Women in Medicine: Obstacles & Opportunities
Editor's Note: We invited six alumnae from the Sanford School of Medicine to a roundtable discussion on Women in Medicine. Three graduated in 1972; one in 1980 and two in 2010. We asked them about the role their gender played in their medical education and career.
'Once we proved ourselves as individuals, that led to women being accepted as a group.'
Emma Ledbetter '72 M.D.: Before us, there would be maybe one woman every other year. There were five of us the first year. Mary joined us in the second year, and then there were six of us women. In 1970, we were really the start of when women began invading professional schools.
Mary Slattery '72 M.D.: But that was only because of a federal law. Professional schools had their reimbursement from the federal government withdrawn if they did not admit a certain number of women. We were probably mostly through med school when that kicked in. It never actually changed just on ebb and flow. It was because of a federal law.
Ledbetter: The state of South Dakota was pushing too. That was a big part of it. We'd have two thirds of our class from out of state. The state was saying, 'Why are we paying for a medical school when we aren't putting South Dakota residents in it?' I think they were told that if you have qualified students from South Dakota, don't turn them down for somebody from out of state.
Patricia Peters '80 M.D.: Many people would say to me, 'Because you're a woman in medicine, didn't you get picked on?' or 'Did you feel like you were a second class citizen?' I don't think I ever felt that way. I suppose every year is different, every person is different, but I always felt well-accepted by the men in my class and the teachers. I never did feel put down. I felt like I had a good education, and I never had that feeling, 'Oh, she's a woman, she can't do what the men can do.' I had fun.
Patricia Wirtz '72 M.D.: I think there was more of that back in 1972, at least when you were interviewing to get into medical school. It was like, 'Well, what are you going to do if you have a child?' Today, they wouldn't dare ask that question.
Ledbetter: During interviews for medical school, they would say, 'Why do you want to be a doctor?' We would give them an answer like 'I want to help people.' Then they'd say, 'Why don't you become a social worker?' Wirtz: You started off feeling like, 'Boy I'm going to have to prove that I'm just as good as the guys, if not better.' And yet, you didn't want that to color your performance and how you treated your patients. Our classmates were wonderful. The guys in our class treated us like they were our brothers, so we had a wonderful experience that way. Very few times did I run into someone who was biased or difficult to learn from. Ledbetter: I think we really had to work hard to be one of the guys. I know that in the '70s, one of my good friends was one of the first female police officers, and it was the same thing. Women going into policing now, women going into medicine now, do not have to be one of the guys to be accepted. We had to work hard to do that. It was just that idea, 'We're not ready to have a woman,' but once we proved ourselves as individuals that led to women being accepted as a group. I think that's the part that makes us sort of trailblazers.
Slattery: I remember the first time we were in Yankton, and I was getting off the elevator. I was way in the back when the elevator door opened, and none of the men would get off the elevator. They wanted me to get off the elevator first. I thought, 'Guys, you've got to let go of this. We just need to get off the elevator.'
Susan Keck Andersen '10 M.D.: I probably encountered a little more of a double standard in science a few decades back than I have in medicine today. It seemed as though the science professors viewed women as lightweights. One of our research advisors was telling our group about a computer class being offered. I said I'd like to take that, and he said, 'Yes, you should. That will help you keep track of your household accounts.' I said. 'Well, I thought I'd use it for my data.' He said, 'Well, that's okay too.' But I never felt that way from my classmates. In medicine today, it's a non-issue. Maybe other schools are different, but I think our med school has been tremendously accommodating of both male and female students.
STARTING A FAMILY
'I was very concerned about whether it would be feasible for me to have a child and be a medical student.'
Carrissa Pietz '10 M.D.: Our medical school class was unique. Most of us were married. And a lot of our classmates had children. I had a child at the end of my second year in medical school. When I talked to my professors about it, they were actually very understanding - they were all male professors - and one even said, 'I think medical school is a really good time to have kids because the professors are understanding, and willing to work with you.' And they were. It was beyond what I could even imagine. Our residency program is very family friendly too. A lot of the residents have kids. It's obviously a great program - it's just another thing that draws a lot of people here.
Wirtz: It was the opposite for us. In one of the early lectures they discouraged medical students from marrying, and the thought of anyone conceiving a pregnancy during med school…. I can't imagine what would have happened.
Andersen: In my mother's youth, she lost her bank teller job when she became pregnant. I wonder if she would have been treated that way if she had been in medicine. Do you think that they would have kicked her out of school?
Ledbetter: A girl in our high school that got pregnant was not allowed back in school. The amazing thing is she ended up as a nurse practitioner, and she's in southern Wisconsin now. Did they kick the guy out too then? Heavens, no.
Wirtz: In my first pregnancy, I lined it up between my third and fourth year of residency and used my two weeks of vacation from one year, the two weeks of vacation from the next year and the two weeks of PME time to have my baby. They were not at all happy with me when they found out I was pregnant.
Peters: I started practicing and then got pregnant. I went to one of our business meetings at the clinic and of course there were all these men, and then there was me. I said I had an announcement to make. I said 'I'm going to be the first doctor in the clinic to be pregnant and have a baby.' They all clapped. Nobody was upset or angry or put me down. I did my six weeks of postpartum at home and that was it. I mean, it was time to go back to work. I had nobody yelling at me for being pregnant or whatever. It was good.
Andersen: I started my family in the midst of my application process. The first year, I got an alternate spot on the waiting list. During the next application cycle, I was pregnant with my son, so I held off for awhile. I was very concerned about whether it would be feasible for me to have a child and be a medical student. I already had a complicated lifestyle involving a long commute from home, but the first years of being a mom went well, so I felt pretty secure that I could continue that pattern if I started school. I proceeded, I was accepted, and I had a plan. Initially, I left my son home with Dad and Grandma so I could get settled into school, expecting to have him join me after the first month or so. But we just found that the high cost of day care - combined with the loss of my income and my health insurance - made that really impractical. I didn't like being away from him at all. It was a very difficult adjustment, but in retrospect, it was the appropriate decision. Even though reality turned out differently than my plan, the fact that my husband did such a wonderful job caring for our son made it okay.
'We got these five women coming, and we'll just have to muddle through.'
Wirtz: Starting a practice was a little different than medical school. Coming back to South Dakota to practice, I was one of the few women doing OB/GYN in the whole state. When I came back some of my patients would say after I talked to them about a hysterectomy, 'Who's doing the surgery?'
Slattery: Weren't you the first female OB/GYN in Sioux Falls?
Wirtz: I think so.
Slattery: I remember I was here before she was, and they were recruiting her husband at the clinic I was at. And I was standing in the hall when the medical director of the clinic approached Bob, who became her husband's partner, and said 'Well, we can offer him a position, but we have talked it over, and we just don't think that women are ready to have a woman deliver their babies, and we can't offer her a position.' And I of course responded in a very negative way and suggested that I would purchase an office for her on Minnesota Avenue where she could show them how many women would like to have a woman deliver their babies.
Wirtz: It took forever for them to let me have a second female partner.
Slattery: You got busy, busy, busy right away, and some of the men weren't busy, and she wanted another woman, and they didn't want another woman.
Ledbetter: When I went to La Crosse they had never had any women in the internship program before, and there were five of us. I found out at the end of the year, very late at night at a party at my house, that the head of the residency program had called that year's residents together before we had started and said, 'I don't know how it happened, but we got these five women coming, and we'll just have to muddle through.'
Slattery: What a tragedy!
Ledbetter: After two years of training, I went on staff there and I was, for at least 10 years, one of two women in a multi-specialty clinic with almost 200 doctors. Finally, in the mid-1980s when we started getting a lot more women in the internal medicine residency there, they hired some of them. They finally figured out they needed women in internal medicine and gave their husbands jobs. It was a business decision. Women doctors were in demand. There was a market for them.
Slattery: The marketing department learned that women spend the money in a household.
Ledbetter: And that women request women to take care of them. We didn't have any to offer, so they began hiring women. They had this blanket policy of no part-time. You had to be full-time or else. These women wisely said, 'We want to be part-time because we're going to want some time to raise our families.' So they had to break that blanket rule, and they never went back to full-time. And they're showcase doctors for them now. But I met much more resistance when I started residency than I did in medical school.
Wirtz: I must admit that when I chose my specialty, that was a consideration, because I really wanted surgery, but I didn't want to spend the next five, 10, 20 or 25 years of my life trying to fight for my place in medicine.
Ledbetter: I did a year of surgery residency. I wasn't allowed in the surgeon's lounge - the surgeon's lounge was for men. You changed clothes in the nurses' lounge. You weren't really accepted.
Slattery: I remember a really uncomfortable incident when I was at a local American Medical Association meeting here in Sioux Falls. I came in and there was a group of young women sitting at a table by themselves. I chose not to sit with them and sat where the men were. They were taken aback by these women sitting separate from them. But in the course of the conversation, one guy offered another guy a high office in the organization with no vote, nothing out in the open. You know, it was all handled behind the scenes, and the women were excluded. I told the men, 'I think that's why there's another table in this room – because of how things are handled.' They both sat back and said, 'That's right, isn't it?'
'Part of women having the burden of being the parent is that men have lost the opportunity to be a parent.'
Slattery: It is challenging, but it is for everyone, women and men, and men are just figuring it out. That's the other half of the equation. I think part of women having the burden of being the parent is that men have lost an opportunity to be a parent. I think in this process men have not really been allowed to be parents, and I think it's their loss.
Peters: To help keep the balance, we always had a woman come into our home and do the cleaning and take care of our child. They didn't live in our house but they took care of the kids, cooking, cleaning and washing clothes. As the kids got older, they would take them to and from school. That's how our family kept its sanity. I've done oodles of things outside the medical office, and I don't think I could have done all those things without somebody helping at home. I tell people we could have bought a lot of nice new cars for the money we spent on having someone come into our home, but it's a choice. My children had, you know, another grandma. I don't think that they had any bad effect from it.
Wirtz: That's pretty much what our family did too. We were both in med school together, both in residency together when we started a family. We both realized that we would have to keep working - we needed help with raising the kids. We tried the day care thing for a little while and then settled on a nanny.
Peters: I think it doesn't matter what a woman does - the job they have - hopefully they all have help. It might depend on your income, but it shouldn't be just physician women that get help. And if your significant other wants to be that helper, fine. It just depends on the couple. It just so happened that my husband was an attorney. He was very busy too. It was difficult for either one of us to have to come home and do the housework.
Slattery: But don't you think that's true in general - that there's not enough help for parents? I just feel that that whole part in society has a long ways to go.
Andersen: There's federal support for child care costs for students if they're undergraduates. But if you go to medical school or law school, you can't get any type of support. It's really frustrating. What is the message then? You can go to school, but don't go to too much school?
Andersen to Slattery: I thought that was so well put when you were talking about how there isn't room necessarily for men in society to be parents.
Slattery: I think it's fundamental.
Andersen: There's not room in the culture, is there? If that space is traded, they go for it. How exactly similar is that to the story that you told about the women around the table? They were sitting at another table because they were excluded. You wonder, 'Why don't men step up? Why aren't men involved in parenting?' It's because there's not room at the table. They sit at another table, because we've excluded them already.
Wirtz: Two of my partners have husbands that stay at home and take care of kids, and that's working in their relationships.
Pietz: I'm glad to be a woman in medicine now. I would hope that I would have had the strength to go through what you went through back then, but without being actually faced with it, you never know. There have been no gender issues for me. There was never a thought that just because I was a woman I couldn't go into medicine.
Slattery: What I feel the problem is right now is that people think that women have arrived, that the movement is done. But I hope people don't feel like it's done, because it's not. In Sioux Falls, for example, there are 30 males and one female in cardiology. The glass ceiling still exists.
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