You graduate from medical school and get your MD degree. At first, when someone calls you “Doctor”, you look around and wonder who they’re talking to, but after years of hard work and sleepless nights, you realize you are really a card-carrying “doctor”. If you’re a woman, however, you start to realize that a lot fewer people call YOU “Dr.” than your male colleagues. At first it’s subtle. And you shrug it off. Then you wonder if you’re just being hypersensitive, or imagining things, or worse, somehow inadvertently sending off some informal vibe that signals you prefer that colleagues and patients call you by your first name. But when you get together with other women physicians, you realize it’s NOT just you. Every female doctor has had the experience of being called by her first name from the podium, in the exam room and in groups, while the men were called “Dr.”
Dr. Julia Files, physician and researcher, inspired and activated our team to prove we weren’t crazy. Here’s the story of the proverbial straw that broke Julia’s back:
A sinking feeling overtook me as I realized what had just happened. I was an invited speaker at an event where I shared the program with three male physicians each of us presenting topics pertaining to our areas of expertise. The moderator (male) ended the program by thanking “Drs. X, Y, Z and Julia.” Wow! This wasn’t the first time I’d been inappropriately addressed by my first name in a professional setting, but it was certainly the most public and glaring example. Had he intended to strip me of my professional title? Did anyone else notice? Does this happen to other women, or is it just me? Instead of being appropriately proud of my contribution to the program I was stuck trying to process why this happened to me (again).
Then just two weeks later, it happened to my friend, colleague and co-investigator, Dr. Anita Mayer. Dr. Mayer was speaking at a program and I was a member of the audience. As if on cue, the male moderator ended with a thank you to the speakers, “Drs. X, Y, Z and Anita”! This time my “wow” propelled me to action.
So Dr. Files assembled and led our team to study this phenomenon in a scientific manner. An informal poll confirmed that every female physician we asked, regardless of practice type, specialty or geographic location, had experienced this. Worse, on the few occasions women had spoken up, they were treated as petty, oversensitive, or worse, mocked. We searched; there wasn’t anything published in the literature that validated our experience. We even looked at business, law, science and other fields. Nothing.
So we set up our own study to compare gender differences in introductions. The venue was Medical Grand Rounds, which at most medical centers is THE formal weekly educational session for faculty and learners. The majority of participants in both the role of speaker and audience member were peers holding MD, PhD, or MD/ PhD degrees. At Medical Grand Rounds one expects formality in speaker introductions, and, as a result, there really shouldn’t be gender differences.
Analysis of data from six months of videotaped introductions left us gratified, validated and saddened at the same time. We confirmed that whether doctors are introduced as “Dr.” depends on the gender of who introduces them. Women introducing any Grand Rounds speaker used “Dr.” virtually all the time (96%) regardless of the speaker’s gender. Men, on the other hand, were less formal overall: across all speaker introductions by men, only 2/3 ever included “Dr.”
Our real validation came when we looked at the gender of the speaker being introduced. Among introducers, there was a distinct gender difference in their use of titles: male speakers were introduced by men as “Dr.” 72% of the time, but less than half of the women were introduced as “Dr.” This is both statistically and socially significant.
Our research team did a little happy dance and quickly wrote up our results. Our enthusiasm was tempered when two journals rejected the manuscript, in part because the reviewers didn’t really think the results were “a thing”. But now that our work has been published, the response from other doctors and professional women across many fields has been gratifying, and it has corroborated our collective encounters with this particular type of gender inequality.
Failure to acknowledge a woman’s hard-earned professional title while men are awarded theirs, even when unintentional, has profound implications and reinforces the perception of women having lower status. This “de-professionalizing” serves to activate stereotype threat and internalized sexism at a time when a woman needs to be at peak performance, whether she’s speaking, teaching or caring for patients. Since learners and patients witness this, it’s a very powerful lesson to them as well.
We hope to see meaningful change as a result of our study. There is no reason to believe that this behavior is intentional, or even noticed, by men. One senior male physician, reflecting on our publication, told me that while he believed the findings, he didn’t think they were that widespread or bothersome to most women — until he recalled that his physician daughter had recently expressed her displeasure at being introduced by her first name as her own hospital’s newly appointed Chief Medical Officer. He then sent her a copy of our paper!
Our goal is to support and lift up other women who share our journey, and these data help us spur change. If we must, we’ll do it one introduction at a time.
Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias, by Julia A. Files, MD, Anita P. Mayer, MD, Marcia G. Ko, MD, Patricia Friedrich, PhD, Marjorie Jenkins, MD, Michael J. Bryan, MD, Suneela Vegunta, MD, Christopher M. Wittich, MD, Melissa A. Lyle, MD, Ryan Melikian, Trevor Duston, BA, MA, Yu-Hui H. Chang, PhD, and Sharonne N. Hayes, MD. Published online before print in JOURNAL OF WOMEN’S HEALTH. DOI: 10.1089/jwh.2016.6044