running a marathon than a sprint.
• Prioritize self-care as essential to enduring in medicine without burnout. Schedule regular time off for spiritual, physical and emotional development.
• Regularly triage activities to live in congruence with personal and family values.
• Respect your need for support in the various roles you play.
• Acquire healthy skills in requesting, delegating and hiring help where needed to negotiate a division of labor in housework and childcare that supports healthy family functioning.
• Develop assertive communication skills to promote family cohesion and a satisfying marital relationship.
• Negotiate patient volumes and scheduled work hours with a realistic assessment of the needs of your patients. While it may result in decreased income, recognize that seeing fewer patients may be the key to your personal well-being.
• Acknowledge that you will often not be able to meet the expectations of those around you. Prayerfully make decisions consistent with God’s expectations, regardless of other competing pressures.

In today’s environment, women fill an important place in the practice of medicine, offering skills and perspectives that patients increasingly demand. In the historical article, Dr. Vincent conducted a survey of 62 female physicians to gain insight into the topic. At a time when women were not considered to hold such an essential place in medicine, it is valuable to note that 92 percent felt medicine was a wise choice for them and they would choose the same career path again if given the chance, despite the problems and challenges they faced in the medical field. While we may not have conducted a survey of today’s female physicians, we are certain that statement remains true today. As female physicians, we can say from personal experience that medicine is still the wise choice. We value the struggles and difficulties we face on a daily basis in our workplaces, our homes, our marriages and our communities. Along with God’s guidance, those struggles and difficulties shape and mold us into who we are today. They fashion us into today’s Christian female healthcare professionals, depending on our faith in Christ to serve both Him and our patients. Medicine as our vocation is a calling from God, and it is a calling we would answer again if given the chance. Bibliography ¹ Statistics in original article are from Canada. Today’s statistics are essentially equivalent for U.S. and Canada. ² McMurray, JE, et al. “The work lives of women physicians.” Journal of General Internal Medicine. 15(6):372-80, 2000 Jun. ³ Mast, MS. “Dominance and Gender in the Physician-Patient Interaction.” Journal of Men’s Health and Gender. 1(4):354-358, 2004 Dec. ⁴ Shrier, DK, et al. “Generation to generation: Discrimination and harassment experiences of physician mothers and their physician daughters.” Journal of Women’s Health. 16(6):883-94, 2007 Jul-Aug. ⁵ Pringle, R. “Nursing a grievance: Women doctors and nurses.” Journal of Gender Studies. 5(2):157-68, 1996. ⁶ Zelek, B and Phillips, SP. “Gender and power: Nurses and doctors in Canada.” International Journal for Equity in Health. 2:1, 2003 Feb. ⁷ Schmalenberg, C and Kramer, M. “Nurse-physician relationships in hospitals: 20,000 nurses tell their story.” Critical Care Nurse. 29(1):74-83, 2009 Feb. ⁸ Shanafelt, TD, et al. “Relationship between increased personal well-being and enhanced empathy among internal medicine residents.” Journal of General Internal Medicine. 20(7):559-64, 2005 Jul. ⁹ Robinson, GE. “Stresses on women physicians: Consequences and coping techniques.” Depression & Anxiety. 17(3):180-9, 2003. ¹⁰ Op. cit., McMurray. ¹¹ Op. cit., Robinson. ¹² Coombs, RH and Hovanessian, HC. “Stress in the role constellation of female resident physicians.” Journal of the American Medical Womens Association. 43(1):21-7, 1988 Jan-Feb. ¹³ Myers, MF. Doctor’s marriages: A look at the problems and their solutions. New York, NY: Plenum, 1994. ¹⁴ Sotile, WM and Sotile, MO. The medical marriage: Sustaining healthy relationships for physicians and their families. Chicago, IL: American Medical Association, 2000. ¹⁵ Maass, VS. Women’s group therapy: Creative challenges and options. New York, NY: Springer, 2002. ¹⁶ Barnett, RC, et al. “Career satisfaction and retention of a sample of women physicians who work reduced hours.” Journal of Women’s Health. 14(2): 146-153, 2005 March. ¹⁷ Op. cit., McMurray. ¹⁸ Op. cit., Myers. ¹⁹ Op. cit., Sotile. ²⁰ Hutchinson, AA, et al. “Pregnancy and childbirth during family medicine residency training.” Family Medicine. 43(3):160-5, 2011 Mar. ²¹ Hotchkiss, NF. Personal communications in psychology practice with women physicians.

²² Op. cit., Robinson.