Imposter syndrome, sexism and the pay gap: Insights from 'Letter to a young female physician'

During an orientation session last June, Suzanne Koven, MD, watched as new interns wrote self-addressed letters detailing their hopes and fears about their upcoming clinical training. At the end of six months, the interns would read them again, enabling them to see how far they'd come.


Dr. Koven, a primary care physician at Boston-based Massachusetts General Hospital, was never encouraged to engage in such introspection when she was an intern 30 years ago, she wrote in the New England Journal of Medicine.

As she watched the interns hunched over their writing, she longed to tell them, "particularly the women — more than half the group, I was pleased to note — what I wished I'd known," she wrote. "Even more, I yearned to tell my younger self what I wished I'd known." So as the interns wrote letters to their future selves, Dr. Koven wrote one to her younger self.

While some of the advice in her letter is applicable to male and female interns, she pays extra mind to advice for the young women, as women in medicine "face an additional set of challenges," she wrote. Dr. Koven cites her own experiences dealing with sexism, such as when she was told as a medical student that "no self-respecting man would go to a lady urologist," or when there was no maternity leave policy in place for house officers at the hospital where she was a resident, and pregnant. Even still, there are times she calls in a prescription and the pharmacist asks for the name of the physician she's calling it in for.

Dr. Koven warns her younger self of the gender pay gap in medicine. "It pains me to tell you that in 2017, as I'm nearing the end of my career, female physicians earn on average $20,000 less than our male counterparts (even allowing for factors such as numbers of publications and hours worked)," she wrote.

She warns that women in medicine are underrepresented in leadership positions and are vulnerable to sexual harassment that can be "so severe it causes some women to leave medicine altogether."

But the biggest obstacle she warns her younger self about is "one that resides in your own head": The fear of being a fraud. Imposter syndrome may be experienced by both men and women, but women are more likely to "denigrate our strengths" in addition to shrinking under their inadequacies, she wrote.

"My dear young colleague, you are not a fraud," she concluded. "You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better."

Click here to read Dr. Koven's article in full.

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