May 12, 2016 | Olivia Hung, MD
Career Development

As we are surveying the new suite that will accommodate our growing laboratory group, I wonder aloud about getting a coffee machine. My female colleague immediately replies, “No. We’ll be the ones always cleaning it.”

My first love was chemistry, which germinated when my seventh grade science teacher carefully held a bucket of mercury for us to observe and later mentioned to me that I had an innate aptitude for the subject. My passion held firm through high school chemistry (where my teacher spent six months teaching us the definition of a mole) and a freshman general chemistry course in college (during which my professor spent an entire lecture wrongly deriving the Schrödinger equation), and blossomed once I encountered the power of aldol mechanisms in organic chemistry.

Chemistry research is a male-dominated field. I didn’t think about it much as an undergraduate, so it was disconcerting to experience some of the more subtle forms of gender discrimination as a first year graduate student. The whispers in the corridor after my female friend was awarded a prestigious national grant: “She only got it because she is a woman.” The times when the laughter abruptly stopped as I walked into the room because the boys had been cracking lewd jokes to each other before I opened the door, and they knew it was inappropriate to do so with a female presence. I responded the only way I knew how – I aced my graduate classes and left the boys in the dust.

In medical school and internal medicine residency, with a more equal balance between males and females, I have not felt the need to prove myself over and over again. No one blinks when females graduate summa cum laude. There are very few questions about the fairness of call, research opportunities, fellowship applications, or job openings in internal medicine. I have chosen to specialize in cardiology, again without giving much thought to the gender imbalance in the field.

I find myself back in a male-dominated society pursuing a field that I love. Cardiology is, frankly, much nicer, and there is more recognition of gender biases than in the academic chemistry world. However, I again encounter that feeling of having to demonstrate that I am better than the boys in order to be recognized for my potential. This time I am older and am less naïve and tolerant. I do not want to be relegated again to cleaning group coffee machines, recording meeting minutes or planning group outings. Enough is enough.

Gender discrimination is real. What are we going to do about it?

Historically, our society has tried to tackle discrimination by using blunt instruments, such as affirmative action and quota systems. Although quotas quickly increase numerical diversity in generated reports and measures, they also set up a double standard, which does no one any favors. The white male population contends with reverse discrimination while the underrepresented minority has to fight even harder to prove that they are truly deserving of that preference. The quota system was struck down in the landmark 1978 United States Supreme Court case, Regents of the University of California v. Bakke, in which Bakke sued the University of California system after being rejected from the University of California, Davis Medical School on two occasions, contending that his rejections resulted from being white and “too old”. The justices issued a plurality ruling that, while race could be used as one of several factors in university admissions policies, specific quotas were not allowed. Interestingly, the issue of age discrimination did not appear to have gained much traction.

While strict quotas cannot solve the discrimination and bias issues present in our environment, efforts to promote diversity still represent progress. Over the past decade in cardiology, there has been a standardization of cardiovascular disease management with the propagation of guidelines and appropriate use criteria. Ultimately, however, we remain focused on the individualization of care as we recognize that one standard approach does not work for all patients. Bernadine P. Healy, MD, FACC, and C. Noel Bairey Merz, MD, FACC, have described the “Yentl syndrome,” where women who have similar cardiac presentations to men (i.e. typical angina) have improved odds of survival compared to those who have more atypical symptoms. As female cardiology fellows, we may also experience a Yentl-type situation, where we feel pressured to dress, live, speak and act like men in order to advance our careers. While it may work for some trainees, statistics suggest that this approach does not work for the majority of us. An individualized approach is required if we truly want to promote diversity and that requires a substantial investment of time, effort and reflection from ALL sides. Let us embrace this challenge so that we can build upon the successes of our predecessors and fulfill the American dream of equal opportunity for all.

The author would like to express her gratitude to Claire S. Duvernoy, MD,  FACC, for her help with this article.

This post was authored by Olivia Hung, MD, a fellow in training at Emory University Hospital in Atlanta, Georgia.