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The unfair advantage

December 14, 2019

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How would you like an unfair advantage? How would it feel to get the benefit of the doubt when you need it, or to enjoy the assumption you’re competent and qualified? This is what it’s like to belong to a privileged class. 

Although doctors enjoy privilege in their ability to care for others, for women and minorities, it’s not that simple. They can be doubted just because of who they are. It’s called unconscious bias. 

Unconscious biases are social stereotypes about certain groups of people that individuals form outside their own conscious awareness. Everyone holds unconscious beliefs about various social and identity groups, and these biases stem from one’s tendency to organize social worlds by categorizing.

Unconscious Bias |

As an example, Fellow A is not paying attention in morning conference, and asks a dumb question. It is treated with respect, because he’s a “good guy,” and occasionally has beers with the attendings. Meanwhile, Fellow B asks questions, thinking it demonstrates engagement and active learning. In her quarterly review, she’s surprised to hear it “makes her seem less competent.” This is unconscious bias at work, and it’s an unfair advantage for those that escape it.

Persistent bias: the unfair advantage

Despite evidence of progress toward gender equity, persistent bias can be downright appalling, like that described in this article on the narrow range of ‘allowable’ female voices.

As an attending IR, I benefit from the authority of my position. Because of what I’ve achieved, people usually listen to me. Yet I still experience unconscious bias.

Sometimes, a staff member will accidentally call me “Sir.” Is this because they are used to getting orders from a male? Or did I subconsciously lower my voice to convey authority? Maybe both. I’ll never know. Female physicians navigate unconscious bias daily.

The consequence: inequity

For those who experience unconscious bias, it can drag on their morale, their self-worth and ultimately, their success. As a woman or minority in medicine, to achieve one’s goals, one must want them really badly. 

There’s an adage for women in medicine: they should aim to be “twice as good” as their male colleagues in order to be respected or noticed. It’s sad, but validating to hear, if you’re someone who suspected that might be the case. In medicine, women can be held to a higher standard due to unconscious bias, and to compensate, they must be ruthlessly, tirelessly excellent, or suffer the consequences.

This dynamic places a burden on underrepresented groups in medicine, sometimes discouraging qualified candidates, causing a leaky professional pipeline. It’s part of an environment that burns women out at a higher rate than men. How many excellent female physicians have we missed out on, because they were discouraged in this way? How do we fight unconscious bias, short of changing the world?

Embrace your own unfair advantage.

I suggest finding and embracing your own unfair advantages. Find the things people assume about you, just based on the package you come in, that could actually benefit you.

Do your patients prefer a female physician because of the perception women care more? That’s a bias that could work in your favor. I’d take it.

What’s your unfair advantage? Figure it out, and use it! Others use theirs every day.

If you’re on the receiving end of a positive bias, consider accepting it. Maybe there is a connection you share with an attending, boss, or other ally. Maybe it’s something stereotypically female, like an adoration for the same brand of shoe. Why not use that connection to your advantage?

Girl squads

Being a woman in medicine can be an unfair advantage. We form girl squads to support each other. Recently, I hosted a women in medicine event at my house, and I heard some male residents felt excluded. But it’s important that female trainees have dedicated time to interface with attendings, because they face different challenges from the guys.

Breaking down bias

Do you share something in common with a colleague or superior, like a second language, background, or place of origin? Do you share a hobby, or a favorite Netflix show? Making a human connection can be mutually beneficial. In the end, unconscious biases can be broken down by making these kinds of connections. It takes extra effort, and that’s not exactly fair, but you can do it. 


By the way, if you have an opportunity to help a woman, do it. She’s fighting harder than the guys to get where she’s going. A few months ago, I was introduced electronically to a trainee across the country who needed a female role model in IR. There were no female IRs at her institution. Over the phone, we talked about her hopes, challenges, and plans.

Beyond mentoring, I realized I could promote her through connections I’d developed through my national society. A few e-mails later, she was on the radar of multiple attendings as an upcoming residency applicant. Months later, they even met in person, boosting her connectivity and the chances of her matching at one of these institutions.

Men have benefited from these kinds of connections for eons. Increasing numbers of women in medicine can do the same. It’s like an “old boy’s network,” but for women. Actively offering opportunity in this way is called sponsorship. It’s arguably as critical to developing a career as mentorship. Can you do this for someone else? How can you find or become a sponsor? 

In the meantime, we’re working on it. 

Many organizations see unconscious bias as a problem, and are actively working to address it. The Society of Interventional Radiology (SIR), for instance, is engaged in addressing the diversity gap in our specialty. From writing a diversity curriculum, to forming a Diversity & Inclusion Advisory Board that works directly with society leadership, SIR is leveraging engaged members and resources toward the effort. The goal is to make our specialty more welcoming to a diverse talent pool. 

Some in the medical community have an inherent advantage: they don’t deal with unconscious bias. Until we fix the world, I hope you advocate for yourself. Find and wield your own unfair advantage!

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