The issue of maternity leave for house officers is a relatively new one. In the 1950s, residency training programs didn’t have to worry about developing specific policies regarding leaves of absence for new mothers for two reasons: First, at that time, there were very few women in medicine; and second, many programs strictly prohibited house officers of either sex from being married. Over the past thirty-five years, however, this situation has changed dramatically: Today over 50 percent of the 105 house officers who make up our program are women, and the majority of these women are married. In recent years we’ve averaged about five new babies born to female house officers annually. As a result, a definite plan regarding maternity leave has been developed, with the intern or resident receiving about three months away from the hospital around the time of delivery.
The development of this plan has been met with mixed reactions from the house officers, both male and female. After all, if one person is given three months off, someone else is going to have to fill in for her. An attempt is always made to spread the coverage evenly, but often a few people wind up doing what they consider more than their fair share. This leads to resentment directed toward the person on maternity leave, resentment that may stay with her through the rest of her training.
But the problems that female doctors face are certainly not limited to these issues surrounding maternity leave. Discrimination against all women in medicine is rampant. Although the foundation of this discrimination is rooted in the past, when medicine was exclusively a male profession and when house officers were referred to as “the boys in white” and specialists such as ear, nose, and throat surgeons were called “ENT men,” the image lives on in the public’s mind. It lives on mainly because the medical establishment, which at this time is composed of those “boys in white” of the 1940s and 1950s who have grown up and taken charge, perpetuates the myth. And so the acceptance of women as medical equals of men is a difficult goal to attain.
It’s easy to see examples of discrimination. In our emergency rooms, any male who has contact with a patient is immediately referred to as “Doctor” by the patient’s parents, regardless of whether he is a doctor, a nurse, a medical student, or a clerk. Any female, no matter how senior or expert, is automatically assumed to be a nurse. At the beginning of the year, the female interns take great effort to correct the parents; they explain that they’ve gone to medical school, have graduated, and are just as much doctors as any man; but as time passes and it becomes clear that these explanations are doing little to change the public’s conception and actually are creating hostility between doctor and patient, the women try to ignore what they consider this slight, managing just to cringe a little and swallow hard a few times when it happens.
And patients often believe that women can’t do as good a job as men when it comes to the technical aspects of medicine. I’ve seen it a hundred times: parents refusing to let the senior resident, who happens to be a woman, draw blood, do a spinal tap, or start an IV on their child, demanding that the male doctor in the next examining room, who happens to be an intern, try the procedure first.
But the patients clearly are not the only ones who discriminate against female doctors; it’s also firmly entrenched in academic bureaucracy. Thus far, few women have achieved positions of authority at medical schools in the United States. As an example, only a handful of the chairmanships of pediatric departments, the specialty with the largest percentage of practitioners who are female, are held by women. Part of this is due to the fact that until recently there weren’t many senior physicians who were female, but part is definitely because qualified women are frequently not offered a job when an equally qualified male candidate is available.
Also, it becomes difficult for female doctors to deal with nurses, the majority of whom also are women. A good intern has to be aggressive, but aggressiveness is not a trait that is viewed as acceptable in women. When a male doctor orders a nurse to perform a task for his patient, it is viewed positively; he is just carrying out his responsibility. When a woman is the one who requests that a nurse do something, she is regarded as “uppity” and a troublemaker. It’s a bind that is difficult for the female house officer to resolve satisfactorily.
These issues present an enormous identity problem for the female intern. On the one hand, she’s not getting equal treatment from her patients or from the nurses; on the other hand, she has few or sometimes no role models to guide her in her training. Very often this second problem is more serious than the first.