“Patropoly” in Practice: Hiring, Evaluation, and Promotion

This installment continues a series on exclusionary practices in the field of medicine in the United States.  I mean for this series to illustrate a phenomenon I am calling “patropoly,” in which a complex set of practices act to keep control of an entire industry in the hands of a few men (like “monopoly” or “oligopoly”).  I am wondering if such practices could be approached on an antitrust basis, as they produce a kind of gender-based cartel.  The antidiscrimination laws are clearly not having an effect. 

This anonymous post was written by a young woman who had a year’s internship in the surgery department of a leading US hospital during the year she worked on medical school applications.  She is now studying at one of the top schools.


Note from Linda: On one of the medical supply sites, I found this pink tote in the section for medical bags. It was the only one marked as a bag for nurses. My point is not that men should carry pink tote bags, but that anything marked as "female" would be assumed to belong to a nurse, not a doctor.


National Institute of Health research shows that, while women have achieved parity with men in entering medical school, a variety of discriminatory practices causes them to drop out at each stage in the academic pipeline: graduate school, post-doc, faculty positions, achieving tenure, and, ultimately, in receiving recognition for groundbreaking work.

Medicine is a boys’ club. Medical school faculty members are disproportionately male. Having primarily male superiors often breeds a hostile work environment for women. Like women in other male-dominated disciplines, female physicians and surgeons are plagued by the subtle forms of discrimination that act as support beams for the glass ceiling. But women in medicine also experience jaw-droppingly overt discrimination. I’ll provide a few choice examples from my time working in a top ten medical university’s surgery department.

One of my few and outstanding female superiors in that hospital was a surgical resident, at that time in her third year.  She was an ivy league graduate, NIH Research Fellow, and fantastic surgeon. When she was first interviewed by the department head, a world renowned heart surgeon, he said to her, “I heard you were very good. Which surprised me because you are a woman.” She asked for clarification as professionally as possible and he replied, “Well, women don’t make good surgeons. They can work very hard, but they don’t see in three dimensions the way that men do.” [Note from Linda:  “they don’t see in three dimensions”??? And this guy is a doctor!]

This woman was the same woman who had to fight to have me hired. You see, they didn’t want to hire me because I was married and would have “marital duties” that would interfere with my ability to do my job. She had to remind them that it would be illegal discrimination to hire one of the male applicants over me for that reason.

When I took the job, there was one female attending surgeon. She had only been there for the better part of a year when I started. Before I ever met her, all I heard from anyone was what a “bitch” she was–a word choice that makes the hair on the back of my neck stand up when I hear it used in professional settings. I nevertheless avoided her out of fear until one day when I was stuck in car with her. She had just had her first annual review by the senior attendings.  It had not gone well. They informed her that her abrupt and harsh demeanor was going to stand in the way of her advancement. She felt that, because she was a woman, she was not allowed to have the gruff and irritable demeanor that is actually pretty typical of surgeons. Feeling that this was an unfair assessment, she had pointed out that while she may not be particularly warm she was always professional and that this was the best anyone in the department with as much call and exhaustion as she had could manage. To this they responded that she should probably work less anyway because she was not going to be able to find a husband working this much. She quit.

This exchange is so wrong on so many levels, I don’t even know where to begin. Let’s not waste time on the obvious inappropriateness of discussing her relationship prospects in a job performance review. Do notice that they told her straight out that she should work less. While the number of women practicing medicine has more than tripled in the last 20 years, female doctors still earn roughly two-thirds of their male counterparts’ salaries, largely because they work fewer hours a week and because there are far fewer of them in the most prestigious and highest-paid specialties.

In New York State, the trend of women working fewer hours is borne out most dramatically among younger doctors. Overall, female doctors work 9 percent fewer hours than male doctors. Among female doctors under 45, the number jumps to 15 percent. The statistics on lower pay and fewer hours for women are usually attributed to the age-old problem that even working women are still considered the primary caregivers for their children. It was nonetheless troubling to hear about a young female surgeon being told she should work less by an entirely male group of senior colleagues.

I would also like to draw attention to the fact that she quit. Much ado is made over women choosing “family friendly” or “lifestyle” specialties. But I would like to posit that some women, while they may be interested in the more prestigious specialties, just don’t want to lead a career of swimming upstream against the patriarchy. This one and only female attending quit because she just didn’t want to struggle that hard against these issues. She decided she would rather be in a more supportive but less renowned institution.


Note from Linda: I found scrubs on another medical supply site. It was one of those you could change the color by clicking. So here's what they look like in pink. Wonder how often anybody really buys that color.


As an aspiring doctor trying to gain exposure to different fields of medicine, it was hard to imagine myself succeeding in that environment. I have spoken with many young pre-med women who have had bad experiences interning or volunteering in male-dominated medical centers and have been put off by an entire specialty because of the misogynistic culture.

Gender parity in medical school admissions is only half the battle- there needs to be parity in residency programs of all specialties. The medical community needs to do a better job at making young women feel welcome and provide an environment where they can thrive.

A post on discriminatory practices in medical school admissions is here. The introductory post for this series is here.  For other posts in this series: post on medical school admissions is here.  The post on sexual harassment in hospitals is here.

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