State of Women in Medicine: History, Challenges, and the Benefits of a Diverse Workforce.

Women in medicine have made progress since Elizabeth Blackwell: the first women to receive her medical degree in the United States in 1849. Yet although women currently represent just over one-half of medical school applicants and matriculates, they continue to face many challenges that hinder them from entering residency, achieving leadership positions that exhibit final decision-making and budgetary power, and, in academic medicine, being promoted. Challenges include gender bias in promotion, salary inequity, professional isolation, bullying, sexual harassment, and lack of recognition, all of which lead to higher rates of attrition and burnout in women physicians. These challenges are even greater for women from groups that have historically been marginalized and excluded, in all aspects of their career and especially in achieving leadership positions. It is important to note that, in several studies, it was indicated that women physicians are more likely to adhere to clinical guidelines, provide preventive care and psychosocial counseling, and spend more time with their patients than their male peers. Additionally, some studies reveal improved clinical outcomes with women physicians. Therefore, it is critical for health care systems to promote workforce diversity in medicine and support women physicians in their career development and success and their wellness from early to late career.

Seeking Parity for Women in Academic Medicine: A Historical Perspective.

In this Invited Commentary, the author applies a historical lens to explore a fundamental paradox in U.S. medical education: the fact that long after women gained parity with men in matriculation to medical school, women remain highly underrepresented in leadership positions in academic medicine. The reasons for this are many and complex, but at the core are the subtle but hurtful indignities ("microinequities") experienced by women physicians and an academic culture that expects single-minded dedication to work, regardless of the costs to faculty members' personal lives. Achieving parity for women in academic leadership will require changing the culture of medical schools and teaching hospitals to correct these 2 fundamental obstacles. In recent years, many medical schools and teaching hospitals have made efforts to improve opportunities and satisfaction for women trainees and physicians, enacting reforms to improve work-life balance for all faculty. It is plausible to imagine a future in which flexible time frames to achieve tenure and promotion are universally available to both women and men, with high scholarly standards firmly maintained. If this occurs, it will represent a profound legacy for women in academic medicine, for their generations of professional sacrifice and advocacy for a more equitable culture will have changed its culture.

Barbara E. Waud, M.D. (1931-), an early woman clinician scientist and professor of anesthesiology at University of Massachusetts Medical School.

After the first successful public demonstration of modern anesthesia in 1846, most female anesthetists were nurses by trade since none were yet allowed to attend medical school to become physicians. The turn of the twentieth century, however, brought about greater opportunity for female physician-anesthetists. We explore the life and career of Barbara E. Waud (1931-), a pioneering woman physician and researcher in the field of anesthesiology. Waud chose to pursue a career in medicine at a time when most women did not even attend college, and for most of her training and practice, she was the only woman in her department. Personal interviews with Waud, her daughter, and her colleagues highlight her rebellious and resilient nature that helped her overcome the obstacles put forth by male colleagues, and the judgment she received from female acquaintances for being a working mother. Waud's impressive career of dedicated clinical practice and ground-breaking research spanned four decades and inspired generations of physicians.

Julia Gordon Arrowood (1900 - 1984): A Brilliant Anesthesiologist and a Woman of Many Firsts in Medicine.

After a brief "golden age" in the late 1800s, the patriarchal establishment fought back and women faced increasing restrictions in practicing medicine. In 1900, 18.2% of all physicians in the city of Boston were women, but this number decreased to 8.7% by 1930. The relatively young field of anesthesiology was one of the more welcoming specialties for women during this time. History has been unkind to these early female trailblazers who have often been overlooked in favor of the men in their fields. Julia Gordon Arrowood (1900-1984) was a forerunner for women in medicine and a prominent anesthesiologist in Boston from the 1930s until the 1950s. Her work included not only clinical medicine, but also research and teaching. She attended Boston University School of Medicine, graduating as valedictorian in the class of 1933. She interned at Belmont Hospital in Worcester, MA where she decided on a career in anesthesiology. She was accepted as a resident at Massachusetts General Hospital (MGH) by chief-anesthetist Henry Beecher in 1935, thereby becoming the first woman anesthesiology resident in Massachusetts. She remained at MGH and was named Acting Chief of Anesthesia in 1943. In 1944, she became president of the New England Society of Anesthesiologists, another first for a woman. In 1946, she joined Reginald Smithwick's team as Chief of Anesthesia at Massachusetts Memorial Hospital, Boston, and concurrently held the position of Professor of Anesthesiology at Boston University School of Medicine. Arrowood led many of the earliest studies on spinal anesthesia, muscle relaxants, and spinal headaches. In 1957, she moved to Kentucky and joined the United Mine Workers hospital system where she worked until her retirement in 1970. Women such as Julia Arrowood remain underrepresented in the annals of the history of medicine. Much work is needed to recognize the many contributions made by women physicians and to provide equal opportunities, pay, and status.

Gender medicine: its historical roots.

Gender medicine as a subject began with Bernadine Healy's 1991 article 'The Yentl Syndrome' which showed that women had worse outcomes following heart attacks since their symptoms are different from men. Since then gender-specific clinical research protocols have been progressively included so that evidence for guidelines can be better informed such that women are then less disadvantaged and care become more personalised. This paper traces back the historical roots of gender bias in medicine in Western culture, which is reflected in the pictorial arts and writings of each historical period, beginning with Hippocrates. It describes the changes that have led to attempts at improving the place of women, and the treatments of disease, on an equal footing with men, precipitated by Healy's paper.

Survival analysis of the Black Death: Social inequality of women and the perils of life and death in Medieval London.

OBJECTIVES: Described as an indiscriminate killer by many chroniclers, the Black Death descended on London during the 14th century. To best understand the pattern of transmission among demographic groups, models should include multiple demographic and health covariates concurrently, something rarely done when examining Black Death, but implemented in this study to identify which demographic groups had a higher susceptibility. Female predisposition to the Black Death was also explored, focusing on whether social inequality added to vulnerability. MATERIALS AND METHODS: Three attritional cemeteries from the Wellcome Osteological Research Database were compared with the Black Death cemetery, East Smithfield. A Cox proportional hazards regression estimated hazards ratios of dying of the Black Death, using transition analysis ages-at-death as the time variable, and sex and frailty as covariates. Additionally, a binomial logistic regression generated odds ratios for age-at-death, sex, and frailty. RESULTS: The Cox model produced a significant hazards ratio for individuals deemed frail. Similarly, the logit model calculated significantly increased odds ratios for frail individuals, and decreased odds for individuals aged 65+. DISCUSSION: The older individuals were not undergoing growth during times of great stress in London pre-dating the Black Death epidemic, which may explain the decreased odds of contracting the Black Death. Further, although women dealt with social inequality, which partially led to the demographic puzzle of the Medieval "missing" women, women's susceptibility to infection by the Black Death was not increased. The phenomenon of the missing women may be due to a combination of factors, including infant and child mortality and preservation.

Women, male doctors, and female historians: a historiographic essay on the history of women, medicine, and gender. / A mulher, o médico e as historiadoras: um ensaio historiográfico sobre a história das mulheres, da medicina e do gênero.

The article presents a partial historiographical review of the history of women, science, and medicine, a prolific, heterogeneous field of studies that intersects politically with feminism and has been written mostly by women. This survey presents the main streams of thought in the field, which established itself in the second half of the twentieth century. It also describes the historical context in which this scholarship was produced, the topics that were defined, and the field's theoretical references, sources, and research problems. Given the vastness of this scholarship, the article focuses on writings in the English language, particularly the most expressive approaches and theoretical and methodological contributions.

O artigo realiza um balanço historiográfico parcial sobre um campo de estudos prolífico e heterogêneo, a história das mulheres, da ciência e da medicina, articulado politicamente com o feminismo e de autoria majoritariamente feminina. Pretende apresentar as principais correntes desse campo que se constitui e consolida na segunda metade do século XX, como o contexto histórico de sua produção, definição de temas, referências teóricas, fontes e problemas de pesquisa. Tendo em vista sua extensão, o artigo concentrou-se na produção bibliográfica em língua inglesa, destacando as diferenças de abordagens e as contribuições teóricas e metodológicas mais expressivas.

A mulher, o médico e as historiadoras: um ensaio historiográfico sobre a história das mulheres, da medicina e do gênero / Women, male doctors, and female historians: a historiographic essay on the history of women, medicine, and gender

Resumo O artigo realiza um balanço historiográfico parcial sobre um campo de estudos prolífico e heterogêneo, a história das mulheres, da ciência e da medicina, articulado politicamente com o feminismo e de autoria majoritariamente feminina. Pretende apresentar as principais correntes desse campo que se constitui e consolida na segunda metade do século XX, como o contexto histórico de sua produção, definição de temas, referências teóricas, fontes e problemas de pesquisa. Tendo em vista sua extensão, o artigo concentrou-se na produção bibliográfica em língua inglesa, destacando as diferenças de abordagens e as contribuições teóricas e metodológicas mais expressivas.

Abstract The article presents a partial historiographical review of the history of women, science, and medicine, a prolific, heterogeneous field of studies that intersects politically with feminism and has been written mostly by women. This survey presents the main streams of thought in the field, which established itself in the second half of the twentieth century. It also describes the historical context in which this scholarship was produced, the topics that were defined, and the field's theoretical references, sources, and research problems. Given the vastness of this scholarship, the article focuses on writings in the English language, particularly the most expressive approaches and theoretical and methodological contributions.