Medicine, with its somewhat tarnished history in this area, has become aware of the cause of inclusiveness. Not long ago, in the early 20th century, the American Medical Association (AMA) orchestrated reforms requiring immigrant European doctors to pass rigorous qualifying exams, which most American doctors themselves were very unlikely to succeed. Rather than concern about standards, it was largely a cynical turf-protection aimed at crowding out the better-trained doctors to whom patients turned. So how will his latest cause pan out? A passing fad, a hijacked platform or a revolutionary reform that will advance the field by leaps and bounds? Based on past precedent, if there is a draw, consider it a win.
That there are now more women practicing medicine is “no thanks” to the open-mindedness of the field itself. Women and societal pressures have broken down barriers. If it were up to the many pioneering “fathers” in this field in this country, women would either be secretaries or nurses who would do as they were told without making a fuss. Consistent with the norm in other fields, female doctors earn less doing the same work as their male counterparts. Tellingly, they make up about 65 percent of the pediatric workforce (low paid), but less than 10 percent in neurosurgery and about 5 percent in orthopedics. The greed and xenophobia that were stumbling blocks for European doctors establishing themselves have not disappeared either. One particular specialty imposed restrictions on its cohorts just north of the border, who received the same, if not better, standards of care. This was for the short-sighted motive of protecting the interests of a few of its own rebellious members, who were otherwise unable to hold on to disgruntled patients.
If we look at our professional bodies, our conferences, our departmental hierarchies or any other aspect of the organization, they do not reflect the reality on the ground when it comes to gender or ethnicity. Let’s say there is an “expert panel” of four people at a webinar, seminar, or working group of some size. Chances are the experts will be men. Or, they may aptly include the token female. Chances are, but for her gender, she is “one of them” and is constrained by many of the same beliefs, prejudices, stereotypes, and xenophobia. There's a good chance she's one of many people sought out for a politically correct appearance. Even in areas where women are in the majority, managers and decision-makers remain predominantly men. Yes, somewhere there are the “firsts” and the “chair” that can be described as “proof of progress”.
Despite recognition and some attempts to make the practice of medicine more egalitarian, results have been mixed at best. Perhaps the fault lies in the way we did it. Do practitioners fairly represent the entire population with respect to ethnic and gender diversity? Are advancement and opportunities in the field based largely on merit, or at least making meaningful progress toward that goal? Alas, the answer is no.
While it is important to recognize a problem to arrive at a solution, continuing to ignore the recognized deficit leads to nothing. This is one of the faults. For years now, we've seen a token number of women stand out among a crowd of men of various shapes, sizes and ethnicities. While some specialties have become more egalitarian in this regard or have simply been pushed to become so by the sheer numerical power of their female workforce, other specialties appear decidedly the preserve of an old boys' club . To save face, they can find a strange female who is helped with the horde of their blue-eyed boys. Among the many highly capable women, a few manage to make their way to the top through courage and a stroke of luck. The overall picture therefore remained unchanged.
Human nature and bias contribute to this dilemma. Most are inclined to have a more favorable view of someone who looks and talks like them. Many also tend to be part of a group or clique that tends to promote its own and avoid outsiders. Such tribalism is particularly evident in academia and can be almost amusing to observe at conferences. The smaller the subsection, the more apparent the different factions are.
To some extent, the case for more equal representation may also be undermined by some women themselves. Being part of the same culture, they are not impervious to xenophobia or cultural, racial or religious prejudices. Then there is the well-known phenomenon of women reaching the top and pulling the ladder behind them. Rather than helping or mentoring, they weaken the youngest and least experienced. Or, use their acquired power to satisfy petty past grudges against other women who they may perceive as a threat. For some, it's just not their purpose in life to uplift others. Some take advantage of the disparity to make hay while the sun shines. They loudly protest the gender gap and exploit gender and financial disparity statistics under the guise of speaking out as representatives while making the most of the issue for their benefit. It's no wonder that the representation of women at the forefront and in leadership doesn't seem to extend beyond the usual suspects.
The current situation invites us to rethink. How do we level the playing field for everyone? Platitudes, feel-good seminars, lectures and symbolism will not be enough. We must design an inclusive strategy at all levels. This will improve medicine.
Shah-Naz H. Khan is a neurosurgeon.