If you logged onto social media on Friday, you may have seen a deluge of photos of women — and a few men — posing in bikinis, some drinking alcohol. If you read the captions, you knew these women were doctors. And you knew they were angry.
Women in the medical community decried this characterization of “professionalism” as sexist, prompting the journal to apologize and retract the article. But the conversation became about more than just one article — for some female doctors, it was an opportunity to talk about a number of inequities across the medical community.
When Victoria Dooley first read the Journal of Vascular Surgery article, it was “shocking and offensive,” but not altogether surprising, she says. A 40-year-old family medicine physician in Michigan, Dooley says that in her experience, male surgeons have “the most privilege” in medicine. The idea that they could dictate right from wrong was par for the course.
As a Black woman who’s in primary care, that hierarchy was acutely felt as she went through training. “There’s always a fear that if you speak up, you’re going to get kicked out of residency,” Dooley says.
Posting to #MedBikini was a way for Dooley to speak out and say it’s time for these hierarchies, as well as the general public’s perception of doctors, to change. “We need to get over this ‘doctors are high and mighty’ sort of thing and they can’t be people,” she says. “I want my patients to know that doctors are humans, too.”
To which I respond: pic.twitter.com/mTWo254bzY
— Dr. Victoria Dooley (@DrDooleyMD) July 24, 2020
To some extent, greater expectations of doctors to act “professionally” in their everyday lives is fair, according to Janis Orlowski, chief health care officer of the Association of American Medical Colleges (AAMC). “Because of the honor that we are given in caring for patients, there is a professionalism that needs to go beyond just our workday,” Orlowksi says. “At the same time, there’s this idea of who gets to be the arbiter. If there’s a shot of you golfing it’s okay, but if there’s a shot of you on the beach it’s not okay. And there’s where some of the gender inequities come in.”
These inequities are well-documented. According to a 2018 report from the National Academies of Sciences, Engineering, and Medicine, women medical students are 220 percent more likely than students from non-STEM fields to experience sexual harassment. The majority of this harassment consisted of microaggressions, including crude comments, sexist insults and implications that women “don’t belong” in a certain specialty or institution.
Although women outnumbered men in medical schools for the first time last year, almost 40 percent of women physicians scale back their practice, or leave the profession altogether, within six years of completing their residencies. As the University of Michigan’s Intern Health Study found, the primary reason was to take care of family.
And even when women do stay in the field full time, pay disparities exist: A 2018 salary survey found a discrepancy in median compensation between men and women at every rank across a majority of specialties and departments.
Orlowski says that beyond the data, gender imbalances exist in “opportunity.” There may be “subtleties” such as informal mentorships or the opportunity to work on certain projects that “add up to a greater advantage over women,” she says.
For women who exist at the intersection of other marginalized identities, these imbalances are only exacerbated. A Health Resources and Services Administration analysis from 2017 found that all minority groups, except for Asians, are underrepresented in health diagnosis and treating occupations.
Eshani Dixit, a third year medical student at Rutgers Robert Wood Johnson Medical School, decided to post under #MedBikini after she saw that most of the doctors in the photos were “thin and white.” “I thought it was important to get some size diversity and ethnic diversity in there,” she says.
Although her class feels fairly diverse in terms of ethnicity and gender, Dixit says, other experiences have made her feel that certain populations still aren’t being represented. Wealth and privilege, for example, advantage students who can pay for extra test prep. Dixit has also noticed a lack of openly LGBTQ classmates and instructors, she says. The Journal of Vascular Surgery paper made her reflect on how all of this might play out once she enters the field.
“Those ideas of professionalism are really just repackaged ideas of sexism, racism, classism, homophobia, transphobia,” she says. “How can we stop people from being professionally targeted for the way they just happen to be in the world?”
That’s a big reason Dooley, the family physician in Michigan, decided to start her own practice: She calls it her “own safe space.” She’s trying to create a safer space for her patients, too, she says, pointing to the adverse health outcomes for many Black women — including having a maternal mortality rate that is 2.5 times higher than that of White women. As recent studies have shown, Black patients have better health outcomes when they are treated by Black doctors. Dooley says she shares information about her personal life with her patients — the fact that she struggled with obesity as a kid, for example — in order to build trust, which in turn can make them more honest about their own habits and health.
“I posted that photo because I am a huge advocate of health disparities and social justice,” she says, referencing #MedBikini. “For me as a physician, I have to be an advocate, because it does boil down to the health of my patients.”
The flood of #MedBikini posts gave AAMC’s Orlowski reason to be hopeful, too. She graduated from medical school in 1982, when less than 20 percent of her class was women, she says. At that time, women “just felt lucky to be there.” She says the fact that women in medicine are collectively saying, “We don’t have to put up with all this crap,” hopefully means that the medical profession will start changing at an institutional level. For Orlowski, it’s akin to the powerful speech Rep. Alexandria Ocasio-Cortez (D-N.Y.) recently gave on the House floor after Rep. Ted Yoho (R-Fla.) reportedly lobbed sexist comments at her. “It’s like, we’re not going to take this anymore,” Orlowski says.
As a young medical student, Dixit is at the front lines of that change. “I think that a lot of medicine for the past several years has been a lot of, ‘Well, I’ve had to go through this, so you have to go through it too,’” she says. “I hope this younger generation of physicians realizes we can say, ‘This ends with me.’”
