In the changing world of medicine, the Doctor no longer makes house calls and there is an increasing chance he will not be a he at all.

Women reach greater heights in the medical field all the time — especially at the Yale School of Medicine, a renowned health care and research center boasting 269 female assistants, associates and full professors. But despite their increasing presence in the profession, women continue to negotiate the precise balance between their career and their family life.

To accommodate these specific and unique needs, the School of Medicine has made many changes that benefit the increasing number of women joining its ranks as students, residents and professors, but some serious changes in female physicians’ roles in academic medicine and American society remain to be seen.

A short history — the ladies’ room

Though the first woman, Elizabeth Blackwell, was accepted to medical school in 1847, social expectations and prejudices long stood in the way of most women hoping to attend medical school, including the Yale School of Medicine, founded in 1813.

Louise Farnam Ph.D. ’16, MED ’20, applied to the School of Medicine after receiving a Ph.D. in physiological chemistry from the Yale graduate school in 1916 but was rejected because there was no women’s bathroom in the school.

However, her father paid for “suitable lavatory arrangements,” and in 1916, Louise Farnam, Lillian Lydia Nye and Helen May Scoville — who was later an instructor in surgery and pathology at Yale — were admitted as the first women to attend the School of Medicine.

“Part of [the move to admit women] was a response to the changing role of women — there had been a large suffrage movement — and an increasing role of women outside the home,” said Susan J. Baserga ’80, GRD ’94, Ph.D. ’88, an associate professor in molecular Biophysics and Biochemistry at the School of Medicine who researched women in medicine as a Yale undergraduate. “A lot of women’s colleges had been started, and a lot of medical schools had been admitting women from the beginning, like Johns Hopkins.”

Farnam graduated in 1920 and later spent 10 years in China at the Hsiang-Ya Hospital and Medical School, part of the Yale-China Association. The Yale School of Medicine’s single women’s bathroom was known for years as the Louise Farnam Memorial.

However, the medical school classes at Yale remained less than 10 percent female until the 1960s, except during World War II.

The unbalanced gender ratio posed a challenged to outnumbered female medical students. Margretta Seashore MED ’65, Yale School of Medicine director of medical studies in genetics, said while she was a medical student, the University had some biased practices. These included denying women’s entrance into Payne Whitney Gymnasium and marking “F” next to women’s names on medical school class lists to alert professors of their presence. However, Seashore said she chose to focus on her studies.

“The institutional bias of Yale was quite shocking — not in terms of treating us badly, but treating us as though we didn’t exist,” Seashore said. “But those were things you could be upset about, or do your work and work with people as individuals. I always felt I was going to do what I was going to do, and the individual men I worked with were always very supportive of what I was doing — Sometimes they were tough, but they were being tough on everybody.”

Since then, the gender ratio has equalized — the first class with a majority of women arrived at Yale in 1998 — and the School of Medicine has instituted a variety of support structures for female students and physicians to help them navigate their educations and professional directions.

A community of women

Since women have begun to arrive in equal numbers as men, the School of Medicine has instituted a system of support for females at all levels of the institution.

The Office of Women in Medicine, founded in 1975, provides mentors and discussion panels for women at the School of Medicine. Services of this sort do not exist as comprehensively at most other schools, said Merle Waxman, director of the office.

“Years ago, the school recognized that it was important to have a focus devoted to interests of women and helping them with their careers, and the choices they make,” Waxman said. “We do a lot of workshops and seminars to help students, post doctorates and faculty, to help them navigate the professional socialization process, help them find mentors.”

One such program is “Women’s Health Action,” which, run by medical students, matches up first and second year medical students with physicians. Emlyn Jones MED ’06 was one leader for the group this past year.

“[The Office] has had a huge effect on my time because I’ve been involved,” Jones said. “Merle Waxman is a good presence — she’s always somebody to go to talk to if someone is having issues, particularly if they have to do with gender.”

The mentorship opportunities available at Yale perpetuate women’s presence by attracting prospective female students and physicians. Dr. Gretchen Green, a third year resident in diagnostic radiology, said she chose Yale based on its high number of female faculty.

“Seeing a number of senior level women faculty members and mentors was one of the most compelling reasons for me to attend Yale,” Green said. “It had amongst the higher percentage of women senior faculty of the places that I interviewed at.”

Dr. Julie Sosa, assistant professor of oncology and endocrine surgery, enthusiastically serves as a mentor to students at the School of Medicine.

“I feel a responsibility to try to both mentor and provide formal and informal advice, and to teach both inside and outside the operating room,” Sosa said. “I’m always happy — if anyone ever wants to hang around with me — to have them.”

As the number of female faculty members increases, so does the number of mentorship opportunities. With 17 female faculty members, the Yale department of surgery ranked 14th out of 126 medical schools for the percentage of women in the typically male-dominated field of surgery by the Association of American Medical Colleges (AAMC).

“There are many things unique about Yale, not the least of which is that we have very senior level women in surgery who serve as mentors and role models [to students and residents] — who then say, ‘We can do that,'” said Dr. Robert Udelsman, chief of surgery at Yale School of Medicine.

However, while the School of Medicine does a considerable amount in providing guidance to women in academic medicine, a larger, social stumbling block remains: having a family and a career in the particularly time-consuming field of medicine.

The balancing act

At all levels of the medical career, especially as more women are starting their medical educations later in life, women are faced with the need to strike a balance between children and family — and medicine.

Medical student Kavita Mariwalla ’98 MED ’04, said the coincidence of medical school and childbearing years poses a problem for some students, compounded with the medical risks of waiting to have children.

“There is the pressure of balancing home life with work life, because as women, you have the privilege of being able to bear children,” Mariwalla said. “And in medicine, because we’re trained as doctors, we know the reality and the risk with the longer you wait to have kids. Your knowledge — puts added pressure. You know waiting till you’re 35 — is not the best thing to do.”

Mariwalla estimated that 75 percent of her classmates are engaged or married, and about ten percent have children. She said the School of Medicine is flexible, allowing some students take a year off to start a family.

But Green said the press of having children is a special consideration for residents, the stage of medical training with the most grueling hours, and in the case of radiology, physical dangers for pregnant women.

“In radiology, women have to plan around rotations in which they would be exposed to radiation,” Green said. “It requires significant training and schedule arrangements — but after you’re an attending [physician], it’s one of the best careers in which to have a balanced life. It’s something a lot of women could consider for having a balance — of family and profession.”

The well-known strenuousness of a resident’s life has been amended in recent years, with rules dramatically limiting a resident’s work week. Sosa said the changes in the residency program have been increasingly hospitable to a more balanced lifestyle.

“The graduate medical education is now different from the way it was five years ago when I trained,” Sosa said. “We routinely worked 110 hours a week — now, nowhere in the country would you have to do that, because it’s illegal. A lot of this is less about women — than residency reform.”

However, medicine remains a high-paced, stressful field for many, and some women opt out of the Yale School of Medicine in an attempt to have a more balanced life.

“[Yale] is a rather high-power institution, and I think sometimes women are much better at balancing their careers and their family, and they often look at options that might not be in such a traditional school of medicine,” said Dr. Marie Egan, associate professor of pediatrics and respiratory medicine at the Yale School of Medicine. “But times are changing, and the number of women who are here is increasing.”

On occasion, family life invades the School of Medicine when couples are hired together. However, oftentimes the husband’s medical career has eclipsed that of his wife.

“Sometimes, in this institution — many women were recruited here with a spouse,” Egan said. “[In] two career families, if you are recruited to an institution, you, and your husband is too, traditionally, one career takes the lead compared to the other, and often it’s the husband’s career … That’s probably been more the rule than the exception up until the recent past.”

But Seashore said some husbands step back from their careers in order to help their wives advance, while keeping a working family life.

“100 percent, on the faculty at Yale, is probably 70 hours a week,” Seashore said. “To do that, have small children, and time for other family things is very hard to do. By the same token there are men who chose to help with that family commitment. They are invisible, they just don’t have the academic commitment of men who chose not to do that, because they don’t advance as quickly — but they’re invisible heroes. They are probably helping the women in their lives advance.”

Currently, there are no tidy solutions to the issue of balancing family life and a career.

“I think we are still stuck with — the problem that if you’re a woman and you’re going to be a mother, and you’re going to have a couple of children, and you’re going to want to really spend some time with them — then you’re going to have a problem,” Seashore said. “Women [should be able] to say, ‘I really want to spend the afternoon on a playground with my four-year-old.'”

Climbing the ladder

The first female full professor arrived in 1961 — Dr. Dorothy M. Horstmann, who worked to develop live vaccines against polio and rubella. Hers is the only portrait of a woman that hangs in the School of Medicine.

Since then, a large number of women have entered the ranks of the school of medicine, but there is still a shortage of female faculty members.

Sharon Gill MED ’05 said when she first entered the school of medicine, she noticed a gender inequity.

“There actually is a striking shortage of female faculty giving us lectures during the first and second years,” Gill said. “These are typically senior basic science professors and are predominantly male — it is a disconcerting initial image of medicine.”

However, at higher levels in academic medicine, the gender ratio among teaching faculty begins to equalize. And as medical school classes finally reach equal ratios of men and women, the numbers of female faculty members at medical schools and hospitals continue to grow as women work their way through higher level training.

Mentorship programs at the Yale School of Medicine are aimed at helping junior faculty navigate tenure. Some departments, like the department of pediatrics, host meetings between senior level faculty and junior faculty to help them deal with professional advancement.

In addition to mentorship, in order to better facilitate women’s assimilation into the ranks of academic medicine, Yale has a history of making policy changes to help women reach higher levels, and finally, tenure.

Under the auspices of Arthur Ebbert, instructor of medicine and associate dean from 1953-1987, the tenure system at the school of medicine was revised. By Ebbert’s efforts, women who want to be fully devoted to academic medicine with a 50 percent time commitment are still considered for tenure but advance in twice the time.

“[The system] opened the door for many, many women to work fully committed to academics but not a 100 percent hours, which meant that we could have time with our children, which is what most of us used that time to do,” Seashore said.

Egan said faculty members traditionally have 10 years to earn tenure, and if they do not, they must seek alternative employment. That 10 years often coincides with faculty childbearing and raising years. However, alternative options have recently been offered to allow women more flexibility.

“Now, there are considerations for when you have children,” Egan said. “The tenure clock can stop — There are different tracks you can be on that don’t put you in the same time frame, or the same ticking clock.”

Dr. Barbara Kinder, William H. Carmalt Professor of Surgery, said the revised tenure system sends an important message about the social importance of family life.

“I think it is very important that there are ways to prolong [women’s time at Yale], instead of either ‘you make it or you’re out,'” Kinder said. “It sends a message that family issues are valued and considered to be important for the institution — it sends the right sort of cultural tones.”

On the horizon

While the medical community works to find answers, and as individual women work out balances for themselves, Seashore warned that an even larger issue looms over American medicine, one that will demand the fervent cooperation of men and women — American health care.

“Men and women will have to work together,” Seashore said. “There is a large percentage of our population that is without adequate medical care. That’s the biggest challenge that we face — we don’t have a medical system that is a pride of the world, as we should have. That’s going to be a huge job, and everything’s going to collapse, and we’re going to collapse under it or fix it. That’s the big challenge of the future.”

Over 88 years after Louise Farnam transcended the gender barrier at the School of Medicine, an increasing number of women are continuing to maintain their family lives while making a home within the medical community.