BMJ  2003;327:1054 (1 November), doi:10.1136/bmj.327.7422.1054

reviews

Exhibition

Changing the Face of Medicine: Celebrating America's Women Physicians

An exhibition at the National Library of Medicine, the National Institutes of Health in Bethesda, Maryland, United States, until 2 April 2005

www.nlm.nih.gov/changingthefaceofmedicine/

Rating:

They treat the whole patient, striving to balance their personal lives and the needs of individual patients and entire communities. Deciding which issues to focus upon, they direct research and funding and are instrumental in implementing the policies, developing the drugs and treatments, and drafting the legislation to meet emerging medical challenges. They are...America's women physicians.

So not all that different from men, then? "Changing the Face of Medicine" celebrates women's achievement of parity with men in American medicine, while giving due attention to the often appalling adversities over which they have triumphed.

It took a century and a half. When Elizabeth Blackwell graduated from Geneva Medical College in upstate New York in 1849 she was the first woman to qualify as a doctor since the renaissance. Even then, she had been admitted on to the course only after the male student body had voted in favour of it, apparently as a joke.

Virginia Apgar examines an infant's head Credit: COLUMBIA UNIVERSITY HEALTH SCIENCES DIVISION/AUGUSTUS C LONG LIBRARY

After qualification, Blackwell and her followers found that their problems were just beginning. Facing exclusion from employment in medical schools, hospitals, and laboratories, they set up women's medical schools and hospitals for women and children. The exhibition shows that the close association between women doctors and the medicine of women and children has been enduring.

A century after Blackwell's graduation, some of America's most renowned women physicians were best known for their work with children. Two examples were Virginia Apgar, whose score for evaluating a newborn's vital signs bears her name, and Helen Taussig, the founder of paediatric cardiology.

It is only in the past few decades that women doctors have felt free to range as wide as their male counterparts. When Linda Shortliffe received her board certification in urology in 1983 there were only 15 women urologists in the United States; now there are more than 200. The medical and surgical team set up by trauma surgeon Susan M Briggs to respond to national and international emergencies dates from 1999.

Surgery and academic research held out longest against women. The career of Florence Sabin (1871-1953) is exemplary in this respect. One of the earliest woman physicians to build a career as a research scientist, she suffered such harassment from other interns when she worked for Sir William Osler that she was left with little time for her own research. Later she was passed over for promotion to a position for which she had been regarded as a certainty. The incriminating minutes suggest that the selection committee preferred a man for the job—any man—to a woman.

But if it is any consolation for the years of discrimination, the wheel has turned full circle, and then some. While America's first women physicians had to confront prejudices about their supposed intellectual and physiological limitations, today's have to deal with their possible superiority to men. "Are Women Better Doctors?" asked a New York Times Magazine cover story in 1988.

If the exhibition has a limitation, it is that it is couched almost wholly in terms of personal stories. A few statistics might have given us a more accurate insight into how women are faring in US medicine today. For example, compared with men, how many women apply to medical school, how many are accepted, and how many graduate and with what grades? How many women are practising medicine 10, 20, 30, 40 years after graduation? What is their average salary and how far up the medical hierarchies have they progressed? Compared with their male peer group, how many children have they had?

Linda Shortliffe (back row, second left) breaks into the inner sanctum of urology Credit: AMERICAN BOARD OF UROLOGY

It is noticeable how many women physicians featured have been photographed with their children—a far higher proportion, one suspects, than if the exhibition was celebrating America's male physicians. But there's a niggle: how typical is that? According to the Financial Times, a recent survey for US lobby group the National Parenting Association found that 42% of female corporate executives aged 41-55 were childless as were half of those earning more than $100 000 (26 September 2003). Has US medicine found ways to accommodate motherhood that US business has not?

It is a success of the exhibition that it made me think of things beyond its remit, such as what was, and is, happening elsewhere. Finding themselves unemployable in mid-19th century America, some early women graduates came to Europe for clinical experience, which suggests that European prejudices may not have been as strong. One hundred and fifty years later, are European women doctors ahead or behind their American counterparts? And whatever the case, what are the reasons?

This exhibition leaves you in no doubt that the most powerful agents of women's advancement in US medicine have been women physicians themselves. Women physicians elsewhere might want to take note.

bmj.com tdelamothe{at}bmj.com

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