Gender & Use of Professional Title

5-6 Minute Read

Primary Author: Judy Bolstad-Hanrahan, JD, MA
Secondary Authors: Marin Gillis, PhD, LPh & Bruce Morgenstern, MD

Purpose

Clinicians, especially clinical educators, must be aware of the subtly derogatory ways professional women are addressed and must self-monitor to ensure not to inadvertently contribute to the unequal treatment of female colleagues and students.

Learning Objectives

1. Recognize that people are more likely to refer to a male physician/scientist by surname or professional title than women with the same titles/degrees;
2. Begin to understand the importance of language in shaping how humans perceive their world; and
3. Apply this knowledge when referring to female colleagues and students.

Clinical educators have an important role in shaping the values, customs, and habits of the next generation of physicians. This process is part of what is referred to as Professional Identity Formation. Medical students learn how to be professionals from observing physicians, and one of the phenomenon they are observing is that female attendings are less likely than their male colleagues to be referred to using their title and surname—Dr. Gillis versus Marin.

Across academic disciplines, people are more than twice as likely to refer to a male professional by surname than a female professional.(1) A study of internal medicine grand rounds looked at how speakers were introduced by their colleagues; both the introducers and the speakers were MDs, PhDs, or MD/PhDs.(2) The study found that when introduced by a male colleague, a female speaker was referred to with a professional title only 49.2% of the time and 96.2% of the time when the introducer was also female.(2) Male speakers were referred to with their professional title by female introducers 95.0% of the time and by male introducers 72.4% of the time.(2)

The differential treatment may be understood in terms of microaggressions. Microaggressions are actions or words that subtly, even unintentionally, serve to “put a person in their place,” suggest that their worth is less than others, or point out their difference from the dominant group. The language we use, including microaggressions, shapes how we think about, see, and even understand the world around us. Lera Boroditsky, Associate Professor of Cognitive Science at UCSD, explains,

[T]he way we think influences the way we speak, but the influence also goes the other way. The past decade has seen a host of ingenious demonstrations establishing that language indeed plays a causal role in shaping cognition. Studies have shown that changing how people talk changes how they think. Teaching people new color words, for instance, changes their ability to discriminate colors. And teaching people a new way of talking about time gives them a new way of thinking about it.(3)

Dr. Boroditsky’s TedTalk, How language shapes the way we think (14 minutes), is illuminating on this topic.(4)

Failure to refer to all physicians by title subtly undermines the perceived authority, eminence, and merit of career awards of those referred to less formally.(1,5) Experimental evidence show that people judge a professional differently depending on how that professional was addressed by others; those addressed by title are seen has having higher status.(6) Julia Files explains,

It gets down to perception of expertise, perception of competence. We know that in other settings, choices of words really impact women’s progress in careers.(7)

Ensuring that we refer to and introduce professional women formally can positively impact how others think about them as professionals. While students are undoubtedly enriched by seeing assorted styles of doctoring, such styles should never include unequal treatment of colleagues or students based on gender.

It’s the inequity and the context. I don’t mind being called “Sharonne” — it’s my name! — but if all the men are being called “Doctor Jones” and all the women by only their first names, that’s offensive. While I have to assume it’s inadvertent, the effect is to put me in my place as “less than.”(7)
-Sharonne Hayes, M.D., Professor of Cardiovascular Medicine, Director of Diversity and Inclusion, Mayo Clinic.

Considerations

Listen to the first 50 second of this video of former New York Governor Andrew Cuomo speaking about ways he has spoken to female colleagues and a physician giving him a COVID test,(8) and then think about the prompts that follow:

Think about how Andrew Cuomo talks about his use of terms of endearment with female colleagues and how that made his colleagues feel. Have you ever used one of these terms with a female colleague?

Consider how the female physician felt when Mr. Cuomo told her on national television, “You make that gown look good.” Have you ever been talked to like that by a patient? Have you ever seen a patient talk to a colleague like that? How did it make you feel? Have you ever seen a male colleague addressed in that way? How did it make you feel? How do you think it made the other person feel? How did you respond?

Have you ever used a diminutive term or term of endearment for medical students, residents, fellows, or other colleagues such as kids, children, pups, sweetheart(s), etc.? Does this kind of language diminish the person’s esteem?

References

1. Atir S, Ferguson MJ. How gender determines the way we speak about professionals. Proc Natl Acad Sci. 2018;115(28):7278-7283. doi:10.1073/pnas.1805284115
2. Files JA, Mayer AP, Ko MG, et al. Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias. J Women’s Health. 2017;26(5):413-419. doi:10.1089/jwh.2016.6044
3. Boroditsky L. How Language Shapes Thought. Sci Am. 2011;304(2):62-65. doi:10.1038/scientificamerican0211-62
4. Boroditsky L. How Language Shapes the Way We Think. TED; 2018. Accessed September 24, 2021.
5. Friedrich P. What’s in a title? When it comes to “Doctor,” more than you might think. The Conversation. Published December 5, 2019. Accessed September 24, 2021. https://theconversation.com/whats-in-a-title-when-it-comes-to-doctor-more-than-you-might-think-127979
6. Takiff HA, Sanchez DT, Stewart TL. What’s in a Name? the Status Implications of Students’ Terms of Address for Male and Female Professors. Psychol Women Q. 2001;25(2):134-144. doi:10.1111/1471-6402.00015
7. Neumann J. Why are female doctors introduced by first name while men are called ‘Doctor’? Washington Post: June 24, 2017. https://www.washingtonpost.com/national/health-science/why-are-female-doctors-introduced-by-first-name-while-men-are-called-doctor/2017/06/23/b790ddf2-4572-11e7-a196-a1bb629f64cb_story.html. Accessed September 24, 2021.
8. Cuomo A. Gov. Andrew Cuomo Resigns: See the Full Statement. NBC New York; 2021. Accessed September 24, 2021.