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I’ve been a physician now for 13 years and a double board-certified critical care physician for eight years. And I’ve really learned a lot along the way. Here are the top 10 things I’ve learned as a woman in medicine. 

1. Always Ask

A study was done where participants were participating in some sort of word game and were told that they would get paid between $3 and $10. After completing the game, the researcher gave the participant $3 and asked if that was okay. For the men, it was not okay. Men requested money beyond the $3 far more than women did, with a ratio of nine to one. 

Another study I came across was published in 2003 by Harvard Business Review. The survey asked 291 men and women the following questions:

• When was your most recent negotiation?
• When was your second most recent negotiation?
• When do you expect to negotiate next?

In regard to the first question, men answered two weeks ago and women answered four weeks ago. For the second question, men said seven weeks ago and women said 24 weeks ago. For the last question, the men said in one week and the women said in four weeks. So statistically speaking, men ask more frequently and therefore more frequently get raises.

Because I knew about this study, I would ask my director for a raise at every single quarterly evaluation I had when I was in academic medicine. She said no every single time and explained that academic medicine budgets are finite within each department. But at least I knew that I was asking and advocating for myself, and I wasn’t going to apologize about that.

2. Always ask, but not for permission

My motto is to ask for forgiveness, not permission. I remember vividly one day when I was in the ICU finishing up my charting, and there was a pen on the counter about six feet away from me. 

A woman came by and was frantically looking around to see who owned the pen so that she could ask permission to borrow it for five seconds. Finally, she made eye contact with me and asked me if she can use this pen. To me, this really just demonstrated that it is such an ingrained, learned behavior to ask for permission. 

Children ask for permission, not women! 

3. Be unapologetically you

I want you to be aware that traditional femininity is viewed as a weakness. And I came to the conclusion that I was going to be unapologetically me because as a woman, you are always going to be hated on. It doesn’t matter what you do. Someone is going to find some sort of fault in you. 

There are even books that suggest women get shorter haircuts in Silicon Valley in order to be taken more seriously because a shorter haircut appears more masculine. Now I’m not saying having a short haircut is complying with masculine standards. What I’m saying is that if you don’t like short hair, then don’t have short hair. 

I really like my long hair. I keep a long hairstyle, but I am very well aware of how I’m perceived. I’m aware that I’m going to be perceived as more feminine, and therefore weaker in certain situations. but I love my long hair and I’m going to keep it.

4. Don’t be afraid to self-promote

When people fail to notice your major accomplishments, it is your responsibility to illuminate them. I’m not saying this in a way that’s blaming you for not getting the raises and the promotions that you deserve because that is a systemic problem.

But, there is a childhood learned behavior of not fully taking in compliments. For example, I have started replacing, “Oh, it was nothing” with a phrase like “I appreciate the recognition. I worked hard to get it done.” 

One year, I was at a networking event with the American College of Chest Physicians, and my sponsor was introducing me to a bunch of the leaders in the organization. He kept introducing me as a “superstar.” It was so amazing and humbling, but it was also very much needed. 

I received that compliment – I didn’t try to correct him or brush it off. I fully received his introduction of me as a superstar, even though he was giving me such a huge compliment. There was only one person that whole night who kind of looked at me a little awkward and made a slight joke about being humble. 

After this happened, I started to analyze. I had 10 introductions so far and only one person had kind of teased me about being humble. That’s a pretty good statistic. 90% of the time people were excited to meet me, wanted to hear about the work that I had been doing with my sponsor, and how I envisioned my leadership roles within the organization.

This is literally the kind of dialogue that went on in my mind. I was constantly reassuring myself and telling myself to accept the compliment. 

5. Say it with a smile

This took me a very long time to learn because I am a very straightforward, no nonsense type of person. If I’m upset or if something you say in the workplace is rude, racist, or sexist, I’m going to get mad. And when I mad, guess what? As a woman, I am more likely to be labeled as aggressive instead of assertive. Accusations of being too pushy or aggressive are designed to keep you quiet. 

I’ve learned that sarcasm mixed with a little bit of shame and a smile can really go a long way. If a male colleague in the workplace says something sexist, I will respond with a sarcastic laugh and say, “ Oh James, look at you, labeling women. You’re so socially awkward” and then walk away. People, not just men, hate being labeled socially awkward. Therefore, it is my favorite phrase to use, and I hope you’ll add it to your toolbox too. 

Another one of my favorites is when someone says, “Oh, you’re too pretty to be a doctor.” I just laugh and say, “Yeah, they started letting women into medical school now, I don’t know if you’ve heard.” Then they kind of have a slightly shameful face, giggle a bit, and the energy is dissipated. 

This type of stuff takes practice. I’m not saying it’s easy. It’s taken me a long time to unlearn some of my childhood behaviors and unlearn initial reactions of getting very upset and angry. But you will get better in time. 

6. You don’t need to be perfect

I want you to know you are all experts in your field already. You don’t need to be 100% qualified to apply for a particular position. I read a study that said men are more likely to apply for a particular job, whether or not they meet the qualifications. Whereas women find that if they don’t meet at least 80% of the job description, they will not apply. 

In January of 2018, I got an email from the American College of Chest Physicians that included an application for an open position as section editor for the journal CHEST. I read the description and it sounded like it was right up my alley, but there were several qualifications that I did not meet. 

Because I knew about the statistics of women applying for these jobs, I knew I had to apply anyways. What was the worst that was going to happen? They would say no, and my ego would be hurt for a little bit. But I would move on with my life.

But if they said yes, this would be an amazing opportunity for me. I then found out that my sponsor was also applying for the position. He had a master’s in statistics, completed a fellowship training with the NIH, and was a big boss researcher. I thought about not even applying, but I needed to practice. I would at least get valuable feedback, and leadership would know that I’m an ambitious young physician. 

So I applied and guess what happened? My sponsor got the job. He was way more qualified than I was, but check this out. He decided that in this role he needed team members, and he developed positions for me. They never really publicized these positions because they were just going to pick team members from that applicant pool. So if I hadn’t applied to the original position, I would have never had that opportunity.

7. Women aren’t always your friends, let alone mentors, and that’s okay

There’s so much implicit bias that goes on in the workplace, and some of it even comes from ourselves. We expect women to treat us better. We expect women to be more nurturing. 

There is something called the “queen bee phenomenon.” This is used to describe a woman who has flourished in a leadership role, especially in a male dominated industry like medicine, and uses her position to keep other female worker bees down. Essentially, in order to survive, this queen bee adapts very masculine traits and doesn’t help other females in the workplace. This type of queen bee might as well just be another man in a leadership position who’s completely clueless about gender bias discrimination in the workplace. 

I don’t necessarily have strategies around this, but what I do want you to know is that you’re not alone. If you feel like you have a female boss who is not advocating for you or you have a female boss that you feel is just as sexist towards you, that is a real phenomenon that occurs in the workplace. 

8. Confidence is key

I learned this very early on in my medical career as a medical student. It really boils down to fake it till you make it. People notice when you impress them. What they don’t notice is when you fall in line with the average knowledge base of every other medical student or every other resident. 

When I was a third year medical student, my first rotation was OB GYN. During rounds, my attending asked the entire group: What is the size of an enlarged ovary that causes a risk of torsion?

I didn’t really have an idea of what the answer was, but I just simply yelled out five. I don’t know what possessed me to do this in front of this extremely large group of senior residents, but I just yelled out five. I didn’t even give a unit of measure, just five. 

And I was actually right! It was five centimeters. Because I was so confident when I said it and I was the first one to respond, the attending was so impressed with me. Of course there were other questions that I just didn’t answer correctly throughout rounds, but he never noticed ever again because I was that bad-ass student that knew five centimeters. 

Because I noticed the way that this particular attending really noticed me, I took that energy of absolute confidence into my surgery rotation. I had a vascular surgeon as my attending, and he liked to play a game called 100 questions.

As you can imagine, 100 questions is literally the attending asking you 100 questions in a row during a surgical case when it’s quiet. He asked me the first 10 questions, and by the end of question 10, he just started laughing because I had gotten all 10 questions wrong. But he said, “You know what, Rozy, I like your confidence.” That left an impression on him. If you have confidence and ambition, attendings will notice.

9. Learn to say no

Your time is extremely valuable. You can use phrases like, “I would love to help, but I can’t right now.” I highly advise you to keep your answers extremely succinct. There is no explanation needed followed by your no.

Women feel that internalized guilt associated with saying no and will follow it up with a blabbering explanation. I noticed that I felt very uncomfortable saying no because of that internalized guilt. Every time I would say no, I would follow it up with this giant explanation of why I couldn’t do it or why I wasn’t able to cover that shift. It was completely unnecessary! 

Another thing I learned is that you don’t always have to be honest or completely transparent. Recruiters will often ask physicians about their personal life, but really it’s none of their business. I don’t tell recruiters too many personal details about me. They just need to know I’m an ICU doctor looking for work. This is my pay rate. These are the locations that I would love to work at. I’m open to working these types of shifts. The end.

If they come back to you and ask you, well why? Go ahead and use this phrase: “It’s personal.” Once you drop that phrase, no one can ask you anything.

10. Take up space

And don’t apologize for it! When there is a large meeting and you have a leadership role, take a seat at the table. Stop getting up to allow other people in this supposed hierarchy to sit down.

I see this during grand rounds all the time in hospitals. Female students will get up to allow someone else to sit down. You got their first – sit down, you’re fine. You’re not being rude by demanding space. 

We have these internal conversations with ourselves that we find it to be very rude, but men do it all the time. If you’re ever on the subway in New York, look at how widely men spread out their legs. Women will just shrink themselves to be able to fit in between the seats. Men are so unapologetic about this, and I want you to use that same type of energy in your work, literally and figuratively. 

Have you had similar experiences as a woman in medicine? What other lessons have you learned? Let me know in the comments below!