Women in Medicine: Where are we 150 years after Dr. Emily Howard Stowe, Canada’s First Female Physician?

| 10 July 2018

In 2016 I commissioned the creation of a Women in Medicine (WIM) Program in the Department of Medicine at Queen’s University. I was inspired to do so by a variety of factors including a diversity and equity course I had taken, some personal reflection on the subject of feminism, conversation with female colleagues, and my observations that the state of WIM would best be evaluated and advanced by women themselves. Launching this program felt like a positive step to enhance diversity and equity, promote professional development and perhaps even contribute to physician wellness.

There were those at the time, including some female physicians I consulted, who felt we did not need a WIM program. In our Alternate Funding Plan (AFP – which is our payment structure) we have pay equity, many women in leadership positions, and half of our Divisional Chairs are female (as just a few examples). Additionally, more than half the medical student class at Queen’s University is female. Therefore, some may ask, why do we need a WIM program? Having continued to hear stories of discrimination and challenges to advancement that were perceived to be based on gender, and in discussion with my fellow Heads of Medicine at CAPM (Canadian Association of Professors of Medicine), it was ascertained that many gender differences remain and these should be addressed head on. Most obvious is the unique female role in reproduction and child rearing during early years in a woman’s career, in particular. However, there are other less intuitive differences I encountered. For example, while every female physician seems to know what “imposter syndrome” is, few male physicians were aware of this condition (a psychological pattern in which an individual doubts their accomplishments, and has a persistent internalized fear of being exposed as a “fraud”- despite being fully competent!). While imposter syndrome occurs in both women and men it seems more on the minds of female physicians in my nonscientific survey….and that’s but one of many differences.

Next, I considered how best to proceed with the idea that we should create a WIM program. I knew just enough to know that this was something I should not attempt to lead or direct! Rather, I turned for guidance to my friend and colleague (and Associate Head of Equity and Diversity in the Department), Dr. Mala Joneja. After discussion she agreed to help start a WIM program (but more on that later).

A proper discussion of WIM programs should start at the beginning. There is a very relevant biography in the archives of Canadian Medical history that is worth a quick review. Let’s go back 150 years and meet Canada’s first female physician, Dr. Emily Howard Stowe (née Jennings). Her story of overcoming adversity and of her interactions with male detractors and supporters remains relevant today. She was born in Norwich, Ontario on May 1, 1831. By 1854 she graduated from Normal School and became Principal at Brantford Public School. Believe it or not this was a first in Canada!

Emily married John Stowe who unfortunately contracted tuberculosis. Reportedly inspired by this adversity she decided to change careers and become a physician. Just one problem: this had never occurred in Canada and was apparently impossible! In 1865, her application to the Toronto School of Medicine was denied (more on that later). So, off she went to New York Medical College for Women, a homeopathic institution that had just opened in New York City in 1863. This College was led by a remarkable woman, Dr. Clemence Sophia Lozier. The College initially had seven students including Ms. Stowe. The school interestingly had gender balance in its faculty complement from day one – 4 male and 4 female. Dr. Lozier served as the Chair of Diseases of Women and Children and as President of the College.

Dr. Clemence Sophia Lozier New York Medical College for Women — **Dr. Clemence Sophia Lozier** *New York Medical College for Women*

In 1867, Canada’s birthday, Dr. Stowe became the school’s first graduate. During a 25-year period this school graduated 219 students. They originated from states across America and included the first African American female MD in New York, Dr. Susan McKinney.

The newly minted Dr. Stowe returned to Ontario at a propitious time, with Upper Canada (Ontario) having joined the Confederation of Canada in 1867. She began her practice (see advertisement below) on Richmond Street in Toronto. Perhaps reflecting her view of the establishment, she began practice without a medical license!

Emily Howard Stowe Advertisement — *http://www.biographi.ca/en/bio/jennings_emily_howard_13E.html*

Dr. Stowe encountered several types of men in her career, as I suspect do modern female practitioners. There were men she loved and men she loathed. There were men who actively opposed her and others who helped in key times in very instrumental ways. For example, she reported that John McCaul, president of University College in Toronto, was not content to merely reject her application to medical school. When she responded to her rejection notice by “… expressing my regret & at the same time remarking that these university doors will open some day to women”, Dr. McCaul reportedly replied “Never in my day Madam”.

In contrast some men she met were advocates and allies, helping open doors. For example, a few years later in 1870 it was a man, Dr. William Thomas Aikins, an Irish immigrant and president of the Toronto School of Medicine, who allowed Ms. Stowe and another woman, Jenny Kidd Trout, to attend medical school classes. For whatever reason Ms. Trout sat and passed the exams whilst Ms. Stowe did not. Thus, Jenny Trout became the first licensed female physician in Canada.

Why did Emily not sit the exams after taking the courses? According to the Canadian Dictionary of Biography the male professors’ and students’ behaviour “had so angered her that she would not sit the exams”. Perhaps she also had concerns about her background as a homeopath and having practiced medicine without a license!

The theme of resilience is strong in Dr. Stowe’s life. She continued her practice but once again met adversity. In 1879 she was charged with performing an abortion. At this point she seemed to have acquired the respect of many colleagues and the leadership of the medical community in Toronto (men) came to her defense, testifying to her skills. She was vindicated. Out of this adversity came a surprising result in July, 1880: her acceptance with formal licensure by the College of Physicians and Surgeons. Once again, her advocate, Dr. Aikins, was among those who testified in her support.

In 1883 her daughter, Augusta Stowe-Gullen graduated from Medical school, continuing her legacy. Also, in 1883 the Toronto Women’s Suffrage Association, led by Dr. Stowe senior created the Ontario Medical College for Women.

Dr. Stowe was not simply a medical pioneer. She recognized the need to improve the life for all women, not just those who aspired to a career in Medicine. She became an ardent and effective feminist and advocate for woman’s rights. In 1888, Dr. Stowe, after participating in an international suffragettes’ conference in Washington, D.C., brought the movement back to Canada, founding the Dominion Women’s Enfranchisement Association in 1889.

The messages that I take from the life of Dr. Stowe include:

Ambition accompanied by resilience is often able to overcome staggering odds.
Even the most resilient and ambitious person needs allies, and in the case of WIM some allies will likely be male.
Activism is required to advance causes and this involves personal engagement and sacrifice.
Medicine is just part of the broader play of life and for females to be accepted as physicians society must embrace feminism and address the related issue of equity.
If you want to effect social change surround yourself with like-minded colleagues (e.g. a WIM program), whether that cause is obtaining the vote for women, securing access to admission of women to medical school or equity in the modern work place.

2017 Travill Debate Poster So how is society doing with the issues of feminism and women in Medicine? Certainly, better than in 1867! However, inequities and bias persist. Since women vote, constitute the majority of the medical school class, are often leaders in academic health science centres and have (to variable extents) access to childcare and maternity leave, do we even need WIM programs? We took on this sensitive subject in the 2017 Travill Debate in which the proposition was “Be it resolved that a Women in Medicine Program is Not Needed in 2017”.

This debate series, like its namesake (Dr. Tony Travill), is provocative and candid. As one can imagine the Pro, assigned to Dr. Romy Nitsch and medical student Roya Abdmoulaie, argued WIM programs was tokenism – we don’t need special treatment. We are already equal! The Con, assigned to Dr. Joneja and medical student Daniel Huang, argued that women are still misidentified as nurses or support staff, treated with less respect than their junior male physician colleagues and on occasion subject to sexual harassment.

So how is our WIM program structured and what are its goals? The WIM program began with meetings attended solely by female faculty. The theme of meetings is simple: women supporting women in medicine.

The goals of our Women in Medicine program are to:

Promote the advancement and success of women in academic and leadership positions
Create a community of women in medicine to provide support and mentorship for one another
Provide a forum for the expression of appreciation of the women in the DOM who have made significant contributions
Achieve 50% female faculty in next 5 years
Achieve 50% female faculty in DOM Leadership positions in the next 7 years

WIM holds quarterly meetings and has an accredited journal club. Meetings are funded by the DOM’s professional development fund. There are 9 members of the WIM Planning Committee and meeting attendance averages ~21 members (~43% of the DOM’s female cadre). One can get a feel for the meetings by reviewing some of the Guest Presenters and Topics.

Video LInk — Queen's Department of Medicine Women in Medicine Committee Video

1st Annual Event:

Dr. Elizabeth Eisenhauer, Head of Oncology, Queen’s University – The first woman in Medicine’s perspective on leadership and career growth
Ms. Jennifer Valberg, Senior Communications Officer, Queen’s University– How networking at Queen’s and building a community can help Women in Medicine thrive.
Dr. Robyn Houlden, Chair of Endocrinology – The History of Women in Medicine at the DOM – a timeline
Dr. Jacalyn Duffin –Hannah Professor of the History of Medicine- History of the first female surgeon Dr. James Barry – Born Margaret Ann Bulkley)

2nd Annual Event:

Dr. Sue Moffat, Associate Professor of Medicine, Respirology –Lesson’s learned as one of the first Women in Medicine in the Department of Medicine.

While I have not attended the meetings so far, they are well received. Each annual event has seen approximately 25 female faculty members in attendance. Feedback on these events has yielded a 100% satisfactory rating from attendees. The WIM have indicated that they plan to make changes in their medical practice including, but not limited to: Women-in-Medicine-Divisional-Chairs

An improved focus on work-life balance
A renewed approach to professionalism in medicine
Increased utilization and provision of mentorship for other women in medicine
Improved focus on creation of a network of supportive colleagues in which to rely on

We have made progress toward the goals of the WIM program. For example, all our search committees are reminded to consider equity in the search process. The Department of Medicine is committed to employment equity and diversity in the workplace and welcomes applications from women, visible minorities, indigenous people, persons with disabilities and persons of any sexual orientation or gender identity. Moreover, the hiring committee membership is broad, diverse, and extends beyond the division in which the new position resides. Quite importantly half of our leaders, Division Chairs, are female.

The following table shows how the Department of Medicine is faring in our march toward gender equity:

The Department of Medicine has recently launched a Twitter and Instagram campaign (@queensudom) for female faculty members using the #whatadoctorlookslike hashtag. You can follow that hashtag to find out more about the leadership roles of women in the Department of Medicine.

An example of the #whatadoctorlookslike campaign on leadership roles for women in medicine. — **An example of the *#whatadoctorlookslike* campaign on leadership roles for women in medicine.**

So how are we doing nationally with the goal of having the number of women in Medicine reflect broader society? As of Jan 2018, the Canada Physician Data Centre reported Canada has 84,260 physicians (that is 2.30 physicians per 1,000 population). Women account for 42% of all physicians. However, the inclusion of women varies widely by the type of physician, being lower in specialty disciplines (true for of all types of specialties) than in general practice (37.8% female versus 45.9%) and lowest in surgical specialties (~29%). https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx

https://www.cma.ca/Assets/assets-library/document/en/advocacy/06-spec-sex.pdf

As past president of CAPM, the Professors of Medicine of Canada (the leaders of our Academic Department of Medicine) I can attest there is diversity in terms of the progress toward equity of the genders in our academic Departments of Medicine across the country. I performed a brief survey of our 13 Academic DOMs and received several responses listed below in graph format:

Percentage of female Faculty based on RD

The above graph shows the percentage distribution of Female Faculty based on their role description as of March 2017 from participating Universities. As you can see, University one has 37% full time faculty an 36% part time faculty that were identified in the survey.

Percentage of female faculty in leadership roles

The above chart shows the allocation of female faculty members in leadership roles in Department, Faculty and Hospital levels. As you can see, University 1 has 21% of female faculty members in Departmental Leadership positions but no faculty members in hospital or faculty level leadership positions.

The above graphs show a comparison between male and female faculty regarding associate and assistant faculty promotion within the first 7 years. You will see that associate faculty promotion in University 1 saw a rate of 62% male faculty promotion while females saw 46%. Data set for two entries were suppressed due to incorrect entry of data.

In the above graph you will see that 50% of faculties provide on-site daycare to their members.

In this graph you can see the distribution of female faculty members throughout divisions. For allergy, University number 5 (Orange) has 100% female faculty in that specialty.

Additionally, the survey revealed the rationale for declining leadership roles for female faculty across universities:

Family commitments
Work-life balance
Uncertainty of being successful in the role

Me Too Movement

In conclusion: In the era of Me Too we still need WIM programs. There are many issues we have yet to resolve such as:

How to provide 24-7 on-site daycare
How to support job sharing
How to deal with equity associated with providing flexible hours
How to cover maternity and parental leaves and more

We need safe spaces to have these conversations in a respectful manner. WIM programs constitute one such safe space. Indeed, I believe because conversations have become more “high stakes” in the current environment, we need WIM programs more now than pre-Me Too. WIM programs provide a forum for female physicians to shape policy, provide mentorship, and support one another, a collegium in which diverse opinions can be shared and pathways forward illuminated. As a Department Head, our WIM program provides me with advice on proposed policies, gaps and inequities informing my decisions with a perspective that I may lack. Rather than being confrontational I find having a vibrant WIM program empowers women, informs men and projects a sense of fairness that makes the DOM a better place to practice.

Thank you to Dr. Mala Joneja and my colleagues in CAPM for their contributions to this blog post.

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