I spoke with the Associate Chief of Infection Prevention for Parkland Hospital and Assistant Professor of Medicine at University of Texas-South Western Dr. Carolee Estelle, M.D. about women in the medical field, their impact and what more can be done to level the playing field in the medical profession.
DW: What impact have you seen from more women entering the medical field, whether that’s in the OB GYN field, whether that’s in brain surgery, heart surgery – and overall, its impact on women’s comfort and willingness to receive medical care?
CE: You know, I think it is truly important that women are part of the medical profession as physicians, as leaders, but also nursing and all of the other staff that help in the care of our patients. You bring up a good point in terms of some women feeling more comfortable, gaining /receiving their care, from female providers. That can help and go a long way in terms of helping facilitate their care, increasing the comfort in terms of coming at all, and bringing up issues that are important to them that they may be otherwise concerned about bringing up to other providers. So I think it’s definitely important. I think the other value of having women in the field is taking women’s needs and women’s issues, and making them a priority in the patient-care spectrum.
DW: What, from your observation and understanding, has been the impact of a lack of women in the medical profession, either in treating infectious diseases, or in treating women going through the ER who need general medical care, who don’t know what’s really wrong with them?
CE: This isn’t a hard, data type of a topic necessarily. But, it’s (the impact of a lack of women in the medical profession) been explored in terms of, are we perceiving our female patients differently, and this is true of not only women, but all sort of minority groups who are underrepresented in medicine who weren’t permitted to be part of the foundations of the field and the work that was done to bring it to where it is. And so that foundational research, frequently, is based on a very narrow scope of population, right. But even women present differently in say heart attacks alone. We know that the symptoms that women will come in and complain about may be different than that of men with heart attacks. So, this question started to be explored in the past of, do women really have less heart attacks than men? Or are we just missing it because they’re presenting in a different way? And there was a period where that was really being explored as that came about, in pain in general, or women’s presentations for pain, and the way that they ask for pain, is it being treated differently than a male? The same thing is happening in our Black populations and other populations where when they present with pain- are they being treated differently in response to those reports of pain then other populations? This is why the work of improving the inequities that exist is important to everyone. Because the inequities that are present in one marginalized group do affect everyone. It may not affect everyone equally, but it’s happening to many more than just those.
DW: Diving more into (as you spoke about), how heart attacks may present differently for men and women, how has a lack of women in the medical profession specifically impacted issues, medical conditions?
CE: The medical field has done the work in terms of getting women into the field. What hasn’t happened is, there aren’t women who have, in equal proportion, been represented in the leadership of medicine, whether that’s academic or community. Whether that’s scientific research, clinical research, leadership positions at any institution, that is where women are not being represented. And in certain fields, so certain specialties in surgery. But I was fairly certain that in general surgery, but then all the sub specialties and surgery, whether that’s ENT (ears, nose and throat) or neurosurgery, things like that- they’re not represented. There’s certain fields that are still inside of medicine that are still discordant representation with women. But the concept of that continuing versus being less likely to choose to go into a certain field, either because of the lifestyle that is required to do it, or because, again, it’s still been so highly dominated by men not wanting to do that. But I do think it’s important to acknowledge that women- we are represented in medicine as a whole. What still hasn’t happened, is in many sub specialties you can see that we’re not represented, and in leadership as a whole, we’re still under-represented.
DW: What has been the specific impact of the lack of representation and leadership on black women who often are arguably double minorities, not including for, you know, socio economic status? And its impact on their ability to receive medical care?
CE: This pattern re-emerges, right? We have increased the representation of black females in medicine. Are we equal to the population that we represent in any given location or even nationally? No, but has it increased? Yes, great. Kudos. But then when you start to look at the representation in leadership positions, it dramatically drops off. And when we look at how many Black females come into medical school, matriculate through medical school, and then residency, and then fellowship and then at the faculty level, you lose (Black women). So even if we take in equal to the population, in medical school, by the time we get to, practicing as faculty and the like, the gap continues to widen the further along that we go. It’s very important to have Black women in medicine to bring up the issues to be passionate about our own patient population. To represent those issues and research them or provide those additional services or bring issues to the attention of the institution that they work for.
DW: Do you find that to have a specific impact on Black women who have been diagnosed with infectious diseases?
CE: I think it’s still the same, I think it’s still a similar response. And that represents what’s already been discussed as-representation matters for our patients, whether that’s in the room with them, so that they can feel seen by someone who looks like them in a position of caring for them. It helps with therapeutic bonds. But, representation also matters in terms of who’s at the table when it comes to conducting research, but even who’s at the table selecting what research is done, and conducted. Or, setting up programming to help patients. Who’s at the table for those decisions, matters. Because it affects all of the patients and the people downstream of that. And if the people who are being affected downstream by that- if someone who looks like them isn’t at the table, it increases the risk and the likelihood that some important aspect or factor won’t be taken into account. And it could decrease the effectiveness of that intervention, or altogether make things worse in some cases. I think, in short, whether we’re talking about women in general, or women of color, or any underrepresented minority group in medicine-its representation does matter, for patient care and their outcomes.
DW: Have you seen or noticed a change in hesitancy some women may have towards medical care, as more women have taken on roles in the medical profession?
CE: We need to look it up to tell you (if we can), if there’s been any studies conducted to suggest or or confirm that off the top of my head? I would have no idea. But I think, subjectively it feels like that, right? When you have a patient who says to you, “I’m so glad that you’re my doctor, because you look like me,” and people do have those experiences, whether that translates across a population to represent a statistically significant change but I think there’s probably research looking into those sorts of things, just like there has been in, looking at patients of color, and what are their performance and what are their outcomes when they’re cared for by a doctor who looks like them? We do find that they can have these improved outcomes in some areas. Does that mean that only women should take care of women, and only people of color should take care of people of color? No, it doesn’t mean that. But there is data to suggest that having a doctor or care provider that looks like you can improve your care and some of your health outcomes in general.
DW: What more do you think can be done to progress, the inclusion of women in the medical profession? Whether that’s just the inclusion of women in the intersectional sense?
CE: You know, the work is hard but I think it’s got to be related to-and again, in medicine, the disparity lot for women lies in leadership and certain sub specialties. And I think that those areas leadership and certain specialties really would benefit from taking the time to look at why is that occurring? What in our selection process may be impacting that? Or is it upstream opportunities, the difference in what opportunities are being accessed or able to be accessed by the women that you’re expecting? So if we’re expecting that women of a certain, or anybody who takes on a certain position has to have had this certain experience? Are women able to equally access those experiences and things? So, I think we’ve got to look at really, how are we deciding who gets into these positions and are they appropriate for the need of that position?
* Interview has been edited for clarity