'Is It Just Me?' Comfort In Commonality

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Blog authors Anita P. Mayer, M.D., Julia A. Files, M.D., and Sharonne N. Hayes, M.D. are physicians at Mayo Clinic.

Just ask any woman with an M.D., D.O. or doctoral degree if she has ever experienced a situation where her title of “doctor” was withheld while a male colleague in the same situation was referred to as “Dr. X.” Invariably you will hear, “Oh yes, this happens all the time, but I never know if it’s just me?”

We now have an answer to that question, and NO, it is not just you! For many women, the early experiences tend to be subtle, and we shrug them off not wanting to be hypersensitive. Worse, we can be left to wonder if we inadvertently send off some sort of informal vibe that signals we prefer to be called by our first names. As co-authors, we had all noticed this annoying occurrence throughout our careers. It took the proverbial straw that broke the camel’s back to move us to share our experiences and to formally investigate.

Dr. Julia Files was the spark. An excellent speaker and educator, Dr. Files is in great demand to speak at conferences to share her expertise. Several years ago she returned from one such event and shared with us her less than gratifying experience. She was the only female speaker sharing the podium with three other M.D.s, all male. The audience was enthusiastic and engaged with Dr. Files during her presentation. Then, at the conclusion of the program, the unthinkable happened. The male moderator ended the program by thanking “Drs. X, Y, Z and Julia.” How had the moderator chosen to omit her title? She and the moderator were not close friends, and to her knowledge all the speakers were of the same status and close to the same age.

Wow, we were flabbergasted! Though we had all had similar experiences over the years, nothing was quite as glaring as this episode. We began to ask ourselves, how frequently does this happen? While annoyed and somewhat riled, we were at a loss as to what to do next. At least we appreciated some degree of comfort in commonality that we as individuals were not alone in this experience. Then, not two weeks later, Dr. Mayer was speaking at a large and formal program. Dr. Files was a member of the audience. As if on cue, the male moderator ended with a thank you to the speakers, “Drs. X, Y, Z and Anita”! That did it. We needed to do more than just talk about this.

We began with an informal poll of female physicians and scientists we worked with and lectured to across the country. It quickly became apparent that, regardless of practice type, specialty or geographic location, all the women revealed similar experiences. In fact, just bringing up the topic would usually lead to an opening of the floodgates with personal stories. The most concerning yet totally relatable aspect of the stories was when women revealed how when they had spoken up and pointed out the omission of their title, they were treated as petty, oversensitive, or worse, mocked. As we researched the topic, we came across accounts of other professional women with advanced degrees in engineering and law reporting similar experiences. However, we could not find any study published in the literature that validated our experience. We looked at business, law, science and other fields, nothing!

So we set up our own study to compare gender differences in introductions. The venue was Medical Grand Rounds, which, despite its name, does not occur during rounds in the hospital or at the patient’s bedside in a small group setting. Rather, Grand Rounds occurs in a large auditorium and is THE formal weekly educational session for faculty and learners. The majority of participants in both the role of speaker and audience member are peers holding M.D., Ph.D., or M.D./ Ph.D. degrees. At Medical Grand Rounds one expects formality in speaker introductions and as a result, there really shouldn’t be gender differences.

With help from both male and female colleagues we viewed and analyzed over a year of videotaped introductions. What we found in reviewing over 320 discreet introductions left us gratified, validated and saddened at the same time. We confirmed that whether doctors are introduced as “Dr.” depends on the gender of who introduces them. Women introducing any Grand Rounds speaker used “Dr.” virtually all the time (96%) regardless of the speaker’s gender. Men, on the other hand, were less formal overall; across all speaker introductions by men, only 2/3 ever included “Dr.”

Our real validation came when we looked at the gender of the speaker being introduced. Among introducers, there was a distinct gender difference in their use of titles; male speakers were introduced by men as “Dr.” 72 percent of the time, but less than half of the women were introduced as “Dr.” This is both statistically and socially significant. Imagine the experience from the woman’s perspective as she approaches the podium. She will hear her formal title from almost all of the female introducers; however, there is less than a 50 percent likelihood that a male introducer will set the tone by calling her “Dr.”

A word about why this matters ― much of our interest in academics prior to this study revolved around the academic advancement of women in medicine. Although advances have been made, women continue to lag behind their male counterparts in many important areas. Very few women are deans of medical schools or medical department chairs. Various forms of gender bias have been shown to contribute to the lack of women in leadership positions. Studies have demonstrated the presence of bias in how language is used to describe female vs. male faculty in their letters of recommendation when seeking tenure, suggesting gender stereotyping may impede career advancement of women. Gender-subordinating language, as in choice of level of formality (i.e., style) in forms of address (e.g. formal title versus first name versus nickname), is a subtle and more than likely entirely unconscious form of gender bias. Word choice and selective use of forms of address may reflect conscious or unconscious assumptions about gender roles.

Failure to acknowledge a woman’s hard-earned professional title while men are awarded theirs, even when unintentional, has profound implications and reinforces the perception of women having lower status. This de-professionalizing serves to activate stereotype threat and internalized sexism at a time when a woman needs to be at peak performance. During the course of our research for our study, we came across an article in the New York Times: “They call me Dr. Berry.” Dr. Carlotta Berry wrote of her insistence and expectation to be called Dr. Berry in the classroom. Dr. Berry, a female African American professor of engineering, acknowledged inconsistencies in the desire to be called “Dr.” in academia. But, she noted those with a stated preference to be called by their first name were “mostly men, almost all white, and they have that luxury.” Conferral of status through use of a title matters more when given to an individual when their status is not automatically assumed..

So again, why does this matter? As we continue to see the response to our work, apparently it does matter a great deal to many professional women. As researchers, it is always satisfying to set out to study something, find what you were looking for and then to have your findings published. However, the response to our work, the personal stories and feelings of validation that just keep coming, have been beyond rewarding. We have received an outpouring of thanks, shared stories and appreciation from women beyond academics and medicine. Women professionals across the country from all branches of science, law and even female clergy now have data to support their collective experience. They now all know it is “not just me.”

We hope to see meaningful change as a result of our study. Our goal is to support and lift up other women who share our journey, and these data help us spur change. If we must, we’ll do it one introduction at a time.

SOURCE: Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias, by Julia A. Files, MD, Anita P. Mayer, MD, Marcia G. Ko, MD, Patricia Friedrich, PhD, Marjorie Jenkins, MD, Michael J. Bryan, MD, Suneela Vegunta, MD, Christopher M. Wittich, MD, Melissa A. Lyle, MD, Ryan Melikian, Trevor Duston, BA, MA, Yu-Hui H. Chang, PhD, and Sharonne N. Hayes, MD. Published online before print in JOURNAL OF WOMEN’S HEALTH. DOI: 10.1089/jwh.2016.6044