A Brief History of Women in Medicine
Author: Krisa Keute, MD, FACP
Keywords: women in medicine, gender bias, history of medicine
A father and son were in a car accident. The father dies and the son is taken to the nearest hospital. In the operating room, a doctor comes in and looks at the little boy and says, “I can’t operate on this boy because he is my son.” Who is the doctor?
Sometimes I share this riddle with my kids and their friends. More than half of the time they look at me confused and can’t figure out the riddle. They scratch their heads and sometimes ask if the surgeon is the stepfather. Could it be the wrong boy in surgery? They look me in the eye, often after a long day of work at the hospital. They forget that I am a doctor, and likely are unaware that by 2021, more women will graduate from medical school than men.
Yet the history of women in medicine began over 150 years ago. The story goes that around about 1844, a young woman lay dying of uterine cancer. She confided in her friend, Elizabeth, that perhaps, had a woman cared for her, she may have been spared suffering and embarrassment. She may have been nurtured through her illness instead of experiencing the sterile, impersonal process she experienced at the hands of the men who had cared for her. This honest testament seeded the call to a new vocation for her friend Elizabeth, thus starting a revolution, and shattering a proverbial glass ceiling.
For women physicians, our pioneering hero was perhaps the most impressive first of all firsts, Elizabeth Blackwell. She was not only the first woman admitted to medical school, she graduated at the very top of her class (despite discrimination, exclusion from certain lectures deemed “inappropriate” for ladies, and blatant and generally accepted misogyny). She was supremely influential in paving the way for others, including her sister Emily. When most medical schools refused to open their doors to women, she founded her own schools specifically for women. She not only educated women, she remained true to her friend and provided health care to women and children, often indigent, by establishing special infirmaries in the US and Britain specifically for women. Elizabeth Blackwell, who simply listened to her dying friend, not only shattered a glass ceiling, she launched her influence far and wide and soared to great lengths, paving the way for women everywhere to follow in her footsteps.
Time marched forward and subsequently many variations of Elizabeth Blackwells entered medical schools around the globe. Rebecca Lee Crumpler, the first black female doctor (who graduated prior to the end of the Civil War!), Virginia Apgar, champion of newborn health and wellbeing, and Elisabeth Kublar-Ross, expert on death and dying, all achieved an M.D. These are Giants in the medical field. When I consider their achievements in the face of discrimination because of gender, my throat tightens with such emotional pride that I want to rejoice— for I get to be a small part of them.
Heading to college with the dream of becoming a female physician, I revel that my dream has come true. Interviewing for residency while five months pregnant, I was blatantly asked how I could possibly do it all. I don’t think a male, obviously not pregnant candidate got that question. After “somehow” tackling a brutal, at times 100 hour work week at Hennepin County Internal Medicine residency, I retained my first job, which included joining eight men, no women in a pioneering hospitalist program, at age 29. One of my consulting colleagues repeatedly referenced himself as “Dr. So-and-So” while calling me by my first name. He couldn’t quite fathom that I was an MD, not a nurse. Yet years flew by and the practice, the patients and the colleagues enriched my life beyond any of my wildest expectations. And the best - the very best - part of all of it have been the women I have met along the way.
In the early morning before the sunrise, we met to run along the north shore of Lake Superior. With her youth, her fresh mind, and her idealistic uncertainty about whether she is truly working in a way which fulfills her calling to serve others, and me, my archaic dog, and my twenty years’ baggage of being a local with a weary acceptance that I will be a physician forever, we begin our sweet, pre-work morning run.
Like many of my female doctor friends, ours is a kindred friendship that often comes naturally with people whose studies, training and experience mirror one another. The kind where two like minded people find one another and become fast friends. She has about four years experience under her belt; I have about twenty. She is single with local family; I am a mom of three who is four hours from my nearest kin. She has school loans and an old jalopy Corolla that worries me; I have no more loans and a somewhat unnecessary sporty Jeep. She is a millennial raised by a bit of a hippy mom; I am a Gen Xer and a latchkey kid. I think this is the start of another beautiful female medical friendship.
We pass the usual morning greetings and start out on the lakewalk, cantoring at about the speed of a lazy bat, maybe a sauntering skunk. We talk of our day, some cases, COVID. We banter back and forth about difficulties with patient care, troublesome cases where we are having an arduous time diagnosing or treating disease. We mention colleagues who are giving us trouble, and colleagues who are helpful. It is a delight to me, and I revel in having found another female friend to socialize and work with.
The years have given me a loyal, globe-trotting gynecologist girlfriend, a wine aficionado and foodie pathologist girlfriend, a med-peds super mom of boys girlfriend who keeps up a sweet long distance relationship with me, among others. It is our own special club, because we are often outsiders in the world of soccer moms, stay at home moms, and those others who (thankfully) run the non-medical logistics of our mom community. We have a special bond, us female physicians.
Women doctors account for one third of the physicians practicing medicine in America, according to the Kaiser Family foundation. In 2017, for the first time in history, women entering American medical schools outnumbered men. While exciting to see this transition, according to the 2019 Medscape Physician Compensation Report, the gender pay gap in primary care widened from previous years to a nearly 25% disparity in income, favoring men over women. This disparity widened three years after JAMA’s bombshell report comparing hospital mortality and readmission rates for 1583028 hospitalized Medicare beneficiaries finding that female physicians had significantly lower mortality rates (adjusted, 11.07% vs 11.49%) and readmission rates (adjusted, 15.02% vs 15.57%) for hospitalized patients. So in essence, female doctors are paid less, but may be giving at least as good, if not better, medical care.
Of course it really isn’t quite as black and white as that, and I must be careful not to toot our own female horn too loudly. I remember when that study came out. A few of us women docs were talking about it, and one of our male colleagues (who is a very gifted physician himself) became agitated. Remembering this, I want to point out that while I am proud to be a female doctor, I cannot dismiss that it takes all of us — mentors, colleagues, friends, both male and female, to make our beloved medical practice valuable, successful, compassionate and altruistic. For I believe that we are stronger together, united in our goal of helping women help themselves and help others.
And so I say, “Thank you, Elizabeth Blackwell. Thank you, wonderful female colleagues and friends who enrich my life, my practice. My patients and I are forever indebted to you.”
About the author: Krisa Keute, MD, FACP, is an internist and a mom (LinkedIn: Krisa Keute, MD, FACP)