Patricia Szima is a Second Year Political Economy student with an interest in gender equality -with a focus on the workplace. Enjoying the sunset on the beach, baking fudgy brownies, and playing Scrabble are her favourite activities.
[Featured Image: A female doctor wearing a mask, gloves, and protective eyewear, touching her head in exhaustion. Source]
“Did you know that women in healthcare are one of the most vulnerable groups?” asked my mother, who has been a doctor for 25 years. I did not fully grasp this statement at first. However, as it turns out she was right. While the gender pay gap, barriers to entry into a profession, gender bias, and other forms of sexism have received much needed and duly paid attention, there is another factor that should be analysed through the eyes of gender inequality. The mental health of female doctors appears to be affected by their profession choice to a surprisingly large extent.
Depleted Emotional Reserves
Women tend to nurture and care while men have a problem-solving approach. This is not to imply that men cannot care, or all women have this nurturing approach. This is a personal observation that has largely proved right so far, and I am not attaching any positive or negative value to either approach. After all, medical cases are puzzles that need to be solved but in some instances people’s lives are at stake so showing support and empathy may very well be necessary.
First of all, women approach patients with more empathy, ask more questions and prompt patients to share their feelings.[i] All in all, they invest more time in communication. Research[ii] supports the statement that female doctors are better at expressing adequate empathy than male doctors. A comprehensive study found that people assigned a significantly higher empathy rating to women than men.[iii] 43 compared to 35 out of 50. Questions included patients’ views on whether their doctors make them feel comfortable and at ease and how attentive they are.
Empathy is crucial because when comparing communicative, caring doctors to more guarded doctors who keep their distance the former is more preferred.[iv] This entails practical consequences. For example, patients are more likely to take the pills prescribed to them in the proper way. A more open approach is also desired because sharing confidential information needed to make a full diagnosis is hard for patients when their anxiety is not lessened by unsympathetic behaviour.
What are the positive consequences of showing empathy? Better patient treatment. However, negative consequences are just as impactful as the positive ones, as doctors’ mental health is at stake. Women are more exposed to burnout and this might explicitly be linked to their empathy level.[v] Burnout means a feeling of exhaustion, detachment from work, cynicism, and a more negative outlook. Burnout is about a depleted emotional reserve. The practical effects include not giving full answers, the higher probability of making mistakes, and the lessened incentive to come up with alternative treatments. When healthcare workers feel emotionally depleted, they cannot give emotional comfort to their patients and they may even show apathy instead of empathy. This phenomenon is called compassion fatigue or the cost of caring – as it is more common among doctors and nurses.
So how does one arrive in a state of compassion fatigue?[vi] Compassion fatigue can be viewed as a survival mechanism. The mind can protect itself by shutting out everything. Showing empathy requires active immersion in patients’ emotions to best deliver emotional support, but doctors also have to process how this affects them on an emotional level. It is logical since in healthcare sharing bad news is sadly very common. At one point the person is reluctant to show empathy because a recharge from the prolonged period of emotional distress is desperately needed. Compassion fatigue -suddenly showing less empathy- acts as a defensive shield to let the nurse/doctor recharge emotionally. Everyone has a limit to how much they can take in others’ pain and make them feel better. When this limit is reached, numbness sets in. This may explain why doctors’ brains have a lower reaction level to seeing patients suffer from pain compared to those working in other professions. They are not emotionless. They just distance themselves from emotions to avoid burnout and personal distress.
A logical conclusion is that women suffer more from compassion fatigue as they provide emotional support to a greater degree. Thanks to the Canadian Medical Association’s research[vii] in 2018 numbers can now support the idea that women are more exposed to suffering from mental health problems. The gender difference in this aspect is quite astounding. The probability of Canadian female doctors experiencing burnout is 23% higher than for Canadian men, depression has 32% higher odds, and suicidal thoughts are more prone to emerge in females than in males by 31%.
However, being disproportionately exposed to burnout does not only come from the nature of women’s approach to the sick. It is also about whether they have a place where they can recharge. Unfortunately, they are expected to perform similar roles in other aspects of their lives as well and juggling many responsibilities that need their emotional input is just accelerating the process of burnout.
When starting out in their medical career, surprisingly many women reconsider their career choice. According to the University of Michigan’s Intern Health Study, in the early stages of their career, almost 40% of female physicians cut down on their hours, search for part-time jobs or leave the field of medicine altogether.[viii] The primary factor to make them do so is family.
A JAMA Network study shows a high discrepancy between men’s and women’s career considerations for the future.[ix] 64.4% of female physicians working full time were considering moving to a part-time basis while only to 21.2% of their male counterparts occurred this idea. Furthermore, when children were included in the equation this gender gap was even more striking. 70.3% of women and 19.0% of men thought about shortening their work hours.
How can we let societal expectations of women’s role in the family make women leave behind the skills for which they studied and worked for and deny them their dream? It is eye-opening that the lack of support to balance family and work is present on such a grand scale.
This is a family affair. In the medical field, education and training is followed by intensive on-site learning, which is extremely time consuming. This leads to a disproportional number of women dropping out following the first 6 years after training. Caring for family falls undoubtedly into the “job-description” of women. To put some numbers behind these claims, research shows that married men with children spent 7 hours more at work per week and 12 hours less at home to care for children and to complete household tasks compared to women.[x] Family roles and being a physician collide and women try to relieve this conflict by working on a part-time basis.
To sum up, women have to attend to family duties while these domestic tasks are not evenly divided up between men and women. This just accelerates the process of burnout in women, which is already more probable for them than for males. In conclusion, if you are a female doctor your anxiety pie chart may include more than just seasonal depression, pandemic depression, depression about the future, work anxiety, since being a woman in healthcare also occupies a slice now.
[i] Samra, R. (2018) ’Female doctors show more empathy, but at a cost to their mental well-being’ Medical Xpress, 24.04.2018 Accessed from: https://medicalxpress.com/news/2018-04-female-doctors-empathy-mental-well-being.html
[ii] Howick, J., Steinkopf, L., Ulyte, A., Roberts, N., Meissner, K. (2017)
How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC Med Educ 17, 136. Accessed from: https://doi.org/10.1186/s12909-017-0967-3
[iii] Howick, J. (2017) ’Female doctors show more empathy than male doctors’ Medical Xpress
06.09.2017 Accessed from: https://medicalxpress.com/news/2017-09-female-doctors-empathy-male.html
[iv] Howick (ii)
[v] Samra (i)
[vi] Samra (i)
[vii] Renkas, R. (2019) ’Female doctors are good for your health, but they experience a gender pay gap, discrimination, burnout and depression’ The Conversation, 29.10.2019 Accessed from: https://theconversation.com/female-doctors-are-good-for-your-health-but-they-experience-a-gender-pay-gap-discrimination-burnout-and-depression-125485
[viii] Paturel, A. (2019) ’Why women leave medicine’ Association of American Medical Colleges (AAMC) 01.10.2019 Accessed from: https://www.aamc.org/news-insights/why-women-leave-medicine
[ix] Frank, E., Zhao, Z., Sen, S., Guille, C. (2019)
Gender Disparities in Work and Parental Status Among Early Career Physicians JAMA Network 02.08.2019Accessed from: https://docs.wixstatic.com/ugd/3fdf20_b47503c5516f4b61b42dc04b94605f15.pdf
[x] Paturel (vii)