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As women join the ranks of psychiatry in greater numbers than ever, they still face inequities in academics, research opportunities, and salaries compared with their male colleagues, noted a panel of women psychiatrists at APA's 1998 annual meeting in Toronto. These inequities are also reflected in the quality of health care and research done for women on all levels, they said.
The moderator for the forum, "Women Psychiatrists: Their Triumphs and Tragedies," Geetha Jayaram, M.D., said that while there have been changes in attitudes about and expectations for women, and the definitions of family as well as "masculine" and "feminine" have become more flexible, women still have to overcome discrimination at work.
Jayaram, an associate professor of psychiatry at Johns Hopkins University School of Medicine, said that recent studies show that women professionals' top concerns include work burnout, the difficulty in networking with other women, competition in male-dominated institutions, difficulty in breaking the "glass ceiling," lack of mentoring and guidance, and the absence of flexible work schedules.
Women need better representation both as researchers and as subjects in clinical trials, she said. Though insufficient funding for studies on women has been a problem in the past, she noted, this condition is rapidly changing through the efforts of the National Institute of Mental Health, women doctors, and large academic institutions.
Half of all entering medical students and 43 percent of all psychiatric residents are women, said Alpa Patel, M.D., a psychiatry resident at Duke University Medical Center. Yet women face tough challenges as they begin careers as psychiatrists, she said. They experience role conflict, gender bias and harassment, limitations to advancement, and lack of mentoring.
Women often find themselves in a double bind, she said. They experience a lack of institutional support for choosing to start families, she said, noting that there is no standard maternity leave and no standard approach to providing work coverage. In addition, she said, women with families are seen as weaker candidates for leadership and research opportunities.
Women psychiatrists still receive less pay then men for comparable work and publish less than men, said Patel. Women under the age of 40 make $58,000 a year to men's $117,000; at ages 40 to 49 women make $81,000 to men's $131,00; and women 50 and over make $78,000 to men's $110,000, according to a 1991 AMA report.
To alleviate some of these problems, Patel sugested the following: part-time residency and job sharing, strategies for covering duties of absent psychiatrists, child care in residential programs, locum tenens (commission work as needed), and the development of mentoring and leadership programs. She also suggested that women psychiatrists receive training in salary contract negotiation and proposed that academic centers create clear guidelines for advancement within academic centers to decrease subtle discrimination, and that the National Institutes of Health require only Social Security numbers on research proposals rather than names so that women will not be discriminated against.
Nalini Juthani, M.D., an associate professor of psychiatry at Albert Einstein College of Medicine, addressed concerns of women in mid-career, and Deborah Cross, M.D., chair of APA's Committee on Women, spoke about women in late career. Many women at these stages of their careers have overcome many obstacles and become strong and vital while succeeding in their careers and raising families, they said. Older women especially have had to work hard to overcome discrimination and loneliness and often had to learn from men who were willing to help, said Cross. Some women have experienced tragedy, such as becoming workaholics or failing to gain recognition for their efforts.
Several presenters noted the sense of isolation and identity conflict that women psychiatrists have experienced. Cecilia Tang, M.D., an assistant professor of psychiatry at the University of Maryland, described how women are influenced by society's expectations that they be soft, nurturing, and vulnerable. "These messages are assimilated by girls at an early age and become part of their self-expectations," she said.
For some women, leaving home, going to medical school, and realizing ambition is a tremendous feat of adjustment and adaptation, Tang said. Women psychiatrists, she said, can now celebrate their achievements and accept the recognition they have received even as they continue to struggle.