Files JA, Mayer AP, Ko MG, Friedrich P, Jenkins M, Bryan MJ,
Vegunta S, Wittich CM, Lyle MA, Melikian R, Duston T, Chang YH, Hayes
SN. Speaker Introductions at Internal Medicine Grand Rounds: Forms of
Address Reveal Gender Bias. J Womens Health (Larchmt). 2017 May;26(5):413-419.
Abstract
BACKGROUND:
Gender bias has been identified as one of the drivers of
gender disparity in academic medicine. Bias may be reinforced by gender
subordinating language or differential use of formality in forms of address.
Professional titles may influence the perceived expertise and authority of the
referenced individual. The objective of this study is to examine how
professional titles were used in the same and mixed-gender speaker
introductions at Internal Medicine Grand Rounds (IMGR).
METHODS:
A retrospective observational study of video-archived
speaker introductions at consecutive IMGR was conducted at two different
locations (Arizona, Minnesota) of an academic medical center. Introducers and
speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD
degrees. The primary outcome was whether or not a speaker's professional title
was used during the first form of address during speaker introductions at IMGR.
As secondary outcomes, we evaluated whether or not the speakers professional
title was used in any form of address during the introduction.
RESULTS:
Three hundred twenty-one forms of address were analyzed.
Female introducers were more likely to use professional titles when introducing
any speaker during the first form of address compared with male introducers
(96.2% [102/106] vs. 65.6% [141/215]; p < 0.001). Female dyads utilized
formal titles during the first form of address 97.8% (45/46) compared with male
dyads who utilized a formal title 72.4% (110/152) of the time (p = 0.007). In
mixed-gender dyads, where the introducer was female and speaker male, formal
titles were used 95.0% (57/60) of the time. Male introducers of female speakers
utilized professional titles 49.2% (31/63) of the time (p < 0.001).
CONCLUSION:
In this study, women introduced by men at IMGR were less
likely to be addressed by professional title than were men introduced by men.
Differential formality in speaker introductions may amplify isolation,
marginalization, and professional discomfiture expressed by women faculty in
academic medicine.
____________________________________________________________________________
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
really are a card-carrying “doctor.”
If you’re a woman, however, you start to realize that a lot
fewer people call you “doctor” 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 “doctor.”
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 speaking
on topics in 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 incident. 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 are
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 6 months of videotaped introductions,
left us gratified, validated and saddened at the same time. We confirmed that whether doctors are
introduced as “doctor” depends on the gender of who introduces them. Women
introducing any grand rounds speaker used “doctor” virtually all the time (96
percent) 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 “doctor.”
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
“doctor” 72 percent of the time, but less than half of the women were
introduced as “doctor” 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’s been published, the response from other
doctors and professional women across many fields has been gratifying and
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
deprofessionalizing 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’s 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
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.
https://www.kevinmd.com/blog/2017/03/physicians-not-called-doctor.html?pop=0&ba=1&xid=ob-md-rt-pcp-all_Fox+News+Homepage
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