Women in Medicine: Female Physicians Get Called 'Doctor' Less Than Their Male Colleagues

5-24-17 Doctors
A recent study conducted at two Mayo Clinic locations found that female physicians are called "doctor" less frequently by male colleagues introducing them during Internal Medicine Grand Rounds. Lucy Nicholson/Reuters

Dr. Julia Files was the only woman onstage with three male physicians and a male moderator. Each doctor had given a presentation on his or her area of expertise, and the event—a large and formal meeting with about 500 people in attendance—was coming to a close. The moderator then thanked Dr. So-and-So Man, Dr. Such-and-Such Guy, Dr. This-and-That Dude. And he thanked Julia.

Files, a physician and associate professor of medicine at the Mayo Clinic Arizona in Scottsdale, was rattled. "I was really quite taken aback. I thought, Did that just happen? Am I being sensitive? Is it me? Did he do that? Did he mean to do that?" Files tells Newsweek. "You have this whole Internal dialogue while you're standing there smiling and looking pleasant." She later wrote that "a sinking feeling overtook me.… 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."

Now, Files has taken some action: She is the co-author of a recent paper, "Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias," published in the May issue of the Journal of Women's Health.

Like many scientific studies, this one was spurred by anecdotal observations. After the event that left Files deflated, she went back to the Division of Women's Health Internal Medicine and told a colleague, Dr. Anita Mayer, about the incident. Mayer, who is also an associate professor of medicine and the chairwoman of the division, was shocked at how blatantly the moderator had stripped the one female doctor of her title. "How dare he call you Julia?!" she remembers thinking. But at the same time, they weren't sure what could be done. A few weeks later, they caught one another's eye from across a room as a very similar scenario unfolded, this time with Mayer as the speaker.

These incidents "really got us charged up to do something about it," says Files. She and Mayer have done a great deal of work mentoring younger women physicians and faculty members in Scottsdale and around the country. "We've had the opportunity to see a lot of different situations where there have been some inequalities in how women progress through the system, advance in academic rank, become leaders, you know, all the things important in career development," Files says. Here was a seemingly small but significant piece of the puzzle they could examine more closely. They started informally polling women in medicine and quickly decided they need to find a way to study the phenomenon empirically.

They chose to analyze introductions made at weekly Internal Medicine Grand Rounds—the most formal meetings held at the clinic at which most in attendance have an M.D., Ph.D. or combined M.D./Ph.D.—to see if the data supported their hypothesis that female physicians are introduced less frequently by their formal title.

The rounds are videotaped and kept in an archive, giving the researchers a trove of material to systematically study how professionals refer to one another. The paper, which lists more than a dozen authors, reviewed 321 introductions made at rounds at the Arizona and Minnesota Mayo Clinic locations. It found that female introducers use the formal title "doctor" when introducing any other speaker 96.2 percent of the time, while male introducers use it only 65.6 percent of the time. Even more striking, however, is the finding that male introducers used the formal title for other men 72.4 percent of the time, but used it for women only 49.2 percent of the time. In other words, on more than half of occasions when a man introduced a woman, he didn't call her "doctor"

The study was not able to take into account prior familiarity between introducer and speaker, age, race, religion or other factors that may have influenced the choice to use the title. Nevertheless, the results are significant.

Imagine it, Mayer says: "I'm a woman and I'm just about to give a very important speech in front of all these people about a medical topic which I am an expert in. And just as I'm approaching the podium and expecting that welcome of my expertise…I don't hear the title 'doctor.' You can be assured it's a man that's not calling me 'doctor' because all the women are going to introduce me" with the proper formal title.

Files and Mayer expected to be mocked when the study came out, as some women have been when mentioning this issue to their male peers. And though they have been asked by some why they would even pursue the subject and why it matters, they've mostly seen responses from women in medicine and a slew of other fields who have had similar experiences.

The comments on articles the researchers published on Gender Avenger and Kevin MD (comments on their Huffington Post article were disabled) reflect as much. Some dismissed the study, with arguments like this one: "As the role of women in medicine becomes more prominent it may be best to concentrate our energies on the real threats facing our profession, threats that appear to have a greater impact on women." Others made flippant comments like, "Boo hoo you weren't called 'Dr.'! BOO HOO! #FirstWorldProblem."

But many women seemed to take "comfort in commonality," as Files and Mayer describe the notion that they are not alone in this experience:

Thanks for publishing this. Those of us who work in higher education also experience this with regard to our job titles and our academic titles and ranks. We tend to be addressed much less as "Professor" or "Dr." by fellow academics, administrators, and support staff. In fact, if we happen to be standing around in our departmental main offices, students invariably assume we're secretaries.
—Carol Leibiger in a comment on Gender Avenger

I am a black female MD. I have introduced myself as Dr. XYZ. The patients have called me Mrs. XYZ. I have replied that "Mrs. XYZ is my mother-in-law. I know you don't want her to take care of you." I have told patients that my first name is reserved for my friends and relatives.
—"Happy1" in a comment on Kevin MD

Thank you so much for this! It is the same for women clergy. I served a parish where the Rector was always "Father Last Name." If one got to know him, one called him "Father First Name." If one got to know him really well, one would call him, "Father." As his Curate/Assistant, fully ordained as a priest, many would take the liberty of simply calling me Ann. One day, I called someone on it (it happened to be a man, but there were women who also took that liberty). I asked if he would ever call Father by his first name and, of course, he replied that he would not. Then I asked why he would not extend the same courtesy to me, and pointed out that our Holy Orders were exactly the same, even though our job descriptions (Rector/Curate) were different. He had no answer, but began calling me "Mother" from that day on. In many cases, it takes a bit of a wake up call and some education. Sad, but not without hope.
—The Rev. Ann M. Tillman in a comment on Gender Avenger

The researchers sum up "why it matters" in the conclusion section of the paper. "Subtle, yet pervasive practices, reinforcing the perception that women are of lower status than men, can negatively impact a woman's career trajectory and her satisfaction with her career even if they are unintentional," they write. "Unequal naming practices may amplify the issues of isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine."

Files and Mayer believe the discrepancy in the use of formal titles is the result of unconscious bias rather than a conscious and malicious action. They are eager to speak about their study at other institutions and, closer to home, they are now working with Mayo to train grand rounds participants to use the appropriate titles for all men and women who have spent years working toward the title "doctor."

"It's something we are going to try to train," Mayer says. "It is remediable."