When Suzanne Koven, a longtime physician and now writer in residence at Massachusetts General Hospital in Boston, was coming up as a young doctor some 30 years ago, the gap was even bigger.
Today, "women make up half or even more than half of the entering classes of many U.S. medical schools," she says of the progress. But "we still have a long way to go."
Koven recently helped a group of medical interns write a letter to their future selves. She took the chance to write a letter of her own, giving advice to her younger self.
In it, she warned a wide-eyed intern version of herself of the challenges ahead and gave the advice she wishes she'd had back then.
"When I started my internship 30 years ago, I wasn’t invited to share my hopes and anxieties in a letter — or anywhere else, for that matter," she wrote in the letter, published in the New England Journal of Medicine.
Better late than never.
Recalling the early days of her own medical career, Koven described plenty of casual and maddening sexism:
"On your urology rotation in medical school, you were informed that your presence was pointless since 'no self-respecting man would go to a lady urologist.'
There will be more sexism, some infuriating, some merely annoying. As a pregnant resident, I inquired about my hospital’s maternity-leave policy for house officers and was told that it was a great idea and I should draft one.
Decades into practice, when I call in a prescription, some pharmacists still ask for the name of the doctor I’m calling for."
She also noted that hospitals are full of crude "bro humor" that can alienate women.
She went on to cite perhaps the most depressing statistic of all: Female physicians earn, on average, about $20,000 less than their male counterparts.
"But there’s also a more insidious obstacle that you’ll have to contend with — one that resides in your own head," she wrote. "You see, I’ve been haunted at every step of my career by the fear that I am a fraud."
"I believe that women’s fear of fraudulence is similar to men’s, but with an added feature: not only do we tend to perseverate over our inadequacies, we also often denigrate our strengths."
After years of trial, error, and experience, Koven came upon a powerful realization:
"I now understand that I should have spent less time worrying about being a fraud and more time appreciating about myself some of the things my patients appreciate most about me: my large inventory of jokes, my knack for knowing when to butt in and when to shut up, my hugs. Every clinician has her or his own personal armamentarium, as therapeutic as any drug.
My dear young colleague, you are not a fraud. You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better."
For as long as there have been women in medicine — and the American workforce in general — they've faced exceptional challenges.
Wage gaps, sexism, underrepresentation in leadership roles, and internal "imposter syndrome" thoughts brought about by these systemic issues have made the simple act of working difficult for women in every position and every trade.
So while Koven wrote of her experience specifically in the medical field, it struck a chord with professionals outside the world of doctors. She's been absolutely stunned by the response so far, she writes in an email.
"What's fascinating is that though the piece is a 'Letter to a Young Female Physician,' it seems to have spoken to older physicians, male physicians, and even many non-physicians — and all around the world."
"This particular vulnerability, this fear of being a fraud," she says, "is widespread apparently."