If you want to find examples of trailblazing women in healthcare, you don’t have to look very far. At Cincinnati Children’s, Bea Lampkin, MD, was the first woman in the nation to hold a division director position in Hematology/Oncology (1973-1991). Marilyn Gaston, MD, established the sickle cell disease program here in 1972. Uma Kotagal, MBBS, MSc, became an international pioneer in the field of quality improvement, and Peggy Hostetter, MD, was the first woman to chair the Department of Pediatrics and direct the Cincinnati Children’s Research Foundation—a position now held by Tina Cheng, MD. Jane Portman served as our first female board chair, Liza Smitherman succeeded her in that role, and of course, Patty Manning, MD, just retired as our first woman chief of staff.

So, all is well on the gender equity front, right? Ummm, not exactly.

In 2023, gender bias is still a force to be reckoned with on the national front, particularly among physicians. That includes pediatricians, even though 70% of pediatricians in the U.S. are women.

Inspire talked with Jennifer O’Toole, MD, MEd, director of the Internal Medicine and Pediatric Residency Program, and Jennifer Reed, MD, MS, an attending physician in Emergency Medicine. O’Toole serves as co-president of Women in Science and Medicine (WIMS), an affinity group at Cincinnati Children’s, and Reed is on the WIMS Executive Council.

“I’ve been participating in advocacy work around gender equity in medicine for about five years now,” says O’Toole, who co-edited the book Women in Pediatrics: The Past, Present and Future. “Although women make up two-thirds of the pediatric field, we still struggle to reach the highest levels of rank and leadership. Nationally amongst all specialties, only 25% of us are full professors, 20% are department chairs, and 18% are deans at medical schools. In pediatrics, we are ahead of that benchmark with 40% who are full professors and 25% who are department chairs. It’s improved a lot in the past 20 years, but we still have work to do.”

Gender equity gets even more nuanced for women of color, women with disabilities, women who identify as LGBTQ+, and women of different nationalities or religious backgrounds.

“This intersectionality adds a whole other layer of complexity and challenges,” says O’Toole.

Assumed Identity

Gender bias manifests in both blatant and subtle ways.

Says Reed, “On a daily basis, I meet families who mistake me for a nurse, although I clearly introduce myself as Dr. Reed, the attending in charge. And, if I’m with a male resident, the family will look to him as the expert, even though he is a trainee, and I have 25 years’ experience.”

Although patients and families often make assumptions based on old stereotypes, sometimes there is a cultural preference about the gender of a physician, particularly when sensitive examinations need to be performed.

“I try to be respectful of that,” says O’Toole. “It’s important to listen to families’ concerns and accommodate them, if possible. In cases where it’s not, I reassure them that I am fully qualified to provide care for their child.”

Female physicians deal with other microaggressions, as well, including:

• Being tasked with office “housework,” such as sending flowers when a colleague has a baby or organizing a meal train if a coworker is ill. “While it does help to promote a supportive culture, this work is not funded, and it doesn’t contribute to advancement. Women more often do these types of tasks as compared to men,” says O’Toole.
• Instances in meetings or on discussion panels where male physicians are introduced using the title “doctor,” while a female physician is called by her first name. Says O’Toole, “It may not seem like a big deal, but the word ‘doctor’ is so powerful. I always use it when I introduce myself to patients and when I introduce my trainees, especially if the resident is a woman.”

The Parent Tax

Gender equity greatly influences career trajectory, compensation and even family planning.

“There are a lot of practices that can hold a woman back,” says O’Toole. “Parental leave is one of them. Fortunately, at Cincinnati Children’s, we’ve made great strides with our leave policy. Years ago, only women could take time off after having a baby. Now, both parents are eligible for time away, which normalizes taking leave.”

Normalizing leave is an important step in diminishing the negative perception that often surrounds taking time away from work to care for children. That negativity has contributed to higher rates of infertility among women physicians.