In 1847, Elizabeth Blackwell became the first woman admitted to a U.S. medical school. Inspired to pursue medicine by a dying friend, Blackwell would eventually be admitted to Geneva College, a school in rural New York. Whether Blackwell knew at the time of her admittance or not, she enrolled despite Geneva offering her admittance as a practical joke. In classes, she would be separated from her classmates during labs and lectures and shunned by the locale.
Nonetheless, Dr. Blackwell graduated two years later first in her class, and in 1851 opened a practice in New York City that offered care for poor women. Throughout her career, Blackwell made the initiative to specifically hire women physicians, trailblazing a pathway into the medical industry not previously open to women before her.
174 years later (as of September 2021), there are more than 392,500 women physicians practicing professionally in the United States (although this does only account for 37% of practicing physicians). Despite the progress that has led to more women physicians, the systemic barriers still limiting accessibility to the profession for women have been exacerbated by the Covid-19 pandemic. This National Women Physicians Day–celebrated annually on February 3, Dr. Blackwell’s birthday–we take a look at some of these barriers and the importance of their abolition.
The Disparate Impact of Covid-19
At this point in the pandemic, the disproportionate impact of Covid-19 on working women is well known. The employment rate for adult women (54.3% reached its lowest point since September 1988 (54.1%). Despite its essential role in helping navigate the pandemic, the healthcare industry has not been exempt from this impact and still remains 200,000 jobs short of its employment numbers in February 2020.
And unlike the world outside of healthcare, the employment of women physicians were disproportionately impacted. Even before the pandemic, women physicians spent nearly two hours more on household and childcare activities. With school closings forcing schooling-from-home and restaurant closings taking away a quick meal out as an option, this disparity has only grown.
A study from JAMA on the impact of the pandemic on physicians found that 25% of women physicians felt they were primarily responsible for childcare and schooling, while only 1% of male physicians respondents felt they were primarily responsible. Within that group, women physicians worked from home–away from their clinics–at nearly twice the rate of men (41% compared to 22%). Of those physicians working from home, women physicians worked reduced hours at a 25.7% rate compared to only 2.6% of men.
As a result, since the pandemic, 51% of women physicians are likely to report burnout compared to only 36% of men, and women medical students express a significantly higher level of concern about the pandemic’s effect on their careers than men (46% of women compared to 36% of men).
The Consequence for Hospitals
Women play a critical role in hospitals and clinics, and data shows women physicians have better patient outcomes than their male counterparts, especially in the quality of patient-perceived care and likeliness to be recommended. Therefore, their increased absence from the workforce during the pandemic has hospitals in crisis and rethinking their workforce models.
According to an op-ed from two assistant professors at Harvard Medical School, hospitals need to begin asking “Are we a good place for women physicians to work?” Per that same article, improving hospital conditions for women means taking an organizational-level approach to abolishing the systemic barriers so common to working conditions before (and elucidated by) the pandemic. This includes removing case-by-case opportunities for flexibility and instead openly providing flexibility “for clinical schedules, job-sharing opportunities, working remotely part of the time, and parental leave policies.” Improvements to workplace conditions for women physicians also come down to a matter of respect–especially by way of involving women in decision-making processes that affect their work–and creating equitable opportunities for career advancement and pay.
As proven by Dr. Blackwell in 1847, once the initial barrier barring women from becoming physicians crumbled, the pathway was opened. Through re-thinking the barriers still present for women physicians, especially where they have been elucidated and exacerbated by the pandemic, solutions can begin at an organizational and institutional level. Through defying the barriers one by one, progress eventually happens.