Challenging conventions, redefining roles, setting trends: the 21st-century female ophthalmologist

The number of women entering the profession is now matching the number of men. The strength and determination of the women who came before made today’s opportunities possible.

Step into a classroom full of aspiring physicians today and you will find that nearly 50% of the students are women. This is a significant change from just 30 years ago, when the percentage of women in such a classroom would have been closer to 5%.

“It really wasn’t until the late 1960s and 1970s that medical colleges opened their doors to women,” Barbara J. Arnold, MD, told Ocular Surgery News. “At about this time, women accounted for less than 5% of all medical school students.”

“Things are much better now, though several recent studies indicate that there is still a difference in the salaries of female physicians.” — Marguerite B. McDonald, MD

“In my medical class of 1976, one-fifth of us were women, and it was a big deal,” said Marguerite B. McDonald, MD. “Time magazine wrote up an article on us. The attitude was, ‘What are medical schools thinking? Why is Columbia P&S accepting so many women?’ This was a very radical thing.”

From the time the first American woman received a medical degree in 1849, it has taken more than 150 years to reach this point, where women are now entering the formerly male-dominated profession of medicine at the same rate as men. Today a steady stream of women is entering the field — and every year the rates are rising.

Data from the American Medical Association shows that in 2001 the percentage of women graduating from medical school increased to 42.4%. Women currently account for 25% of all doctors practicing medicine in the United States, and this figure is estimated to rise quickly with the increasing numbers of women graduating yearly.

While higher numbers of women can be found in the nonsurgical areas of medicine such as pediatrics and family care, their presence in surgical specialties such as ophthalmology are also on the rise.

Increasing percentage

“In the past, only about 0.3% of ophthalmologists were women. Today, the percentage of women in the field of ophthalmology has increased to 1%,” said Dr. Arnold, immediate past president of the organization Women in Ophthalmology Inc. (WIO). While 1% may seem small, any increase at all is crucial to strengthening the female workforce, Dr. Arnold said.

“This marks a huge increase in career opportunities. We have 300% more women in ophthalmology than we did just 30 years ago. The plateau that was steady for years and years has started to increase dramatically. In the near future, women will represent 30% of ophthalmologists,” Dr. Arnold said.

Other women with established and nascent careers in ophthalmology agreed with Dr. Arnold’s assessment.

“Attitudes and perceptions are really changing,” said Dr. McDonald, who is currently serving as the first female president of the American Society of Cataract and Refractive Surgery.

“We owe a lot of gratitude to the women who have helped make so many opportunities for us,” Dr. Dhaliwal said. “At this point, I feel that there is nothing holding me back from succeeding in my career.” — Deepinder K. Dhaliwal, MD

“Things have gotten easier for us women entering the field in the last 20 years,” said Deepinder K. Dhaliwal, MD, chief of refractive surgery at the University of Pittsburgh School of Medicine. In 1995, Dr. Dhaliwal became the first woman to join the ophthalmology faculty at her institution.

“We owe a lot of gratitude to the women who have helped make so many opportunities for us,” Dr. Dhaliwal said. “At this point, I feel that there is nothing holding me back from succeeding in my career.”

Elizabeth A. Davis, MD, FACS, said, “If I persist hard enough, I feel like I can accomplish anything.” Dr. Davis has been an assistant professor at the University of Minnesota and a partner ophthalmologist at the Minnesota Eye Consultants in Bloomington, Minn., since 1999.

Dr. Dhaliwal and Dr. Davis both said they feel that they have not encountered as much sex discrimination as other women who entered the field of medicine before them.

“I feel as if I’ve been given the same opportunities as men. I’ve faced no blatant barriers in my career,” Dr. Davis said.

“While there are inequalities that still exist, the situation has improved tremendously for women,” Dr. McDonald said.

Defying convention

When Dr. Arnold first began her medical career in 1969, she was the first woman accepted into a rigorous ophthalmology program at the University of Colorado. At that time, she said, women entering medicine had to prove to their professors and peers that they were as qualified as any male candidate.

“In those early years, I was under pressure to perform in a way that would look as close as possible to being without flaw, without question. We knew that we were being watched, so we didn’t dare do something that might be questioned,” she said.

Dr. McDonald, who was also one of the first few women in her residency program, agreed.

“All of us who trained early felt like we were under a microscope. We had to show every day that we could compete, excel and succeed,” she said.

“Women at this stage of medicine were breaking new ground, venturing into uncharted waters. We were very careful not just for ourselves, but for those who might succeed us,” Dr. Arnold said. “We didn’t want to fail those women who were coming behind us.”

Attaining recognition

In earlier days, the assertiveness necessary for women to succeed in medicine often exacted a price on the social level. Gaining acceptance and respect from male colleagues was difficult. Fierce determination was often was met with disapproval, mockery or sexual discrimination.

“Women who were perceived as ambitious go-getters were often seen as bossy or pushy, whereas a man would have been perceived as driven. Consequently, men felt threatened. These were not the women they were used to dealing with – because many women still stayed at home,” Dr. Arnold said.

Today, however, women in medicine are more representative of women as a whole.

“There are women who throw themselves into research and practice long hours as well as those who work from 9 a.m. to 5 p.m. and go home to their families. There are both introverts and extroverts in the field — all types of women are represented,” Dr. McDonald said.

Dr. Arnold said women in medicine still share the trait of a high level of commitment, but they are sometimes not recognized for the quality of their work.

“It has become an expectation that if you ask a woman to do the job, you will find it to be done exceptionally well and done in a timely manner. Many women are so result-oriented on behalf of the patient to get the job done that there is a possibility that a lot of terrific work may go without the fanfare and notice that others may receive,” she said.

Achieving leadership roles

According to the ASCRS, 20% of its international membership is female. The American Academy of Ophthalmology says 14% of its members are women.

“These percentages are very encouraging, but now we need to be better represented in the activities,” Dr. Arnold said.

“I feel as if I’ve been given the same opportunities as men. I’ve faced no blatant barriers in my career.” — Elizabeth A. Davis, MD, FACS

She said the WIO encourages all its members — both women and men who support the organization — to participate actively in AAO scientific, political and social activities.

“We also work as a referral source to identify many of our talented members who might be able to serve on committees, to deliver scientific presentations or to work on priority projects,” Dr. Arnold said. “The organization has brought surgeons to the forefront who otherwise might be overlooked.”

According to the American Association of Medical Colleges (AAMC), women are still often overlooked for managerial positions, society boards and faculty positions at universities.

In 2001, according to the AMA, women held 28% of medical university faculty positions. The fields with the lowest percentages of women were the surgical fields, such as ophthalmology, in which only 13% of faculty members were women. Of female physicians employed at universities, only 11% hold full professorships, whereas 31% of male physicians employed by universities are full professors.

Statistics from the AAMC show that in 2001, women accounted for only 8% of department chair positions in medical colleges across the country. At least 21 medical schools had no female department chairs at all.

“For the most part, women who don’t take part in a lot of male recreational networking often suffer career-wise — so when it comes time to elect board members or a panel, someone will say, ‘I’ll put all my buddies on the panel.’ Consequently, the most skilled or experienced person for the job might not get the position,” she said.

The glass ceiling

According to Dr. McDonald, there is an invisible barrier — the glass ceiling — that still occasionally materializes, prohibiting women from progressing to certain stages of a career.

“Young women today don’t realize that it is still sometimes a factor. When they are in their residencies they think, as I did, ‘What are these older women talking about? I’m treated equally, the chief resident this year is female. …’ They don’t encounter it until they get out in the real world for a few years. Hopefully, these situations will occur even less frequently in the years to come,” she said.

“If a woman doesn’t have CV a mile long, that doesn’t mean she isn’t accomplished. It just means she’s been there, every day, giving all her effort in the office and in the home.” — Barbara J. Arnold, MD

According to Dr. Arnold, women finishing residencies today, after training alongside many other female students, may have a skewed perception of the realities of the workplace.

“These recent graduates are not the ones making the rules when it comes to advancement and equal opportunity in the workplace. The people who are calling the shots for selection committees and faculty positions trained 30 years ago, when women made up 5% of medical students and were not as accepted in the field as they are today,” she said.

“Things are much better now, though several recent studies indicate that there is still a difference in the salaries of female physicians,” she said.

According to the AMA, the average net income of a female physician in the United States in 1997 was $120,000 — $55,000 less than the average male physician, who took home $175,000 that year. A study in 2000 by the University of Pittsburgh Graduate School of Public Health found that on average, female physicians can earn as much as 28% less per hour than their male counterparts.

Making career choices

Dr. Davis speculated that women may tend to sacrifice higher salaries to spend more time with family and involve themselves in social and civic activities. In fact, she said, many women “put the reins on themselves” when making career decisions.

“Some women decide that they want to settle down, work part-time to care for their children, or just don’t want to pursue their career as ambitiously as some men do,” Dr. Davis said.

AMA statistics show that women physicians work fewer hours than men do and tend to apply for positions that are less demanding of their time, so that they have more energy to focus on other interests and obligations.

“Women today are setting their priorities to their own needs and living according to those rules,” Dr. Dhaliwal said. “In most families, women are the primary caretakers, so they need more time to devote to taking care of their families. Oftentimes work hours are sacrificed.”

Additionally, because most women have not had the time to build up their practices as much as most men have (the AMA says female physicians are on average younger than male physicians), their lower incomes may reflect their relative youth.

Finding balance

While there are many young women working hard toward a successful career, many seek a balance between their professional and personal goals. And according to Dr. Arnold, a “blended balance in life” can enhance one’s performance in the operating room.

“If you have a meaningful weekend with your friends or family, you are restored and regenerated to return to work and give your utmost level of care,” she said.

“Many women want to be more active in raising their children or want to spend more time developing fulfilling relationships with their spouses. While these women are excellent clinicians, they are probably excellent wives and mothers too,” Dr. Dhaliwal added.

“If a woman doesn’t have CV a mile long, that doesn’t mean she isn’t accomplished. It just means she’s been there, every day, giving all her effort in the office and in the home,” Dr. Arnold said.

“We will continue to put effort into balancing these varied aspects of our lives, and we’ll do it with as much dignity and grace as possible,” Dr. McDonald said. “Remember Ginger Rogers’ famous quote, after she retired? ‘I did everything Fred Astaire did — only backwards, and in high heels.”

For Your Information:

• Barbara J. Arnold, MD, can be reached at 7275 East Southgate Drive, Suite 201, Sacramento, CA 95823; (916) 393-1000; fax: (916) 393-4087; e-mail: bjarnold@ucdavis.edu.
• Marguerite B. McDonald, MD, can be reached at the Southern Vision Institute, 2820 Napoleon Avenue, Suite 750, New Orleans, LA 70115; (504) 896-1240; fax: (504) 896-1251; e-mail: mbm2626@aol.com.
• Deepinder K. Dhaliwal, MD, can be reached at University of Pittsburgh, 203 Lo throp Street, Pittsburgh, PA 15211; (412) 647-2214; fax: (412) 647-5119; e-mail: dhaliwaldk@msx.upmc.edu.
• Elizabeth A. Davis, MD, FACS, can be reached at Minnesota Eye Consultants, 710 E. 24th Street, Minneapolis, MN 55404: (952) 885-2467; fax: (952) 885-9942; e-mail: eadavis@mneye.com.