Letter to a Female Premed
Last Friday, I got together with two other female medical students for dinner and drinks. As we recounted highs and lows from a busy week of inpatient medicine, the topic of discussion turned to this recent piece in the New England Journal of Medicine, entitled “Letter to a Young Female Physician.” In it, Dr. Suzanne Koven touches on some of the unique challenges faced by female physicians, including explicit and implicit discrimination as well as the insidious nature of imposter syndrome.
Though I still have another year to go before earning those two extra letters behind my name, Dr. Koven’s stories felt oh-too-familiar, and her advice echoed what mentors have said to me all throughout this first year of clinical training. So, while I certainly don’t feel qualified to be writing something like this, the timing seemed oddly fitting when SheHasDrive reached out to me, as the fourth-years at my school just graduated and the AMCAS med school application for the class of 2022 just opened.
Letter to a Female Premed
1. On age
First of all, I took out the word “young” from Dr. Koven’s title because you might not be, and that’s perfectly ok. Medical training is a long and expensive process, and whether you had to work for many years to support your family before being able to afford the application proce$$, or have had a whole other career before making the switch, there is no shame in starting med school older than 22. In fact, that is increasingly the trend because you will be a more interesting applicant, a more well-rounded person — and might even have some savings in the bank, which turns out is a great situation. And perhaps you’re taking more time because you were discouraged from pursuing medicine, as is often the case for women, people of color, and anyone who doesn’t fit the traditional image of a physician. I had family members who feared I would become overeducated and unmarriageable, advisors who saw my subpar science grades and encouraged me to give up on medicine and “consider majoring in English instead.” Especially because I will be the first physician in my family, it was not easy to imagine a world beyond those types of comments.
2. On appearances
But also, I submit that as a woman in America, you will never be the right age. Our society seems to have an insurmountable bevy of opinions and feelings about a woman’s age (and makeup, and size, and covered shoulders, and tone of voice…). Even though over half of medical students today are female, many of my female classmates and I have been told we are too young (“It’s just so hard to take you seriously”) and too old (“Won’t it be too late to have kids?"). I used to modulate my voice, apply more makeup, and wear darker colors to try and project more gravitas, but at some point this year, I decided to simply be who I am: a 5’5, 100lb Asian woman who shops at J.Crew kids. Plus, no matter the age, a female physician will always look more like a nurse to many people. I rarely feel offended when this happens to me (weekly) since nurses are incredible, although there was the time I was interrupted while presenting on rounds and told to go clean a patient room...
However, what does consistently upset me is how these stereotypes play a role in the wage disparities that plague female-majority healthcare fields, as well as female-majority specialties within medicine. “Women’s work” should not be seen as less intellectually challenging or vital to society, and I hope that if you have chosen medicine instead of nursing or social work, it is not because you’ve dismissed those fields as lesser.
3. On specialty choice
As soon as you enter medical school, people will tell you that picking a specialty is mostly about “finding your people.” Institution-specific and general stereotypes exist about most specialties, and they are often fairly gendered. The boundaries are shifting and the barriers far less rigid, but even today, there is a skew towards women caring for women and children, while more men pursue high-paying subspecialties and surgical fields. Female surgeons have told me how much better it is these days, but even just last month, I attended a Cardiology and Cardiothoracic Surgery weekly conference and there were just 5 women and 2 people of color in a room of nearly 40 physicians and trainees. Perhaps subconsciously this has influenced my decision to pursue Pediatrics… although, more likely, I am merely fulfilling my destiny as predicted three years ago by my clinical skills instructor when I showed up to class with a giraffe named Jamal as my reflex hammer.
Either way, while I hope you will not feel constrained by tradition when exploring specialties, I also think it is unreasonable to ask any individual woman to cast off a lifetime of gendered socialization, or dismiss the very real differences in hours and culture that exist in different specialties. “Find your people,” yes, whether they be the people who you feel most comfortable with, the people who challenge you to exceed expectations, the patients you connect with most easily, or those who best align with your personal goals of spending time with people who are not your colleagues.
4. On interests
Other than really wanting to mention Jamal, he also highlights my next point that we all bring some element of ourselves into our work, but the work of medicine has long been undertaken by people who look a certain way and have certain interests. At first, I felt pressured and insecure about the “fun” topics that frequently came up in the OR or during rounds, such as skiing, boating, backpacking, shooting, gardening, or family reunions at lake houses. I used to feel as though these topics were necessary prerequisites for becoming a doctor, like doing well in biochemistry or being able to recite Light’s criteria. But as I’ve learned more about historical and ongoing reasons for the lack of diversity in medicine — especially academic medicine — I’ve shifted my thinking.
Now, I focus on the fantastic conversations I’ve had with fellow trainees about how nobody can pronounce our “ethnic” last names. I’ve swapped online bargain-shopping tips and discussed healthcare reform and advocacy with attending physicians, and even bonded with a resident recently about our previous lives as web designers. And even though my love of the New England Patriots (sorry, Washington readers) is understandably unpopular, perhaps my other interests aren’t common in medicine because "women who were raised by a low-income single mother, started working at age 12, and have never had a backyard” are not all that common in medicine. Yet. So remember that you are not alone, even if you are different.
5. On self care
Finally, the application process can be pretty (extremely) stressful, as can medical school and this whole long career path. It’s easy to sacrifice self-care, especially if you have older family members or children or partners/friends/pets/struggling houseplants to worry about. I won’t pretend to get always 8 hours of sleep and 8 glasses of water and run 8 miles a day, but over and over, the most important lesson I have learned these last three years is that there is no substitute for taking care of your body and having empathy for your own feelings.
So in addition to meticulously curating your spreadsheet of schools, take this time before med school to cultivate a self-care regimen and a support system. Figure out what you can do (hopefully cheaply and quickly) that reliably brings you joy – mine is watching HGTV, a great tip from Hillary Clinton. Try to get medical care if you have time and insurance now, especially mental health care and dental work. And most importantly, identify the people who will love you and support you, even when you are a snotty, formaldehyde-smelling mess who is failing Anatomy (thanks Theo!). Put it into your gCal, your Moleskine planner, or on your to-do list, to thank them in advance, because they will get you through.
Good luck! See you on the other side!