For Female Emergency Docs, Lack of Respect Is Part of the Job

SAN FRANCISCO -- Female emergency physicians were more likely to report misidentification and mistreatment based on their gender compared with male colleagues, according to a pair of studies.

In response to a survey sent to nurses, residents, and attendings who worked in an academic emergency department (ED), female residents and attendings reported more gender-based discrimination (P=0.002) and misidentification as non-clinicians (P=0.039) compared with men, reported Michelle Suh, MD, of Baylor College of Medicine in Houston.

They were also more likely to report that gender-based discrimination increased their personal risk of burnout (P=0.002) and sense of self-doubt (P=0.003), she said during a presentation at the American College of Emergency Physicians annual meeting.

"There's evidence of gender-based discrimination coming out in these interactions," noted Suh. "At a time when everyone's talking about burnout and wellness, these reports and incidents have a direct effect on job satisfaction."

Suh's group said that female attendings were significantly more likely than men to:

• Encounter rudeness
• Be dismissed
• Face issues with procurement of supplies
• Have gender-based discrimination reduce their job satisfaction and sense of personal well-being

Female residents had similar experiences: they were significantly more likely than men to report often being dismissed, experiencing gender-based discrimination, being mistaken for a non-physician, having requests/orders ignored, and feeling less trusted.

Female residents also reported that gender-based discrimination significantly decreased their job satisfaction and personal well-being, and increased their personal risk of burnout and self-doubt, while female nurses only reported feeling self-doubt as a result of gender-based discrimination.

In another single-center prospective study, survey responses showed that female physicians were more likely to be misidentified as a non-physician compared with male physicians (P<0.001), and there was no statistically significant change in rate of misidentification with the addition of "Doctor" badges, reported Kathryn Wellman, MD, of St. Luke's University Hospital in Bethlehem, Pennsylvania.

"It's frustrating to constantly have to justify my role," commented one female attending who reported that nurses look at her as if she's less qualified while not treating less-experienced male doctors the same way. In another comment, a female attending said, "I'm constantly being asked if I'm the physician or if I can sign EKGs."

"I feel like the nurses love the male doctors so much more and listen to them, and then when a female doctor says something, it's questioned easily or there is so much attitude about it," a female resident commented. Another resident said it's common for nurses to question female-led or all-female physician teams. "This creates self-doubt," she noted.

A previous study suggested that doctor badges reduce incidents of misidentification. "But obviously we didn't have that here," Wellman said. Physician misidentification contributes to job dissatisfaction among women, she continued, so "this ends up having personal ramifications for not only us as individuals, but also for the profession as a whole."

She said the next steps for research are to determine how women physicians are misidentified (are they assumed to be nurses?) and who's misidentifying them -- other professionals in the ED or family members?

"We need to identify the root cause of misidentification and come up with solutions that can be more overarching and applied more broadly," she added.

For their study, Suh and colleagues sent an online anonymous survey to all nurses, residents, and attendings at an ED in a large county and received responses from 24 residents (55% response rate), 25 attendings (56% response rate), and 55 nurses (53% response rate).

An expert panel of attendings, residents, and nurses developed the survey based on two previously published surveys looking at gender issues in the ED and inter-departmental professionalism.

The study by Wellman and colleagues was inspired by an earlier hospital survey of patients asking whether they'd seen a physician during an ED visit. The survey suggested that patients were more likely to realize that they'd seen a physician if the doctor was a woman (75%) over a man (68%), "which was surprising to us and didn't really correlate with the day-to-day interactions and experiences of our female physicians," said Wellman. "So we decided to take it one step further."

For this study, 60 emergency physicians from a large academic medical center responded to survey questions about the misidentification they encountered while wearing standard badges. Subsequently, 32 physicans wore large red "Doctor" badges for another 2 weeks and answered the same questions.