In the spring of 2020, as Boston’s first COVID-19 wave raged, I was the gastroenterologist on call responding to a patient hospitalized with a stomach ulcer. Wearing a layer of yellow personal protective equipment over a pair of baggy scrubs, I spent 30 minutes explaining to him that he needed an endoscopic procedure. We built a rapport, and by the end of our conversation about the pros and cons, he seemed to agree with my recommendation. I told him we would be ready to perform his endoscopy within half an hour.
“Well, before we do anything, I’m going to need to discuss it with the doctor.”
When I entered the room, I had introduced myself as the doctor. I had also just explained, in great detail, a highly specialized procedure.
He still assumed I was a nurse, or a medical technician, or a physician assistant—anything but a doctor, especially his doctor.
I wish I could tell you his assumption was rare, but it’s not. A recent study in the Journal of the American Medical Association revealed that patients were about 20 percent less likely to assume that a woman wearing scrubs was a surgeon, compared with men. The study also found that patients consider a woman in scrubs to be “less professional” than a man in the same outfit. Because many hospitals, including mine, required workers to wear scrubs and PPE during the pandemic, this became an even bigger problem than usual for female physicians.
My tale of mistaken identity is just one example of the many ways the coronavirus sparked the tinderbox of gender inequity in medicine. Women hemorrhaged from the health-care workforce in staggering numbers; at least 1.4 million left their jobs in April 2020 alone. That number rebounded somewhat, but more than a year later, women still held half a million fewer health-care jobs than they did in 2019. Female doctors are still paid 75 cents for every dollar made by their male colleagues, and since the pandemic began, they have fallen disproportionately ill from COVID-19, turned down more leadership opportunities, spent more time on home and family responsibilities (while writing fewer research papers), and been provided a level of support for child care and maternity leave that is outright insulting, given our field’s supposed calling as caregivers. On top of all that, we’ve had to deal with this new wrinkle in the double standard related to the oldest problem we face: our appearance, specifically our clothing.
For generations, the hallmark of physician attire was a crisp white coat. The coat became an icon of medical authority, cleanliness, and scientific inquiry in the late 19th century, an era when few women had the opportunity to practice medicine. Over time, though, male physicians moved away from the white coat to … well, whatever they wanted to wear, really: a formal business suit, a shirt and tie, or a Patagonia Better Sweater fleece jacket embroidered with their institutional logo. It doesn’t matter. Male physicians can generally count on commanding respect by virtue of their profession alone, whereas the majority of patients still believe that it’s inappropriate for their female physicians to forgo the white coat.
The pandemic rendered all this moot. Concerns about the white coat’s potential to harbor and transmit pathogens led many hospitals to drop it—along with the business-casual alternatives—in favor of unisex scrubs for all. A chance to level the playing field? You’d think so. Instead, the goal posts for women physicians just shifted.
Female physicians don’t even need to be at work to experience sexism related to how we look and dress. In the summer of 2020, during the brief respite between the onset of the pandemic in the spring and the fall surge to come, a medical journal posted an article titled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons.” Under the paternalistic guise of wanting to ensure that early-career physicians were “cautious of their social media content,” three male “screeners” used fake accounts to scour the accounts of their unwitting female colleagues (who make up a paltry 6 percent of their specialty) to evaluate their “unprofessional” clothing; they were off-duty female surgeons accused of “provocative posing in bikinis/swimwear.” (In the middle of a global pandemic, it is unclear how this issue became a pressing scientific question.)
I felt attacked. This wasn’t the work of trolls in some creepy internet backwater. These were our own colleagues publicly passing judgment, in a respected journal, on female doctors—many emerging from the most traumatic experience of their career—who were doing nothing more than posting vacation photos to Instagram. Although the study was met with swift backlash and quickly retracted, the debacle captured the spirit of the quotidian sexism faced by women doctors.
Now, with COVID-19 in retreat once again, hospitals are relaxing their dress codes to pre-pandemic standards—which unfortunately means swapping out one source of appearance-related sexism for another. I am bracing for a return to the kind of distressingly routine encounters that marked my early years as a physician.
One day, during my senior year of residency, I was explaining the etiology of a patient’s heart murmur to my team of seven more-junior physicians, pharmacists, and medical students. I asked my patient how much exercise he was able to tolerate with his condition.
He hesitated, then smiled. “I’m sorry, I got distracted. It’s that little leopard skirt you have on. Can’t take my eyes off.”
I froze. The atmosphere in the room transformed. I was no longer leading a large medical team in a didactic moment but turning red under the male gaze as everyone stared … at my hips.
Immediately, I asked myself: Is my outfit unprofessional?
I was indeed wearing a leopard-print pencil skirt. But the fit was relaxed, and I’d purchased it at a popular store for women’s “business-formal work clothing” where hemlines rarely made it above the knee. Mine was no exception—and no, it was not unprofessional.
Still, should I stop wearing skirts? Why did this man treat me with such disrespect?
I scrambled to collect myself and carry on. But the damage was done. For the remainder of my rounds, I felt like an impostor playing a doctor on TV.
Even before the pandemic, research showed that up to 40 percent of female physicians leave the medical profession within six years of completing their residency. The time and energy we women expend dealing with role misidentification—clarifying our jobs to patients and co-workers alike and questioning our own sense of belonging as we second-guess which clothing would be deemed acceptable—is an insidious diversion that keeps us from focusing on our merits and career advancement. One study found that more than half of female physicians react to misidentification by changing their attire. This is pointless and a waste of time. Instead of worrying about measuring up in ways our male colleagues never seem to lose any sleep over, I hope my sisters in medicine will marshal our pandemic-proven grit and compassion to rise up and speak out against the biases that continue to limit us.
We need you, as patients, to do your part too. Listen when a woman comes into the room and explains her role, regardless of what she’s wearing. Don’t automatically address your questions to the male member of the care team. (He might be just a medical student.) Let us finish speaking without cutting us off; patients are more likely to interrupt female physicians than male physicians. And above all, don’t comment on our outfits. Female physicians want to be judged by the treatment we give you—and nothing else.
It’s about time we all recognized that male and female physicians are cut from the same cloth.