The Good Daughter Syndrome In Academic Medicine

Women should focus less on pleasing their mentors and more on establishing their independence.
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When I was young and uncertain about my future, my father helped me to build a decision-making spreadsheet. Columns were headed by a list of job characteristics I valued, like autonomy or security, and rows were labeled with potential professions. I weighted job characteristics according to how important they were to me, and then I scored each profession for how well I thought it would deliver on that metric. In the end, a tidy numerical score that told me I should be a doctor—probably because that was the conclusion I subconsciously wanted from my highly biased decision-making exercise.

One of the metrics on my spreadsheet that most favored the medical profession was absence of gender bias. I had spent a summer working as a gopher at a chemical company, where I learned firsthand how demoralizing workplace sexism could be. In my young mind, doctors were above all of that. After all, nearly a third of practicing physicians are women, and medical school enrollment is split nearly evenly between men and women.

The truth, however, is that women in academic medicine face many of the same hurdles as women in other work settings. At the entry level, women are overrepresented relative to men, but few climb the ladder to the highest ranks. Only 21 percent of full professors are women, and a paltry 15 percent of departments are headed by women.

There are many reasons why women might not succeed in academic medicine. Some choose family over career, which can restrict work hours and geographic mobility. Some face overt discrimination—two thirds of female academic medical faculty report that they have been affected by gender bias, and one third have been victims of sexual harassment. Hiding behind these more obvious forces, however, is a widespread—albeit subtle—issue that needs to be addressed for women to achieve parity in academia. I came to think of this issue as the “good daughter syndrome.”

Mentorship is critical to advancement in academic medicine, and as the majority of the upper faculty echelons are occupied by men, inexperienced women are usually paired up with older men. In the early days of these relationships, the mentee is eager to please her new boss, and the mentor is benevolent, happy to advise and guide a promising young woman. This often leads to a father-daughter dynamic, which at first seems fine for both parties—the mentor gets free labor and credit for the work of his underling, and the mentee gets a free ride on her boss’ coattails. What starts out as a congenial relationship can sew the seeds for later strife, however.

When women act like deferential daughters, they fail to prepare for future independence. Like Ivanka Trump, they become subsumed by their father’s brand; they are seen as helpmeets and extensions of the older man’s success. Unlike Ivanka Trump, however, ambitious junior faculty members cannot ride Daddy’s coattails forever. The time comes when they must apply for promotion, and that is often when things falls apart.

It is common practice in academic medicine for senior faculty members to get help with grant and paper writing from more junior members. Insofar as the junior parties benefit from research dollars rolling in, this is not an unfair arrangement; in its extreme, however, this practice is exploitative. At one point in my career, I found myself writing entire grant proposals without input from my mentor, but I still named him as principal investigator. The grants I wrote under my mentor’s name generally received favorable reviews, but when I submitted grants under my own name, they were graded more harshly, in part because the reviewers did not see me as being sufficiently independent. Like many of my female colleagues, I realized that by being overly helpful and deferential, I was painting myself into a corner.

A mentor who is used to being a father figure may not react well to a mentee suddenly demanding credit for her work and asking to be treated as an equal, but even if he does react well, it is often too late to change the perceptions of others. No matter how talented she might be, the academic world will not give a scientist a seat at the table if they don’t believe that she has earned it, and there’s no way to retroactively claw back credit for past work.

The “good daughter” role is a comfortable one for many women to play but a dangerous one. Women should focus less on pleasing their mentors and more on establishing their independence; they can do this by insisting on proper credit for their work, seeking mentorship from multiple individuals and forming their own collaborations. It may be harder in the beginning to stand up for oneself than to play dutiful daughter, but it is a far better way forward.

For more narratives and perspectives on women in medicine, please see From Doctor to Doct-her: The Tale of a Skeptical Feminist, by the curator of this collection Jessica Gold, MD MS.