Women in Medicine: Getting in, Growing, and Advancing

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Janet Bickel

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  • Dedication

    This book is dedicated to the hundreds of women physicians and medical students who have shared their experiences and stories with me over the years—the primary sources of my medical education.

    This book represents the views of the author and not necessarily those of the Association of American Medical Colleges.

    Copyright

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    Foreword

    Women physicians, increasing in number, are enjoying the challenges and rewards of their profession. However, they still encounter barriers to the achievement of their professional and personal goals, some societal and common to all professional women, and others unique to medicine.

    Janet Bickel, America's best-informed scholar on this topic, has written this insightful book culled from decades of teaching and research with women in medicine. An empathetic, insightful, and practical approach in this “must-read” primer, they discuss the unique problems these women face and the personal and professional skills needed to succeed in medicine today.

    Janet Bickel, M.S., Associate Vice President of the Association of American Medical Colleges (AAMC), has worked at the forefront of medical education for over 25 years. Most recently she has focused on planning and development in medical education, keying in on issues related to women. A renowned speaker at national meetings and more than sixty-five medical centers, Ms. Bickel publishes articles on a broad spectrum of areas in academic medicine, including students' and residents' ethical development. She also directs the AAMC's Women in Medicine program, where she has developed and implemented a series of professional development seminars for women leaders in academic medicine. These have received excellent reviews from more than 2,000 faculty members who have attended.

    As more and more women enter medicine—currently 43% of medical school classes are female—the dynamics of this profession will continue to change dramatically. As such, men as well as women would be wise to peruse the valuable contents of this book.

    Robert HolmanCoombs, Professor of Biobehavioral Sciences, UCLA School of Medicine, Series Editor

    Acknowledgments

    The author thanks Renee Marshall Lawson for her superb and patient administrative assistance throughout this project and also Kathy M. Croft for her research and editorial assistance.

    Introduction

    What is unsought will go undetected.

    Sophocles

    No wonder so many women are choosing to become physicians. Medicine offers abundant and diverse opportunities to take care of individuals, improve public health, advance science, make a good living, and become a leader in the community, in an academic center, and in professional organizations. To be sure, the choice to pursue medicine is not an easy one; it is a big investment, and not every young woman's family will be supportive. But if you have a solid academic record and the determination, you can become a great physician.

    The demand for women physicians just keeps growing as more and more women health care consumers actively and specifically seek them—and not just for birth control advice and Pap smears. If offered a choice, many women would also prefer a woman breast surgeon, pediatrician, dermatologist, and psychiatrist. The power of women as health care consumers is just beginning to be recognized. Women make three fourths of the health care decisions in American households and spend almost two of three health care dollars.

    This is also an exciting time in history relative to women's health. The complexities of women's life cycles and the largest causes of mortality in women—for instance, heart disease and breast cancer—have only recently begun to receive hefty research funding and the attention of medical educators, public policy makers, and physicians across the board.

    Women no longer feel like newcomers to medicine. They now make up 43% of entering classes in medical schools, up from 5% 50 years ago. With all this progress, some women and men might legitimately question the need for a book targeted at women. They might similarly question the value of women's groups or meetings. If invited to an open house sponsored by the women faculty organization, some women medical students might ask “What are those old fogies still talking about?” and some men might respond “Is this a plot against the men here?“

    As a glance at this book's table of contents reveals, there is still a lot to talk about. Gender inequality is still characteristic of our culture, with men's careers more highly valued than women's, and the medical profession is not immune from these cultural inequities. So compared with men, women in medicine still face extra challenges in the development and valuing of their skills and potential.

    However, none of the issues dealt with here are “women's issues“; they are societal issues, the responsibility and concern of men and women both. Improvements to ensure that women have equal access to all career options and resources will not only enhance what women can contribute to the profession but will ultimately improve the quality of patient care and research in this country.

    The primary aim of this book is to help women entering medicine to maximize their options and to have the fullest possible lives and careers. Actually, because men and women share so many characteristics and needs, much of the research cited and advice contained here is relevant to both. But building as it does on all the best available literature and studies on gender differences and on the experience of thousands of women physicians who have come before you, this book is designed for women. An added benefit is that all but the last chapter conclude with a “Diagnose Yourself” section, to help you personalize the content, to stimulate you to begin necessary preparations, and to support you along the journey.

    Most chapters are relevant for anyone considering a medical career whether they be in junior high school or in their 40s and contemplating a major life change. In this regard, it will also be of interest to health professions advisers and to teachers who want to be better mentors to students considering becoming a physician. Medical students and young physicians in residency training will also find here a great deal of practical guidance. The book is also a resource that can be referred to again later—for instance, when it comes time to interview for a job.

    A couple of disclaimers. First, women are just as different from each other as men are from each other, so any generalization here about women will certainly not hold true for all women. Moreover, the special issues facing ethnic minorities, disabled women, and lesbians are barely touched on. However, the Association of American Medical Colleges' (AAMC) Medical School Admission Requirements (Varner, 1999; see Chapter 1) does include sections addressed to minority applicants and to disabled students. Lesbians can get advice before and after medical school entry from the American Medical Student Association's (AMSA) Lesbian, Gay & Bisexual People in Medicine Task Force and from the Gay and Lesbian Medical Association (see Appendix F).

    One piece of advice is offered up front: Most women entering medicine want to “have it all”—a thriving practice, academic pursuits, a loving partner, healthy children, plus personal time! But no one can have it all, all at once. Understanding what is ahead and evaluating your options at every stage will mean wiser choices and prioritizing. That is how to maximize the resilience of your career and the satisfaction you find overall.

  • Appendix A: Foremothers

    People … ask not, Is she capable, but, Is this fearfully capable person nice? Will she upset our ideal of womanhood and maidenhood, and the social relations of the sexes? Can a woman physician be lovable; can she marry; can she have children; will she take care of them? If she cannot, what is she?

    Mary Putnam Jacobi, Shall Women Practice Medicine? (1882; quoted in Lovejoy, 1957, p. 10).

    When it comes to women as physicians, “We've come a long way, baby!” To put the challenges women have faced into perspective, until a century ago, a woman's identity was based largely on her relationship to men. As society moved from an agricultural to an industrial base in the mid-19th century, a woman's sphere broadened but remained based in domesticity as homemaker and family and child care provider (Tom, 1997). Although women did gain a leadership role privately in the home, publicly they were allowed only a subordinate role. The questions posed by Dr. Jacobi in the opening quotation remained all too real.

    Even though women's focus on the family positioned them to fight for health and social causes, women who practiced medicine in the 19th century were met with shock (Tom, 1997). Women doctors had to function in a society that was structured around men, most of whom resented female deviance from traditional roles. Even women considered women doctors more like “grannies” than serious doctors (Luchetti, 1998). Moreover, women were considered unfit to practice because of “the physical and mental disturbances induced by menstruation” (Roth Walsh, 1977). Consequently, up until the current century, even though they provided a great deal of care, women remained peripheral to mainstream medicine, serving either as midwives or in subordinate roles as nurses. Those few who did practice as physicians were not allowed access to the same medical training as men.

    Seventeen women's medical colleges opened in the United States between 1848 and 1900; five of these later merged with male-only institutions and nine did not survive into the 20th century. By 1900, over 1,200 women were enrolled in U.S. medical colleges and over 7,000 women physicians were in practice (Roth Walsh, 1977). But beginning in 1910, curricular standardization and the advent of physician licensing requirements added rigor heretofore missing from U.S. medical education. Of the 17 women's medical colleges, only the Women's Medical College of Pennsylvania remained open after Abraham Flexner's Report and investigations, thus acting to decrease women's access to a medical education.

    But throughout these years, women never stopped trying to gain access to mainstream medicine. For instance, Dr. Harriot Hunt had already practiced medicine for 12 years when she applied to Harvard; she was rejected twice. After a donor promised a gift on condition of Harvard's admission of women, Hunt was grudgingly enrolled (but never granted a degree). Male students protested her presence: “No woman of true delicacy would be willing in the presence of men to listen to medical discussions” (Luchetti, 1998). Similarly, in 1882 a group of prominent Boston women physicians offered Harvard $50,000 with the stipulation that its medical school open admissions to women; again the offer was rejected. (Harvard did not admit women medical students until 1945.) Johns Hopkins University set a precedent by opening its doors to women medical students in 1893, after a group of women benefactors offered $500,000 to the medical school if women were admitted on the same terms as men.

    When World Wars I and II cut the supply of male medical school applicants and staff physicians, many male-only institutions opened admissions to women. However, after the wars, just as they told “Rosie the Riveter” to go home, practicing women physicians were also removed from staff and clinic positions to make room for returning veterans.

    The largest leap in the number of female medical school applicants occurred during the first half of the 1970r when their numbers nearly quadrupled, rising from under 2,300 to just over 8,700. By 1975, women were over 20% of the total applicant pool. Several forces were at work during the 1970s, beginning with an overall change in women's aspirations engendered by the “consciousness raising” of the feminist movement. Also important was the passage of Title IX of the Civil Rights Act of 1972, which stated that no person would, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program receiving federal assistance.

    This highly abbreviated history of the long way we've come can in no way convey the courage of those first pioneering women physicians. Here are a few of the most stellar of your “foremoms”:

    • Probably the first English-speaking woman physician was Dr. James Miranda Barry, who served as a medical officer and inspector-general of the British Army hospitals between 1813 and 1865. She was found to have been a woman only after her death (Lovejoy, 1957).
    • Elizabeth Blackwell was the first woman graduate of a U.S. medical school, Geneva Medical College in New York in 1849, where she was also first in her class. She was shunned by fellow students and the community and also excluded from clinical demonstrations. Provoked by these early obstacles, she went on to establish, in 1868, one of the first women's medical colleges, the Women's Medical College of New York Infirmary. She also set up a free clinic, The New York Infirmary for Indigent Women and Children, now known as the New York Infirmary/Beekman Downtown Hospital (Weisman, 1998).
    • Former faculty member of the New England Female Medical College and protégé of Elizabeth Blackwell, Marie Zakrzewska founded the New England Hospital for Women and Children. Owned and operated by women, the Hospital provided internship training denied to women by most hospitals.
    • Nancy Talbot Clark was the first woman physician in the United States to seek certification from a state medical society (1852).
    • In 1864, Rebecca Lee was the first black woman to receive a medical degree in the United States.
    • Dr. Mary Putnam Jacobi, who studied under Dr. Zakrzewska, gained notoriety for dispelling Harvard professor E. H. Clarke's theory that women's inferior biological status made them unsuitable for medical practice. Her essay, “The Question of Rest for Women During Menstruation,” disproved Clarke's theory with statistical analyses and case studies (Morantz-Sanchez, 1985).

    Appendix B: Statistical Overview

    Applicants and Students

    In 1998, the proportion of women in the U.S. medical school applicant pool stood at 43.3%. Compared to rapid growth in the 1970s and steady growth in the 1980s, the proportion of women applicants has plateaued. Recently, women have been accepted into medical school at a slightly higher rate than men. In 1998, women constituted 43% of new entrants and almost 43% of total enrollment in U.S. medical schools.

    There are large school-to-school variations in the proportion of new entrants who are women, from a low in 1998 of 23% to a high of 63%. During the 1997 to 1998 academic year, women made up the majority of new entrants at 20 schools.

    Residents

    The proportion of women in residency programs has grown from 22% of all residents in 1980 to 35% in 1996 and 36% in 1997. The specialty with the highest proportion of women residents is pediatrics, where 64% are women, followed by obstetrics/gynecology with 63%. The proportion of women in most of the surgical subspecialties remains low: orthopedic surgery, 7%; urology, 10%; and thoracic surgery, 5%.

    Of the 34,882 women residents in 1997, over one-quarter are training in internal medicine (including subspecialties). The next highest concentrations are 16% in pediatrics (including subspecialties), 14% in family practice, 9% in obstetrics/gynecology, and 7% in psychiatry (including child psychiatry). The proportion of all women residents who are training in each of the surgical subspecialties remains below 1% (e.g., neurosurgery, plastic surgery, and urology garner less than .4% each; thoracic surgery and colon/rectal, less than .1 % of all women residents).

    Medical School Faculty

    The proportion of full-time faculty who are women was 26% in 1998, totaling 22,970. Orthopedic surgery continues to have the lowest proportion of faculty who are women (9%), and pediatrics, the highest (40%).

    Clinical departments that have seen the greatest increases in the representation of women since 1989 are emergency medicine (1.8 times, from 13% to 23%), ophthalmology (1.6 times, from 14% to 23%), OB/GYN (1.6 times, from 24% to 38%), family practice (1.6 times, from 24% to 34%), dermatology (1.5 times, from 21% to 32%), and internal medicine (1.5 times, from 16% to 24%).

    The departments where the highest proportions of full professors are women are public health (19%), anatomy (18%), pediatrics (18%), and microbiology (16%). In orthopedic surgery, only 2% of full professors are women. The number of women full professors is growing very slowly. Between 1997 and 1998, the number of women basic science professors grew from 811 to 834, and in clinical sciences from 1,493 to 1,533.

    Of all women faculty, just above 10% are full professors; 19% are associate professors; 50% are assistant professors; 17% are instructors. Men are much more evenly distributed across professional ranks—31%, 25%, 35%, and 8%, respectively. These distributions across the ranks have not changed for men or women in over 15 years.

    On average there are 19 women full professors per medical school including nontenured and basic sciences faculty, compared to 160 men full professors per school.

    With regard to the ethnic breakdown of women faculty, 18% are not Caucasian. Compared to Caucasian faculty, underrepresented minority groups have higher proportions of women faculty.

    Medical School Deans

    In 1998, nine of the 125 U.S. medical school deans were women—Dr. Bernadine Healy, Ohio State University College of Medicine; Dr. Amira Gohara, Medical College of Ohio; Dr. Patricia Monteleone, St. Louis University School of Medicine; Dr. Barbara Atkinson, MCP Hahnemann University School of Medicine; Dr. Julia Bonilla, Universidad Central del Caribe; Dr. Deborah Powell, University of Kansas School of Medicine; Dr. Marjorie Sirridge (interim), University of Missouri, Kansas City School of Medicine; Dr. Carolyn Robinowitz, Georgetown University School of Medicine; and Dr. Anna Cherrie Epps, Meharry Medical School (Bickel, Croft, & Marshall, 1998).

    Appendix C: Addressing Gender Inequities and Sexism

    Assessing Gender Fairness

    To assess the equity of the environment for women at the University of Virginia School of Medicine, the Committee on Women surveyed all faculty, residents and students (Hostler & Gressard, 1993). Following are examples of items from the survey, with instructions: “Circle the response which best describes how you feel: strongly disagree, disagree, agree, strongly agree, not applicable/don't know.”

    • There is an atmosphere that enables women physicians and scientists to fully participate in teaching, administrative, and research activities.
    • There tends to be a condescending attitude toward women physicians and scientists in the Medical Center.
    • Men are more likely than women to receive helpful career advice from their supervisors.
    • There is recognition of the presence and importance of women and their contributions on the wards and in the classroom.
    • Women are adequately represented as visiting professors and invited speakers.
    • Women are appropriately represented among the tenured faculty and in the senior administrative positions.
    • There is an adequate number of female faculty as role models for students and housestaff.
    • Sexist remarks are heard on rounds in the classroom.
    Sexism Discussion Case

    (To be adapted to stimulate discussion in courses on social and bioethical issues or during student orientation or workshops on gender issues)

    Jane is a member of the first class at Prestige Medical School in which the proportion of women is over 50%. The faculty generally agrees that this class is one of the most energetic and committed in recent memory, but some are unprepared for and uncomfortable with this large a group of women. In turn many of the women notice that the 70 kilogram white male is presented as the standard to illustrate test results and clinical findings. By the end of the second year, Jane is notorious for asking faculty to detail significance and differences relative to female anatomy and physiology. Although some students of both sexes appreciate her efforts, a number of her classmates wish she would “give it a rest.”

    A new and highly regarded obstetrics and gynecology division chief gives a key lecture. Included in Dr. Blunt's slides are shots of female genitalia displayed in sexually suggestive ways. Jane interrupts the lecture, charging Dr. Blunt with treating women as if they were sexual objects. A number of men students hiss their disapproval at her interpretation and interruption. Jane walks out of the room and into the student dean's office, accompanied by a few other women. The student dean arranges a meeting between Dr. Blunt and the concerned students. Dr. Blunt explains that he had been showing those slides to students for years, with no complaints. When the students explain why they find the images offensive, he states that indeed part of his goal is to “desensitize” students to the potentially sexually arousing patients they would encounter. After a long discussion regarding how such “desensitization” might better be achieved, Dr. Blunt agrees not to use those slides again. However, he also makes it clear that he believes this handful of students is overreacting.

    Jane has known for years that she wants to become an obstetrician/gynecologist and has eagerly awaited this rotation. But by the end of the fourth week of her OB/GYN clerkship, Jane is very uncomfortable. A couple of the residents regularly speak condescendingly to their patients, many of whom are African American. Jane can barely resist confronting these residents but restrains herself out of fear for her evaluation. Finally, after hearing a resident say in a loud voice to a crying woman “Honey, I just don't have time to explain the procedure right now,” Jane runs after him, pointing out his lack of respect for this patient. He explodes at Jane that she doesn't know what she's talking about and that he is late for a meeting with Dr. Blunt.

    During the last week of her clerkship, Jane overhears a conversation in a corridor between two of the women residents. One had just overheard Dr. Blunt say to a group of residents “None of my residents had better get pregnant. We run a tight ship here. I expect 100% from everyone.” Jane asks them if they are going to respond to Dr. Blunt's “encroachment on their individual rights.” They advise Jane to pipe down if she wants to get into an OB/GYN residency.

    What should Jane do? Questions to probe this scenario follow:

    • What are students' responsibilities relative to faculty when they have a grievance or when they disagree with or disapprove of teaching methods or materials? What kind of process would be optimal in resolving such conflicts? Are there structures and resources for addressing continuing problems with sexism in medical education?
    • Does a student have a responsibility for action after witnessing a patient being treated in less than respectful ways? How can students resolve tensions they experience between being a “team player” versus a “truthteller?” Does it matter whether the problem is with a nurse, a resident, an attending, or a department head? Because of their long hours and often difficult working conditions, should residents ever be excused for using humor at patients' expense?
    • The multiple missions of medical centers create a complex environment that is often far from optimal for student education. What problems with this OB/GYN clerkship most need to be addressed? Should students have the opportunity to rate faculty and residents on professional behaviors? What resources might help Jane with her bind between her conscience and the need for a good evaluation and good references?
    Outline for a Medical Student Workshop or Elective on Gender Stereotypes

    (These can be adapted by individual faculty and student groups.) Possible workshop objectives include the following:

    • Encourage women students to increase their valuing and use of an emphatic style and examine stereotypes of “feminine” and “masculine” styles
    • Increase students' appreciation for the complexity of gendered experience
    • Increase their reflection on their own experience and development and increase their valuing of self-reflection
    • Facilitate students imagining a more humanistic practice of medicine.

    Hypotheses to promote discussion on the experiences of medical students follow:

    • Female medical students have conflicts about their visibility.
    • Female medical students experience lack of support from family.
    • Medical students struggle with the lack of a realistic ego-ideal.
    • Males struggle with unrealistic expectations of omnipotence.
    • Females struggle with combining the opposing constraints of both traditional feminine and traditional masculine roles.

    Appendix D: Learning Objectives in Women's Health

    The Association of Professors of Gynecology and Obstetrics (APGO; 1996) has developed knowledge and skill competencies in the following areas, recommending that all disciplines caring for women emphasize these. The competencies may be obtained from APGO (see Appendix F).

    • Autoimmune Diseases
    • Breast Disease
    • Cardiovascular Disease
    • Contraception, Sterilization, and Abortion
    • Diagnosis and Management Plan
    • Domestic Violence and Sexual Assault
    • Gastrointestinal Disorders
    • Gynecologic Malignancies
    • Immunizations
    • Maternal-Fetal Physiology
    • Menopause
    • Menstrual Cycle and Its Abnormalities Nutrition
    • Papanicolaou Smear and Culture
    • Pelvic Pain
    • Pharmacology
    • Physical Exam
    • Preconception, Antepartum, and Postpartum
    • Premenstrual Syndrome
    • Psychiatric and Behavioral Problems
    • Pulmonary Disease
    • Sexuality
    • Sexually Transmitted Diseases
    • Spontaneous Abortion and Ectopic Pregnancy
    • Urinary Tract Disorders
    • Vulvar and Vaginal Diseases

    Appendix E: Definition of Women's Health

    Women's Health is devoted to facilitating the

    • preservation of wellness and
    • prevention of illness in women,

    and includes screening, diagnosis, and management of conditions which

    • are unique to women,
    • are more common in women,
    • are more serious in women, and
    • have manifestations, risk factors, or interventions which are different in women.

    Women's Health also recognizes and includes

    • the importance of the study of gender differences,
    • multidisciplinary team approaches,
    • the values and knowledge of women and their own experience of health and illness,
    • the diversity of women's health needs over the life cycle, and how these needs reflect differences in race, class, ethnicity, culture, sexual preference, levels of education, and access to medical care, and
    • includes the empowerment of women, as for all patients, to be informed participants in their own health care (National Academy of Women's Health in Medical Education, 1996).

    Appendix F: Organizations and Websites

    It is not what you know, it's how fast you can find out.

    Anonymous
    General Medical Organizations

    Association of American Medical Colleges (AAMC): http://www.aamc.org;telephone: (202) 828-0400; AAMC Publications Office: telephone: (202) 828-0416. The AAMC is a nonprofit organization representing 125 medical schools in the United States and 16 in Canada, and approximately 400 teaching hospitals and 86 academic and professional societies. AAMC conducts a broad range of programs in the areas of medical education, biomedical research, health care for the nation, related policy issues, student and applicant relations, and more. Information on AAMC's Website especially valuable for medical students includes the following:

    • Medical College Admission Test (MCAT)
    • American Medical College Application Service (AMCAS), including a downloadable version of the AMCAS-E (electronic application) software
    • MEDLOANS, a comprehensive loan program developed to provide financial assistance to medical students
    • Organization of Student Representatives (OSR), student representation from each U.S. medical school as a principal voice and vehicle for enhancing medical education and academic medicine
    • National Residency Matching Program (NRMP) and Electronic Residency Application Service (ERAS)
    • AAMC's Community and Minority Programs, activities and resources to support and increase the number of underrepresented minority students in medical and other health professional schools
    • AAMC's Women in Medicine Program, activities and resources to support women's advancement and leadership potential
    • MedCAREERS, a career planning tool developed jointly by the AAMC and AMA, is available online at http://www.aamc.org/medcareers.
    • AAMC sponsors a Medical School Admission Requirements electronic mailing list called MSAR_Clipboard. To join this list, send an e-mail to majordomo@aamcinfo.aamc.org. Type the words “subscribe to MSAR_Clipboard” in the body, not the subject, of the message; you will be notified upon receipt
    • AAMC's annual Women in U.S. Academic Medicine Statistics (Bickel, Croft, & Marshall, 1998) can be accessed at Website http://www.aamc.org/about/progemph/wommed/stats/start.htm,
    • Enhancing the Environment for Women in Academic Medicine: Resources and Pathways (Bickel, Croft & Marshall, 1996) is downloadable from the following AAMC Website: http://www.aamc.org/about/progemph/wommed/wimguide/start.htm.

    American Medical Association (AMA): http://www.ama-assn.org; telephone: 312/ 464-5000. The AMA is a membership organization representing approximately 300,000 physicians and medical students. AMA publications of possible interest to students include the following:

    • Journal of the American Medical Association, a monthly journal on clinical science, disease prevention and health policy issues (table of contents available on the Web)
    • American Medical News, weekly news about professional, social, economic, and policy issues in medicine

    AMA's Women in Medicine (WIM) Advisory Panel and WIM Services offer some activities in support of women in medicine (e.g., they have endorsed gender neutral language in all medical communications and also created an internal women's health office). The AMA WIM Data Source (available on the Website) includes statistical data on physicians by gender, age, specialty, practice characteristics, and income. Call 312/645-4392 for more information about AMA's women and minority services.

    American Medical Student Association (AMSA): http://www.amsa.org; telephone: (800) 767-2266. AMSA is a student-governed, national organization representing approximately 30,000 medical students, premedical students, and residents across the United States. AMSA has local chapters at most medical schools and premedical chapters at over 400 universities for special community projects, educational reform efforts, and other networking activities. AMSA holds an annual meeting and offers regional workshops for students to explore medical education and health care issues with both local and national leaders; a Chapter Officers Conference helps chapter officers develop leadership skills.

    A legislative affairs director (medical student) represents AMSA members on Capitol Hill, coordinates grassroots activities and educates members on health policy issues. AMSA also has various health policy fellowship and internship programs to help interested students gain the knowledge and analytical skills necessary to understand health policy and experience firsthand the legislative process. Among its many standing committees is the Women in Medicine (WIM) Committee which advocates for the interests of women in medicine and women patients, and promotes women's health education, and works to protect women's reproductive freedom. The WIM Committee offers networking opportunities through its collaboration with AMWA, as well as a listserve and newsletter.

    The national office maintains a Resource Center, a variety of electronic discussion fora and an Online Residency Directory. The New Physician Magazine, an AMSA member benefit, covers the social, ethical and political issues facing medical education and health care.

    Association of Professors of Gynecology and Obstetrics: telephone: (202)863-2507. Women's Health competencies may be obtained from APGO, 491 12th Street, SW, Washington, DC 20024.

    Women's Specialty Organizations

    Although participation in mainstream organized medicine is essential to developing networks, many women have formed specialty groups within their respective disciplines. Positive results and resources have emerged, including improved networking opportunities, investigative collaborations, and formulation of policy changes adopted by the particular discipline or group.

    AAMC's Women in Medicine office maintains a list of these highly diverse organizations: http://www.aamc.org/wim; telephone: (202) 828-0521. A few examples follow:

    American Medical Women's Association (AMWA): http://www.amwa-doc.org; telephone: (703)838-0500. AMWA is an independent network of more than 10,000 women physicians and medical students nationwide. It holds annual, interim, regional, and branch meetings, and offers opportunities to serve on special committees (including a Student Committee) and many member discounts. AMWA has membership chapters across the United States for local activities and projects. AMWA publishes The Journal of the American Medical Women's Association (JAMWA) and a variety of periodic booklets. One AMWA resource is a Gender Equity Information Line, 1-800-995-AMWA, which offers telephone advice to women physicians, residents, and students experiencing gender discrimination or sexual harassment.

    Committee on Women in Science and Engineering (CWSE): http://www2.nas.edu/cwse. A division of the National Research Council, CWSE was founded to increase the number of women in science and engineering through activities, meetings, and research. CWSE maintains a directory (available on their Website) of professional organizations which support the education and employment of women in science and engineering.

    Association for Women in Science (AWIS): http://www.awis.org; telephone: (202)326-8940. AWIS is a national nonprofit organization of over 4,500 members working together to promote educational and employment opportunities for women and girls in all fields of science, mathematics, and engineering. Events at more than 50 local chapters across the country are designed to facilitate networking between women scientists at all levels and in all career paths. AWIS chapters also encourage the participation of girls and women in science by sponsoring educational activities in schools and communities. AWIS publishes a variety of materials to inform girls and women about science programs and women's issues, including the bimonthly AWIS Magazine.

    Gay and Lesbian Medical Association (GLMA): http://www.glma.org; telephone: (415)255-4547. GLMA represents over 1,900 physician and medical student members who seek to address homophobia within the medical profession by promoting the best health care for lesbian, gay, bisexual, transgendered, and HIV-positive people. In addition to meetings and special projects, GLMA publishes the Journal of the Gay and Lesbian Medical Association, a peerreviewed, multidisciplinary journal dedicated to lesbian and gay health. GLMA holds an annual Women in Medicine conference for its membership to discuss current lesbian health issues.

    The Association of Women Surgeons (AWS): http://www.womensurgeons.org; telephone: (630)655-0392. AWS publishes a Pocket Mentor, a survival guide for new surgeons which fits nicely into a “white coat” pocket. This resource includes suggestions for getting organized, understanding politics, and finding mentors.

    American Association for Women Radiologists (AAWR): http://www.aawr.org; telephone: (703)648-8939.

    Additional Internet Resources
    • Department of Health and Human Services (DHHS) http://www.dhhs.gov: Agencies, news and public affairs, research, policy and administration, health information. For more information about DHHS U.S. Public Health Service Office on Women's Health and the designated Centers of Excellence in Women's Health (COE), contact http://www.4women.org/owh/aboutowh.htm; telephone: 1-800/994-WOMAN.
    • Food and Drug Administration (FDA) http://www.fda.gov: Consumer and industry information, education, state and local officials
    • La Leche League International http://www.lalecheleague.org; telephone: (847)519-7730
    • National Library of Medicine (NLM) http://www.nlm.nih.gov: Free medical literature searches, health information resources, research programs, grants
    • National Science Foundation (NSF) http://www.nsf.gov: Education projects, grants and awards, fellowship support
    • National Institutes of Health (NIH) http://www.nih.gov: Institutes and offices, news and information, health information, scientific opportunities, research training, grants
    • National Women's Health Information Center http://www.4woman.org/owh/index.htm: Health information, references, current events, women's programs

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    Author Index

    • Allandale, E., 75
    • Allen, W., 15
    • Andrew, L. B., 62, 74
    • Arnold, L. M., 6
    • Aschenbrener, C. A., 51
    • Ash, A. S., 16, 58
    • August, A., 38
    • Azari, R., 74
    • Baker, L., 54
    • Baldwin, E. N., 22
    • Barnett, R. C., 16, 58
    • Barreca, R., 38
    • Bateson, M. C., 25, 47
    • Beiser, C., 29
    • Benokraitis, J. V., 40
    • Bergen, M. R., 7, 32
    • Berlin, J. A., 39
    • Bemay, T., 44
    • Bertakis, K. D., 74
    • Bias, W. B., 60
    • Bickel, J., 4, 6, 7, 8, 23, 27, 31, 74, 84
    • Bindman, A. B., 33
    • Bishop, J., 4
    • Blackstock, D., 39
    • Bland, I. J., 39
    • Blue, A. V., 77
    • Bodycombe, D. P., 55, 59
    • Bower, D., 62
    • Brogan, D. J., 34, 75
    • Brooks, F., 74
    • Brotherton, S. E., 16, 18
    • Brown, W. V., 20
    • Bruge, S. K., 20
    • Buchanan, C., 14
    • Budner, N., 75
    • Bulger, R., 16
    • Butler, D., 40
    • Calking, E. V., 6
    • Callahan, E. J., 74
    • Candib, L., 15
    • Cantor, D., 44
    • Caplan, P., 31
    • Carbone, K. M., 60
    • Carlson, B., 71
    • Carr, R L., 16, 43, 58
    • Chaloner, K. M., 27
    • Chow, K., 19
    • Cohen, A. J., 77
    • Cohen, J. J., 41
    • Cohen, M., 34
    • Conley, F., 8
    • Cook, D. J., 33, 34
    • Coontz, S., 14
    • Cotton, J., 59
    • Council on Graduate Medical Education, 76
    • Crandall, S. J. S., 8
    • Croft, K., 4, 8, 84
    • Cutler, E. R., 33
    • Daugherty, S. R., 35
    • Diehr, S., 62
    • Doepel, D. G., 77
    • Doherty, W. J., 20
    • Donaldson, M., 56
    • Donaldson, M., 56
    • Douglas, R S., 55, 59
    • Dukes, K. A., 43
    • Ehrlich, C., 75
    • Ekstrum, J., 74
    • Ellsbury, K. E., 58, 60
    • Epps, R. P., 77
    • Ernster, V. L., 17, 58
    • Falik, M., 75
    • Feldman, D. S., 74
    • Fields, S., 18
    • Fisher, R., 56
    • Fiske, S., 40
    • Fletcher, R., 16
    • Fletcher, S., 16
    • Flower, J., 47
    • Francomano, C. A., 60
    • Frank, E., 20, 34, 75
    • Fried, L., 60
    • Friedman, K. A., 22
    • Friedman, R. H., 16, 43, 58
    • Gammon, W., 77
    • Geis, F., 40
    • Gelberg, L., 15
    • Gilligan, C., 45
    • Gillotti, S. S., 14
    • Gjerdingen, D., 27
    • Goodman, L. J., 35
    • Gracely, E., 74
    • Grady-Weliky, J., 68
    • Greenberg, R. S., 75
    • Griffith, C. H., 77
    • Griffith, L. E., 34
    • Guarino, C. M., 7, 32
    • Guyatt, G. H., 34
    • Haapanen, K., 58, 60
    • Haas, J., 75, 76
    • Haber, R. J., 33
    • Hafferty, F. T., 6
    • Haid, R. L., 49, 72
    • Hall, J., 75
    • Hall, L., 56
    • Hall, R., 38, 39, 59
    • Harris, D. L., 19
    • Hawkins, C. E., 33
    • Healy, B., 77
    • Heim, P., 52
    • Heinig, S. J., 2
    • Helms, L. J., 74
    • Helwig, A. L., 43
    • Hersh, K., 35
    • Hickey, M., 14
    • Hippensteele, S., 35
    • Hojat, M., 75
    • Holton, G., 46
    • Hundert, E., 68
    • Hunt, K., 75
    • Irish, J., 75
    • Isaacs, K., 6
    • Iserson, K., 26
    • Jacobs, C. D., 7, 32
    • Jacobson, E. W., 77
    • James, J., 47
    • Jamieson, K., 38
    • Jeruchim, J., 59
    • Johnson, K., 77
    • Jonassen, J. A., 77
    • Justice, A., 37
    • Kahn, H. S., 75
    • Kaltreider, N., 14, 16, 75
    • Kane, S. L., 33
    • Kaplan, S. H., 43
    • Kassenbaum, D. G., 33
    • Katalin, J. M., 33
    • Kazis, L. E., 43
    • Kelch, R. P., 43
    • Kettyle, C., 68
    • Kiely Law, J., 19
    • King, D., 33
    • King, J. A., 56
    • Klag, M. J., 20
    • Klebanoff, M. A., 18, 19
    • Komaromy, M., 33
    • Korn, D., 2
    • Kritek, P., 56
    • Krueger, P. M., 7
    • Kwolek, D. S., 77
    • Lane, A. J., 37
    • LeBailly, S. A., 16, 18
    • Lee, S., 6
    • Leider, R. J., 48
    • Lense, L., 75
    • Lent, B., 4
    • Levinson, S. P., 6, 18
    • Levinson, W., 15, 28, 58
    • Lewis, C., 15, 18
    • Limacher, M. C., 55, 59
    • Linney, B., 20, 21
    • Little, M. O., 7
    • Loemker, V., 8
    • Lovejoy, E. P., 81
    • Luchetti, C., 80
    • Lurie, N., 74
    • MacDonald, S. M., 60
    • Maibach, H., 20
    • Mangus, R. S., 33
    • Margolis, K., 74
    • Marshall, E., 76
    • Marshall, R., 4, 8, 84
    • Martin, J. B., 17, 58
    • Mazor, K., 77
    • McGovern, P., 74
    • Mead, L. A., 20
    • Mendelsohn, K. D., 6
    • Meyer, R. E., 2
    • Miles, S., 38, 76
    • Miller, J. J., 33
    • Miller, L., 75
    • Mindell, P. A., 50
    • Mokdad, A. H., 75
    • Morantz-Sanchez, R., 74, 81
    • Morzinski, J., 62
    • Moscarello, R., 33
    • Moskovitz, M. A., 16, 43, 58
    • Mulrow, C., 37
    • Murray, S. F., 15
    • Mutha, S., 8
    • Myers, A., 39
    • Nattinger, A. B., 43
    • Nelson, M., 77
    • Neumayer, L., 58
    • Newman, M. M., 60
    • Nicolete, J., 77
    • Nieman, L. Z., 6
    • Nora, L. M., 35
    • Novack, D. H., 74
    • O?Brien, B., 34
    • O?Neil, E. H., 8
    • Osborn, E. H. S., 58
    • Osborn, L. M., 17, 19
    • Osborne, J., 15
    • Palepu, A., 16, 58
    • Parker, K., 76
    • Pearse, W., 77
    • Pearson, T., 46
    • Pearson, T. C., 35
    • Philibert, I., 27
    • Phillips, C. F., 43
    • Phillips, S., 34, 37
    • Prather, M. B., 19
    • Pugnaire, M. P., 77
    • Putnam, C., 58
    • Quam, L., 74
    • Quon, A. S., 2
    • Ragins, B. R., 59
    • Reading, J. C., 19
    • Regan, M. B., 77
    • Rhoads, G. G., 18, 19
    • Rhode, D., 14, 38
    • Robbins, J. A., 74
    • Roberts, J., 29
    • Rollman, B. L., 20
    • Rossi, M., 33
    • Roter, D., 75
    • Roth Walsh, M., 80
    • Rothenberg, R., 20
    • Rothman, E. L., 16
    • Ruffin, A., 6, 8
    • Salmans, S., 14
    • Sande, M. A., 33
    • Sandler, B., 34, 36, 38, 39, 59
    • Scaramucci, A., 16
    • Schaad, D. C., 58, 60
    • Schaller, J. G., 43
    • Schapiro, N., 56
    • Schiffman, M., 34
    • Schifter, M. H., 14
    • Schmidt, J., 35
    • Schneider, M., 34, 37
    • Schulman, K. A., 39
    • Schuman, K. L., 19
    • Schwartz, F. N., 14
    • Schwartz, J. B., 55, 59
    • Scott-Collins, K. S., 75
    • Secundy, M. G., 39
    • Sells, C., 18
    • Sells, J., 18
    • Seltzer, V., 77
    • Shapiro, P., 59
    • Shervington, D. O., 39
    • Shiono, P. H., 18, 19
    • Shoop, R., 34, 36
    • Siders, C. T., 51
    • Silverberg, L., 38, 39, 59
    • Simeos, E. J., 75
    • Simpson, D. E., 15, 62
    • Slater, J., 74
    • Smith, D. G., 2
    • Sonnert, G., 46
    • Sotile, M. O., 21
    • Sotile, W. M., 21
    • Spiro, J., 15
    • St. James, D., 50
    • Steingart, R. M., 75
    • Stewart, S. C., 77
    • Stobo, J. D., 60
    • Stokes, E. J., 60
    • Sullivan, L. M., 43
    • Szalacha, L., 16, 58
    • Takayama, J. I., 8
    • Tannen, D., 44, 50
    • Tesch, B. J., 15, 43
    • Thomas, K. W., 52
    • Tidball, C. S., 2
    • Tidball, M. E., 2
    • Tobin, J. N., 75
    • Toffler, W., 18
    • Tolle, S. W., 15, 18
    • Tom, S. C., 79
    • Tronto, J., 31
    • Turk, M., 19
    • Ury, W., 56
    • Valian, V., 43, 45
    • Vanderscoff, J. A., 27
    • vanlneveld, C. H., 33
    • Veloski, J., 75
    • Volk, R. J., 8
    • Wachpress, J., 75
    • Wagner, E. M., 60
    • Wallis, L., 77
    • Walsh, M. N., 55, 59
    • Wang, N. Y., 20
    • Warde, C., 15
    • Wassertheil-Smoller, S., 75
    • Weeks, D., 51
    • Weisman, C. S., 81
    • Wexler, J. P., 75
    • Whitfill, J. T., 46
    • Wiebe, C., 19, 26
    • Wilke, A. J., 23
    • Willoughby, T. L., 6
    • Wolf, W. J., 46, 48, 55, 59
    • Wolf-Wendell, L. E., 2
    • Wood, H. M., 43
    • Wright, J. S., 55, 59
    • Xu, G., 75
    • Zaher, C. A., 55, 59

    About the Author

    Janet Bickel, MA, is Associate Vice President of the Association of American Medical Colleges (AAMC), Division of Institutional Planning and Development. She has worked at the forefront of medical education for over 25 years, most recently concentrating on issues of women's professional development. She has spoken at over 60 academic medical centers on these issues and published articles on these and a broad spectrum of other areas in academic medicine, including students' and residents' ethical development. Ms. Bickel created a series of professional development seminars for potential women leaders in academic medicine which has received excellent reviews from the over 2,000 faculty who have attended. Prior to directing AAMC's Women in Medicine program, Ms. Bickel staffed AAMC's Organization of Medical Student Representatives, composed of student leaders from all U.S. medical schools; this work included writing an issue-oriented newsletter received by all 16,000 medical students in the country. Her involvement with medical education began at Brown University where she served as admissions, financial aid, and student affairs officer for the new medical school between 1972 and 1976.


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