Morgan Lindstead | October 1st, 2024
It is well known that the medical field is a male-dominated industry, and discussions about this disparity frequently highlight the limited opportunities for women. Additionally, social stigmas often dictate that a woman’s place is in the kitchen, not the OR. There are far fewer conversations about the unintentional biases in medical professions, such as the kind of language used to describe female applicants versus male applicants in documents like recommendation letters or even in spoken conversation. This bias is not always external, with differences also being noted in how applicants describe themselves in their applications and resumés. Ultimately, the language we use to describe ourselves and others is gender-dependent, and it is important to be conscious of this both as an applicant and as individuals who may one day be on the other side of the table actually reviewing these applications.
The Motherhood Penalty and the fatherhood bonus
While not unique to medical or STEM professions, mothers are repeatedly discriminated against when applying for jobs, largely because it is perceived that the commitments they need to make to their family conflict with work responsibilities. In other words, being a “good mother” is viewed as being incompatible with being a “good worker.”
Often, these stereotypes are implicit, as seen in Correll et al., 2007. In this study, student participants were paid to evaluate two candidates for a mid-level marketing position based on a short memo, a fact sheet, and a resume which included information about parental status and gender. Participants rated mothers as significantly less competent and committed and recommended salaries $10,000 less than non-mother applicants. They were also less likely to recommend mothers for a promotion or management role and almost half as likely to recommend them for hire. Meanwhile, participants rated fathers as more committed than non-fathers and had a higher recommended salary than non-fathers.
It is important to be aware of the biases that currently exist in our society, and while we cannot seek to eliminate them on our own, we can learn from these examples and vow to do better if and when we become the evaluators instead of the evaluated.
Unintentional biased language in residency and tenure applications
A few studies have looked at the difference in language used for applicants for residency programs based on gender. These studies tend to use a program called Linguistic Inquiry and Word Count (LIWC) which analyzes words and places them into different categories such as analytical thinking, authenticity, emotional tone, and work. These words can fit into multiple different categories. For example, the word “cried” could fit into five different categories: sadness, negative emotions, overall affect, verbs, and past variables.
Ophthalmology residency (Lin et al., 2019)
Lin et al. looked at gender differences in recommendation letters for the UCLA Stein Eye Institute Residency Training Program. They found that recommendation letters for males used more authentic and leisurely terms like “cook,” “chat,” and “movie” as well as anecdotes with lots of detail. This additional complexity and positivity may lead to an unintentional bias for reviewers to then be more likely to select these individuals for the program. Female applicants were found to have more “feel” words in their recommendation letters that included references to work ethic instead of their ability or talent, which was more commonly seen for male applicants. Additionally, there were greater references to biological processes like “eat” and “pain,” though the authors did not have a strong explanation for why this may be. An important limitation of the software used for this study is that it cannot take into account the context in which these words were used, which may alter the results.
Chemistry and biochemistry tenure (Schmander et al., 2007)
Schmander et al. tested this idea with tenure applications for chemistry and biochemistry and did not find as great of differences as Lin et al., but these differences were still present. Notably, standout adjectives were used more frequently to describe men, such as “outstanding,” “unique,” and “exceptional.” Although these differences are not as great or extreme, they still may influence the evaluation of these candidates for these positions. Additionally, a potential limitation of this study is that there were over five times the number of letters reviewed for male applicants than female applicants.
Radiology residency (Grimm et al., 2020)
Grimm et al. looked at applications for radiology residencies at Duke University with a more intensive version of the LIWC program. Specifically, they were able to modify the program to group certain words into the same categories, like “ambitious” and “ambition”; remove certain terms from the program’s analysis, such as the term “dominance” which was used to explain autosomal behavior in genes rather than the applicant; and add in their own variables like “agentic” and “communal” to explain personal agency and control versus collaborative behavior. By adding this additional control into the program, the results of this study may be more easily defended than Lin et al. and Schmander et al. Grimm found that female applicants had more agentic terms used to describe them — meaning greater personal competence — in categories of skill, leadership, and dedication. Considering previous discussions of this article about the Motherhood Penalty, this language use may be trying to compensate for the difference in implicitly perceived competencies male and females as well as mothers and non-mothers.
Acknowledgments
I would like to thank my friend and classmate Bella Lough for inspiring me to write this article after hearing her presentation on this topic and allowing me to use her slides as reference. Additionally, I’d like to thank my Medicine, Health and Society professor Lucie Kalousová for introducing me to the concept of the Motherhood Penalty which aided me in writing this article.
References
Correll, S. J., Benard, S., and Paik, I. (2007). Getting a Job: Is There a Motherhood Penalty? American Journal of Sociology.
Grimm, L. J., Redmond, R. A., Campbell, J. C., & Rosette, A. S. (2020). Gender and Racial Bias in Radiology Residency Letters of Recommendation. Journal of the American College of Radiology, 17(1), 64–71. https://doi.org/10.1016/j.jacr.2019.08.008
Kalousová, L. (2024). Gender Disparities in Health and Illness. MHS 1930: Social Dimensions of Health and Illness, Lecture 10, PowerPoint slides. Vanderbilt University.
Lin, F., Oh, S. K., Gordon, L. K., Pineles, S. L., Rosenberg, J. B., & Tsui, I. (2019). Gender-based differences in letters of recommendation written for ophthalmology residency applicants. BMC Medical Education, 19(1), NA-NA. https://doi.org/10.1186/s12909-019-1910-6
Lough, B. (2024). Language Used to Describe Applicants in Letters of Recommendation Based on Gender. PSY-PC 3130: Introduction to Formal Linguistics, Maria Osina, Canva Slides. Vanderbilt University.
Schmader, T., Whitehead, J., & Wysocki, V. H. (2007). A Linguistic Comparison of Letters of Recommendation for Male and Female Chemistry and Biochemistry Job Applicants. Sex Roles, 57(7–8), 509–514. https://doi.org/10.1007/s11199-007-9291-4