Closing the Gender Gap in Medicine
Written by Shala Hainer Friday, November 04 2011
Snapshot: Linda Brodsky, physician
Describing herself as a woman who likes challenges, Dr. Linda Brodsky entered the medical field to make a difference. She quickly moved up the health care ranks, becoming a successful pediatric surgeon and an educator. She founded the first Center for Pediatric Quality at the Children's Hospital of Buffalo and was the first female to be promoted to tenured full professor of otolaryngology and pediatrics at the State University of New York at Buffalo.
In the late 1990s, she realized she was being paid less than her male co-workers and recognized other forms of gender discrimination in the health care field. She spent a decade in a federal legal battle with her employer over gender discrimination. Using her experience gained during the litigation as well as 25 years as a health care practitioner, Brodsky now tries to help women in the health care field overcome issues with pay inequity and gender discrimination as a founder of Expediting the Inevitable.
She and her team work to close the gender gap in medicine while avoiding legal battles when possible. She contributed her story to the book, Get Your Woman On: Embracing Beauty, Grace and the Power of Women, released in August. She describes her fight for gender equality and how it led to the creation of Expediting the Inevitable, allowing her to advocate for change in the health care field.
Her numerous awards include being cited as one of the Best Doctors in America from 1992 to 2002 and being named honorary chair of President George W. Bush's Advisory Board on Health Care Reform.
Womenetics: How did you discover that gender inequality existed in the health care industry?
Linda Brodsky: I went through much of my life and career unencumbered by any form of gender discrimination. I attended a women’s college, Bryn Mawr, and the Women’s Medical College of Pennsylvania, where, in 1979, my class was 50 percent women. I trained at Albert Einstein in the Bronx, where women physicians are welcomed and treated very well.
When I started my health care career in Buffalo, I sensed something was different, but I didn’t, even for one minute, suspect gender discrimination. It had simply never been a prominent force in my life, so therefore not in the forefront of my mind. I climbed to the top of the ladder, where I found the playing ground was shockingly not level. The view became a lot clearer at the top, and differences that seemed ambiguous before became much clearer and quite pronounced. In particular, there were pay disparities between men and women not only at the same level, but between high-seniority women and men significantly junior to them.
I had doors shut in my face for reasons that I couldn’t understand. I wasn’t quick to assume gender discrimination; in fact, it was quite the opposite. I isolated all possible variables – actually hoping I would discover another common thread tying a number of seemingly unrelated events together. Soon it was clear that the unifying theme could be discrimination. It was the first time in my life I felt I had no control over my destiny; that I felt decisions were being made against me on such arbitrary grounds. I started doing research and found that many other women were facing similar situations. It was 10 years after I completed my training that I made this discovery.
If gender discrimination came as a shock to me back then, it’s no surprise that it comes as a shock to people now. Yet it still persists and continues because we are fooled by the overwhelming sense of liberation and equal rights that women in society at large now enjoy. My new path of advocacy and commitment to change revolves around closing the gap between what society wants, upholds, and is moving toward and the antiquated standards being perpetuated by aged institutions – health care and otherwise – under this guise.
Womenetics: What inspired you to begin fighting for gender equality?
Brodsky: After discovering the reality of the situation, I was unable to ignore it. I had to decide, should I go on working under the given circumstances, despite knowing what I knew, or fight in pursuit of what I believed to be fair and right? My strong sense of the pursuit of justice prevailed as it was the only one capable of yielding positive change.
From there forward, I spent 10 years in legal battles with the university and hospital. It was draining both emotionally and financially. But I continued because I knew that someone had to stand up and fight. There is a sociological principal that was at work here: You have to be enough like the people that they will listen to you and enough unlike them that you have something interesting to say. I was a highly regarded tenured full professor; I also had the emotional strength and financial resources to endure. Essentially, I already had “power” and money, so I hoped it was obvious to my peers that my only goal was to reveal the truth of the situation that did not just affect me. This pursuit of “truth and justice” is what kept me going.
On Dec.26, 2007, I held a very large settlement check in my hand from the University at Buffalo. It wasn’t really satisfying; however, because nothing had changed. I realized that the system for redressing gender discrimination was useless in its present form. I was no longer a university faculty member (I retired with benefits), and I believed the university was still treating women differently and poorly.
I knew that if I ended the story there, I hadn’t accomplished my ultimate goal.
Womenetics: What is the best advice you give women on negotiating their salaries?
Brodsky: I have seven important recommendations:
- Know your value and make sure you are getting compensated correctly. The data is readily available through a number of different sources, which will give you an idea of the ballpark you should be in (adjusted for specialty, practice setting, geographic location, etc.)
- Make sure you understand all aspects of the “compensation” model, for example, how productivity bonuses are determined or the structure of your faculty practice plan (if you’re in academics).
- Investigate the resources you are given so that you are able to be productive and “earn” that salary. If you are a surgeon and are only given access to an operating room three times a month, then you aren’t set up for success, and therefore won’t be able to achieve what is expected of you.
- It is important to know and enforce the idea that productivity and quality patient care are not be measured only in hours worked. Therefore, working flexible hours should not equate to a disproportionate salary decrease. Creative scheduling, work load commitments, role adjustment, and career path trajectories can and should be part of the discussion.
- Get help planning your negotiations. It is shown time and time again that when women negotiate, their employers perceive them differently – and negatively – than men in the same situation. This latent and intangible factor could derail your effectiveness. Seek the insight of someone who has been on both sides of the table to prepare, and be willing to handle things differently than might seem natural to you if advised to do so.
- Remember that negotiating is a conversation, not an argument. Give thought to how you can align your needs with those of your employer. Don’t approach the situation from a vantage point of attack or view your employer as the enemy. Be reasonable yet firm.
- Know that they need you as much as you need them. This is a symbiotic relationship; neither party could go on without the other. This fact shouldn’t result in righteousness; it should set the stage for mutual respect.
Brodsky: As described above, I had endured a lengthy court battle, but had not achieved my perhaps not-so-humble goal of “revealing truth.” I was broken for a while. I was lost. It took me a long time to admit that to myself, which lead to bitterness. (This actually may be the first time I’ve revealed that fact in a public forum, although I’m sure it manifested itself in different forms in the months following the case.) My failure to achieve my ultimate goal became my vulnerability, but I was careful not to let this become a reason to continue fighting in a way that was so destructive and counterproductive. Instead, I wanted to turn something negative into something positive, rather than harbor resentment, play victim, or let it take over me.
It took me a while to figure out what this would be. I thought about writing a book, but I knew that while doing so would be cathartic to me, it might not lead to progress for others. I kept coming back to the idea of mentorship and teaching and using process improvement techniques, with which I had a lot of experience as the head of the Center for Pediatric Quality for 10 years, to change the cultures and behaviors at health care institutions. After three years, Expediting the Inevitable (ETI) finally “revealed” itself to me. It was so simple and obvious that I knew it was right.
ETI is my way of not only revealing the reality that gender discrimination exists in health care, but also that it is harmful to our patients and society. ETI is my answer to how women and organizations can work together to build upon a healthier foundation. Women and health care organizations should not be at odds with one another; they should act as partners in pursuit of a common goal – improving the quality of patient care for all. If this is not the health care organization’s or physician’s primary goal, then their goals need to be reviewed and recalibrated. ETI is committed to reassessing and implementing these joint goals.
Because gender discrimination is largely considered a thing of the past, talking about it can turn people off – both men and women. It places the speaker at the wrong end of the sociological principle I mentioned before – positioning the speaker as an outcast, someone who is different, and therefore whose opinion doesn’t matter. And because it is so well hidden these days, fighting the problem involves first convincing people that it exists. Yet it is prevalent enough in our health care organizations that someone – many someones, rather – needs to risk this type of backlash to improve the system once and for all. In the meantime, our women physicians are at risk of falling victim to it. Women who aspire to become physicians – women who work hard at anything, for that matter – don’t like to see themselves as victims.
Fifty percent of the medical students today are women, and 46 percent of graduating physician trainees are women. Unless the system starts to value them and their potential to contribute optimally, none of us – not the physicians, the health care administrators, or the patients – will be in positions to benefit from this influx of talent.
Womenetics: What is the biggest challenge you overcame in seeking equal pay? In your opinion, what other major challenges exist?
Brodsky: I had two major challenges. One was with the systemic disparity, and one was in my personal litigation. In my research I discovered that the university had begun to expand its faculty rapidly in 1983, just when I was hired. Without anyone noticing, they hired faculty with university stipends significantly below what was guaranteed by contract from the state to its university health sciences employees. In 1997, I brought forward a grievance through the Union of University Professionals to which all faculty belonged. The union took almost five years to agree to bring it forward, and then it took another two years to have it go through arbitration. But we won. They had breached the contract, and I was awarded back pay and raised to the minimum salary for rank, then a full professor. My stipend from the university nearly doubled, but still I was receiving much less than my peers from the university. The union then brought forward a class-action grievance for the faculty at all four medical schools and won. Because more women had been hired during those years, 1984-2004, and because they more often received the lowest stipends ($5,000 was not uncommon), they benefited more, but not based on discrimination.
My other major challenges came during my legal battles. These included:
- The ability to get data – discovery was delayed and incomplete despite multiple petitions,
- The ability to identify “comparitors” in a field where job descriptions do not fit into the narrow legal definitions of comparable,
- The difficulty in understanding and articulating how compensation models can be manipulated to “show parity.
Womenetics: As an accomplished surgeon and professor, how have you balanced family and a busy work life?
Brodsky: With a lot of help! My husband is also a professor and surgeon, so he understands the demands of the life of a surgeon. We carefully planned how we were going to have people help us care for our children, our home, and help with certain aspects of our lives. We chose live-in help, and for the last 30 years we have had only three wonderful people become part of our “family.” We have three grown children who are responsible, resilient, independent, and productive.
When they were young, we made sure that one of us was always home for dinner (which worked about 90 percent of the time). Afterward, because the chores were done, we were free to spend time with the kids. We built our home around certain times and spaces which could not be invaded, such as Friday night dinner for the Jewish Sabbath and going to synagogue on Saturday morning. Only medical emergencies could interrupt. They got used to the fact that although we loved them very much and cared about their lives and concerns, that sometimes a sick child needed our help. I think it taught them that sometimes your own needs were less important than those of others.
I was fortunate to have a work partner who believed in flexible scheduling way back in 1983 before anyone ever thought it should be available. I worked hard but set my own pace and schedule. I was the busiest surgeon at the hospital for many years. My husband and I managed to get free to attend important events in the kids’ lives. I have to admit that we did not get to every tennis match or every school event during the day, but we got to enough and enjoyed watching them grow.
I learned to delegate everything I didn’t like – housework, shopping, and other errands. Even when we had little disposable income when we were residents, living in a small NYC apartment, we had live-in help. And even though all our kids are grown and on their own, we still have full-time help, plus some.
Work-life fit is a journey that is one of the greatest concerns for women physicians. ETI offers help in exploring the alternatives that might work in many situations. It is very important to discuss these issues with your life partner and be clear and flexible about solutions you can live and work with. Don’t expect that everything is going to be perfect, it’s not. But it will be good enough – be kind to yourself.
Womenetics: What can women do to ensure they are being compensated equally and receiving promotions they deserve?
Brodsky: Do your homework regarding fair compensation (see above). Know the system for moving up in whatever practice setting you choose. Make sure you discuss expectations and your progress regularly with the appropriate mentors/supervisors. Communicate with those who can help you move up and, in particular with the key decision makers, such as chairs and senior partners. Frequent communications on “how am I doing” go a long way. Network with other women to see what they do and how they got where they did.
Womenetics: How does the disparity toward women in the health care industry transfer to the care of female patients?
Brodsky: This is a complicated and long discussion. The research here is just beginning. Understanding how patient care is affected is far from clear. But simply put, an unhappy work force doesn’t do its best work.
Womenetics: If women are experiencing gender inequality in the workplace, how do you suggest they begin the process of seeking equal pay and promotion considerations?
Brodsky: You begin by really understanding the problem. Then you go up the chain of command in as non-confrontational way as possible and start to build the awareness and the case so the employer can make these adjustments without feeling threatened that they are going to be sued. This is one of the most common scenarios that we deal with at ETI. Make sure you keep excellent records with follow-up communications.
Most importantly, do not react when you are angry or upset. Coming across as reasonable and using all available administrative remedies available to you within your work environment are essential. Although it is necessary to take it through the chain of command, I found that the reality was that once I started to bring forward the subject of gender inequity (as early as 1989), the game seemed to change. While the law is supposed to protect you from retaliation, there are no remedies until after the retaliation has occurred and these cannot undo what damage has been done.
Womenetics: How do you find time to relax, and what do you like to do to unwind?
Brodsky: When the kids were younger, I built my relaxation time into their needs and activities. They were all involved in a sport and took a musical instrument. I did the same with them, such as tennis, piano, and voice. We took frequent and very low-key family vacations to Martha’s Vineyard every summer. This has become our family gathering place. Sometimes we would travel; I even learned how to ski.
My middle child, my oldest daughter, turned me onto Pilates and yoga, which I have been practicing for nine years. I continue to play tennis and ski. I read a lot and am in a book club, and I love to write. I love going to films, plays, and concerts.
I try to be involved in some community activities, enough to have experiences that are outside of medicine. We travel as much as possible; traveling always takes me to new experiences and refreshes my outlook and replenishes my energy levels.
Friday night continues as our sacred time; we have friends and family over to catch up and just let go. Our lives continue around the schedule we had for the whole family to recover and reconnect on a regular basis.
Based near Atlanta, Shala Hainer has been writing and copyediting since 1995. Beginning her career at newspapers such as the Marietta Daily Journal and the Atlanta Business Chronicle, she most recently wrote and edited articles for several nonprofit organizations before purchasing a flower shop in 2006. She earned a bachelor’s in communications from Jacksonville State University.
© Copyright 2009-2013 Womenetics.com, Inc All Rights Reserved
