Scenario 1: A male surgical resident speaks over a female emergency medicine resident as she performs her trauma survey, confusing the care team about the patient’s injury burden and plan. Afterward, the emergency medicine resident voices her concerns to her male attending about having her role publicly undermined. “I think this is particularly a problem for female residents,” she says. He responds, “It’s not a female resident problem. They do this to everyone.”

Scenario 2: At the physicians’ workstation, a nurse asks the male attending about the plan for a patient being cared for by a female resident physician sitting in proximity. The attending answers the nurse’s question without involving the resident. The resident then respectfully tells the attending that she’d appreciate being looped into conversations about her patients. “Female residents often aren’t recognized as the decision makers about our own patients’ care,” she says. He responds, “It’s not a female resident problem. This happens to male residents, too.”

Scenario 3: During a residency conference, a resident brings up several barriers to placing central lines in the emergency department for critically ill patients. She recounts the numerous times she was told the procedure could be performed in the ICU and to send patients upstairs. A male resident says, “I’ve never had that experience.” She responds to her male co-resident, “I think this is a female resident problem,” reflecting her personal perception and her female co-residents’ perceptions that ED staff show more support for male residents to perform procedures. A male attending responds, “It’s not a female resident problem.” He says the decision depends on whether there are beds ready.

Common Experiences for Female Physicians

As female resident physicians, we have the privilege of working with masterful clinician-educators on a daily basis. We are humbled by their knowledge and clinical skills. However, we are troubled when we raise concerns about gender inequalities to attending physicians and receive the response, “It’s not a female resident problem.”

We recognize not every health care challenge or unprofessional interaction stems solely from gender inequalities.¹ Maybe the surgery resident was under extraordinary stress from sleep deprivation. The nurse who bypassed the resident might have forgotten her name, choosing to defer to the attending, whom she knew well. Though the patient headed to the ICU needed a central line, the ED volume was high, limiting the ability to perform time-intensive procedures.

However, when we witness unprofessional and unsupportive interactions happening repeatedly and disproportionately more often to us than to our male colleagues, we feel compelled to bring it to the attention of our superiors. We do so in hopes of improving patient care and developing a better training environment for ourselves and others.

Emergency medicine remains a numerically male-dominated field, with recent national surveys estimating women constitute only 33 percent of academic EM faculty and 35 percent of EM residents.^1,2 Compounding the lack of representation, female emergency physicians struggle to be recognized as doctors and are frequently mistaken for nurses or technicians.^3,4 Furthermore, female EM residents are rated as less competent than male counterparts, both by supervising faculty and by nursing colleagues.^5,6 In one recent survey of medical trainees, including EM residents, 86 percent of male respondents and 96 percent of female respondents reported observing or experiencing gender-based discrimination in the workplace.⁷

Despite increasing evidence highlighting gender discrimination in emergency medicine, as female physicians, we are often told problematic interactions are not related to our identity. As interns, we mostly stayed silent about discriminatory incidents. We were doubtful of our instincts and our perceptions—a common reaction among clinical trainees who face discrimination in the workplace.^8,9 As we progressed in residency, however, our cumulative experiences cast away self-doubt.

Beyond how these interactions affect our confidence, gender discrimination affects patient safety. When we are removed from critical conversations, orders go unrecognized or duplicated, and medications are administered without our knowledge. When colleagues assume control during resuscitations, leadership roles become muddled, and information risks being lost.

When we explicitly name a gender-based problem in a training environment, we risk being labeled a troublemaker—someone who is not adaptable, someone who is not a team player, someone who is fixated on inequalities. Despite the professional risk of calling attention to a challenging issue, we feel obligated to name these problems and advocate for solutions, for residents and patients.

A Better Approach

We have a simple message for emergency medicine faculty: When we reveal gender-based disparities occurring in our work environment, we are welcoming you into the conversation surrounding unacceptable interactions in female residents’ educational experiences. We invite you to listen and consider the possibility that what we are telling you is not happening in isolation. Even if the problem affects male residents, too, we want you to know we perceive that women bear the brunt of these problematic interactions. Regardless of your intention, the impact of the response, “It’s not a female resident problem,” is to dismiss a perspective that is based on a lived reality of daily discrimination. “It’s not a female resident problem” is a response that justifies inaction.

Strategies exist to reduce the impact of gender bias on female residents. Help assure roles are clarified and respected during high-stakes situations, such as resuscitations. Direct questions about patients to the female residents taking care of them, especially when we are in close proximity. Join residents in conversations with administrative team members about throughput and procedural needs.

Ultimately, female residents want to be recognized for our potential and capability. Please accept our invitation to help create a work environment that supports all physicians equally.

References

1. Madsen TE, Linden JA, Rounds K, et al. Current status of gender and racial/ethnic disparities among academic emergency medicine physicians. Acad Emerg Med. 2017;24(10):1182-1192.
2. Bennett CL, McDonald DA, Hurwitz S, et al. Changes in sex, race, and ethnic origin of emergency medicine resident physicians from 2007 to 2017. Acad Emerg Med. 2019;26(3):331-334.
3. Boge LA, Dos Santos C, Moreno-Walton LA, et al. The relationship between physician/nurse gender and patients’ correct identification of health care professional roles in the emergency department. J Womens Health (Larchmt). 2019;28(7):961-964.
4. Prince LA, Pipas L, Brown LH. Patient perceptions of emergency physicians: the gender gap still exists. J Emerg Med. 2006;31(4):361-364.
5. Dayal A, O’Connor DM, Qadri U, et al. Comparison of male vs female resident milestone evaluations by faculty during emergency medicine residency training. JAMA Intern Med. 2017;177(5):651-657.
6. Brucker K, Whitaker N, Morgan ZS, et al. Exploring gender bias in nursing evaluations of emergency medicine residents. Acad Emerg Med. 2019;26(11):1266-1272.
7. McKinley SK, Wang LJ, Gartland RM, et al. “Yes, I’m the doctor”: one department’s approach to assessing and addressing gender-based discrimination in the modern medical training era. Acad Med. 2019;94(11):1691-1698.
8. Wheeler M, de Bourmont S, Paul-Emile K, et al. Physician and trainee experiences with patient bias. JAMA Intern Med. 2019;179(12):1678-1685.
9. Torres MB, Salles A, Cochran A. Recognizing and reacting to microaggressions in medicine and surgery. JAMA Surg. 2019;154(9):868-872.

Dr. Chary is a Harvard-affiliated PGY-3 emergency medicine resident.

Dr. Cleveland is assistant professor of emergency medicine at Boston University School of Medicine.

Dr. Dadabhoy is a Harvard-affiliated PGY-3 emergency medicine resident.

Dr. Molina is a PGY-3 Harvard-affiliated emergency medicine resident.

Dr. Samuels-Kalow is assistant professor of emergency medicine at Massachusetts General Hospital in Boston.

Dr. Landry is assistant professor of emergency medicine at Brigham and Women’s Hospital in Boston.