Author + information
- Division of Cardiology, University of Florida, Gainesville, FloridaDivision of Cardiology, University of Florida, Gainesville, Florida
- ↵∗Address for correspondence:
Dr. Monica Aggarwal, University of Florida, Division of Cardiovascular Medicine, Health Science Center, Room M-415, PO Box 100288, 1600 SW Archer Road, Gainesville, Florida 32610-0277.
When a woman screams in the forest, if no one is around to hear it, does it make a sound? This koan is age old and has given me much pause over the years as I have considered the ebbs and flow of my voice.
Growing up as a child of immigrants, I was keenly aware of how the Indian culture viewed women as docile and subservient—that a woman was first a daughter, then a wife, and then a mother—always defined by those around her. Luckily, my parents were strong and taught me to depend on no man and always reach for the highest bar. However, navigating those cultural experiences taught me that being quiet and to “only speak when spoken to” were proper virtues.
Navigating the field of medicine was fraught with social challenges. I recall my days in medical school, where male physicians remembered me by my “big, brown eyes” or my smile instead of my quick wit or good clinical acumen. I remember being a resident in training, already an MD, always smiling a lot to make sure people didn’t feel that I was too strong in my opinions—too forthright. We women border on sounding “ditsy” so as not to sound too smart and too imposing to our colleagues. We used to remark among our own that we had to do this only because we were women; our male counterparts considered none of this. But we did what we had to do—as women. As a cardiology fellow, I was lucky to have had another female comrade. This is rare as only 20% of cardiology fellows are women (1). I remember so often patients mistaking me for the nurse. I remember being the senior doctor in the room telling a patient his diagnosis and plan and that same patient looking to the male members of my team to make sure they agreed with my plan—to validate me.
As a practicing cardiologist, new challenges arose. I have been offered salaries lower than male counterparts. I recall moments presenting cases in a room of all men and then a male physician in the room walking out and whispering in my ear before leaving about how sexy I looked while presenting. I remember being asked why I needed a lock on my door while I was nursing and pumping milk at work. I remember being told that the women’s pumping room was in the obstetrics ward and that it would take me only 10 min to get over there. And then there is the now, 3 kids later, the constant pull where my senior male physicians tell me that there can be no leniency for going home for children, for taking less intensive care call—that everyone has children and we all have to chip in. Still today, I ignore the comments from patients about how pretty I look or all of the calls of “honey” or “sweetheart.” I also remember explaining to my physician colleague why I didn’t have lunch with the rest of the “guys.” I explained that I did my work during those times so I could get home earlier because I didn’t have a wife at home. He responded by saying, “Well, no one told you to go into this field.” The rage slowly builds. It is insidious. We women so often scream in private so as not to appear outwardly “difficult,” “unreasonable,” “a typical woman,” or “a bitch.” If we scream in the forest, and no one is around, does anyone hear us?
Latest statistics show that although women are noted to be more compassionate and competent doctors, only 20% of cardiology fellows are women and only 12% of board-certified cardiologists are women (1–3). Survey data assessed why women do not go into cardiology and found 5 barriers; namely, radiation exposure, sex discrimination, family planning, lack of advancement, and disparity in compensation (1,4). Women are more likely to avoid invasive cardiology specialties to avoid radiation exposure and are more likely to avoid family planning while exposed to radiation. Women are also often unaware of radiation safety precautions for pregnancy. It also is often tricky to point out that we need extra radiation protection during our first trimester, when 20% of women miscarry, making it clear to everyone that we are pregnant and the pain even more acute if there is a miscarriage (5).
Women experience sexual discrimination and discrimination about parenting. That sexual discrimination comes from all levels of staff, patients, and senior administration. Women cardiologists are more likely to be single and less likely to have children. Women choose noninvasive specialties to avoid more night call that comes with invasive subspecialties, barriers to making it home for children. This choice to be a noninvasive specialist often justifies the pay discrepancy of $37,717 for private cardiologists and $33,749 for academic cardiologists to our senior leadership (1). This is what we are so often told. These trends have not changed. Even in the newest professional life survey, the barriers that women faced 20 years ago still persist today (4).
From when we are young, we are told that women are to be calm, cool, “put together,” humble, and quietly smart. With the rise of women’s liberation, we are told that we are as good as any man. Of course, there is no question about that. I chose a challenging career that few women go into because I knew that I could handle it and that I was as good as my male counterparts were and likely better. But what has taken me 10 years of practicing as a cardiologist to realize is that although we are as good as men, we are not equal to men. We are not the same. As women, we carry babies and we are often doing the bulk of raising them. We manage households—often doing the cooking, groceries, and cleaning. We arrange the camps, the tutors, the play dates. These are our roles. We are taught to aspire to work in the structure that has been created by our male counterparts, and it is only when we shine in their world that we are seen as equal. But we are not equal. We have more to consider, and those considerations need to play a role in how we practice our field. Modifications need to be made—not because we are weak and cannot handle the work, but because we have more responsibilities that are equally important. For so long, we women stay quiet outwardly and have rage that builds. We scream to each other but in the quiet of the woods where no one hears us. No More. We need to start screaming in places where people can hear us. Because I am a cardiologist. But I am also a mother of 3 beautiful children whom I share care of equally with my husband. I am also the primary household provider. I do the bulk of the cooking, cleaning, and organizing. And I am proud of these roles. I deserve not to be told at work that I have to “chip in;” but rather, what we do as women should be celebrated and protected. We should be able to go home to get our children from bus stops, and we should be encouraged to be there to parent them. We should be given access to work stations so that we can make up work at night so we can contribute at the same level as our male counterparts. We should be given access to good-quality child care at work so we are not running around everywhere trying to get our kids off safely and then rush to work. We should be able to take time off if our children are sick and not made to feel bad about it.
When will the world hear our voices? I, for one, am tired of screaming in the woods. We, as women, need to stand together, without fear of retribution and tell our stories. These stories are important and changes need to be made to make our lives and the lives of our daughters better—as women, as doctors, as moms.
These comments are not a reflection of any one workplace or my current workplace; but rather, a reflection of navigating over 10 years of training and clinical practice.
Dr. Aggarwal has reported that a small portion of her position (10%) is funded by a Gatorade Grant for Education.
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- ↵Mayo Clinic. Miscarriage. Available at:. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298. 1932019. Mayo Clinic. Miscarriage. Available at: https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298. Accessed March 19, 2019..