The Glass Ceiling: Women in Medicine

By Katy Callicott

Pictured above is Dr. Nicole Smith. She is standing in front of the wall of famous academic white men, referenced in this article.


“Once, as a pre-med, I was shadowing a white male surgeon who advised me to be a physician assistant (PA) or a nurse practitioner (NP) if I wanted to practice medicine because women have babies and leave the workforce, thus taking up spaces in medical school that could go to men. Men who will continue to work and provide more to society … I then began to question why I had the audacity to think that I could force myself into a job where I did not belong.”


Dr. Smith sits upright, ready to share her views of her workplace; a little woman in one of the large hallways of NIH. Someone, who despite the struggles and obstacles that life threw at her and is still throwing at her, sits today in a prestigious institution ready to share her journey thus far into the medical world. The National Institutes of Health, a world renowned research institute, has arguably one of the largest contributors to the advancement of science and innovation. However, data provided by the NIH in 2018 reveals that the workforce is made up of 58.7% female and 41.3% male, males dominate the workplace at the NIH in the highest level positions. The workforce is dominated by caucasian men at the upper levels, according to Dr. Smith and Dr. Joseph Callicott, senior research physician, MIMH, NIH.


Dr. Smith isn’t just one person out of the many people who work at NIH, she is someone with a story. A unique story that should be shared with the world, discussing how she came to be where she is today. And with that, how she is among the many women who defy the odds at a hospital in need of more diversity in total. Dr. Nicole Smith describes herself as a small, short, and kind of scrawny woman. She has big poofy curly hair. “I don’t usually wear makeup at work because there is no time. I don’t wear heels or pencil skirts or anything that you’d imagine some powerful female wearing in an authoritative role like you see in a movie. I actually do look like an adolescent boy in my oversized scrubs and white coat that are not made small enough for a 5’ 4” woman.”


When asked what her role is, she replied, “I am a psychiatrist and currently working as a clinical fellow at the NIH. I first completed medical school, then residency, which is like an apprenticeship where you work hard with hands-on experience and learning on the job. I am now in the fellowship stage which is a subspecialty. I am learning to be a specialized research psychiatrist.” To understand what this job is like, Dr. Smith mentions how her job is much like Scrubs, a popular TV show aired in (2001).


Dr. Smith decided to study this medical field of psychiatry, despite “it [being] a long, convoluted way to reach this field[.] … I wanted to be a surgeon at first, and thought working 120 hours a week seemed noble. I liked the idea of proving myself. Yet, then through the medical school rotation all of the residents and attendings did not look happy. When I rotated to psychiatry, it seemed so different and more relaxed. This opened up time for intellectual curiosity and academic debate. The attendings were happier and engaged in more thoughtful conversation and a bit more chill. The blood flow was more to your brain in psychiatry versus running around on your feet in surgery. Psychiatry is on the cutting edge of many frontiers. Lots of medical and surgical fields come down to the same algorithms, but psychiatry is much more artful.”


She became a doctor because science came easily to her, and so she choosing the path of least resistance is a good way to escalate through life’s ladders. This seemed like the natural choice as I was good at science and liked the idea of a prescribed path in medicine. One where you study and advance from path A to path B. This seemed very secure.”


Focusing more on what it is like to work in a male dominated environment, Dr. Nicole Smith proceeds to speaks about how there are “lots of resources and great people to work with; however, if you walk over to the wall of important people you will only see men. While my bosses are women, at the top echelon, there are white men. It is common to see these walls of famous people throughout academic institutions. I can show you the hallway of pictures full of stern looking people that were award winners or chiefs or VIP over the years and every single one of them are white men. No one tells you that you can’t do these things, but there is a subtle message this communicates such that you should not be in this place.” In a lot of places there is this sense of male superiority, even if there are more females than males in a workplace.


Dr. Smith remarked that she works with amazingly strong, independent minded women. The people that are running the psychiatric consult team here at the NIMH are all women, fantastic clinicians, and inspire everyone. Clearly, they are the bosses. It is great to see women in power as it makes such a difference of what you can be and what you want to be. It is a great example. My principal investigator (PI) in my lab is also an amazing woman, one of the few, maybe the only woman in her med school class back when she was studying to become a doctor. She had to really push her way through lots to be in charge. Even so, surrounded by lots of great women in leadership positions, but you will notice that the top of the top folks here are men. Nevertheless, NIH does have a female scientific director and a female clinical director. It is the ‘leaky faucet’ concept. Have you ever heard of that concept? Women come in at the same rate, but over time, they do not make it at the top positions and not sure why. It may be they are falling off or maybe because they do not want those positions it seems. It may be hard to get, and with a male dominated top tier, it may say in a subtle way that you do not belong. I would say that day to day, there are still so many amazing women and men that I am not sure I feel the total male dominance. Yet, I do not think I would want this top tier, but it would be good to have this more reflective of different persons.”


With finding a field, there is almost always a backstory to why a person has come upon a certain position. Hers is that “[I] was a nerdy kid, and when all the other kids were outside playing, I was inside reading. Well, I did not know that many people that had even had gone to college. No one in my family attended college, so I did not know what you do as a biology major or what people do in labs. I grew up in Irmo, South Carolina, it is 20 minutes out of the state’s capital, Columbia. It is a little suburb, an idyllic place with lots of trees and families, but not really a cute town. I am trying not to say anything bad about where I grew up. It was relaxing to sit out on a porch in a rocking chair and read a book. My parents told me, ‘Nicole, you can do anything you want’ and guess my parents did play a big part in my career choice. They said anything, except own a restaurant like my Dad. He worked so much that we had to eat family dinner early, so he could start work by 5 p.m and work all night. It was a hardship to own and run a pizza restaurant. This business has many economic pressures. He was always checking pricing changes of things like gas and food. When those would increase, it would cause a financial hardship. After he paid the rent, the supplies, the food, his employees, there were times when he could not pay for himself. I did not want to live a life of an uphill battle; however, I learned from him how to work hard watching his work ethic and this mentality. I started at a young age to help the family business. With a family business, you do not have to worry about labor laws and so by the age of thirteen, I was not just sweeping the floors, but was interacting and taking customers’ orders. I have learned how to be better with people due to this experience.”


There is always a reason someone works at the place they do. Dr. Smith’s reason is that “[w]ith research as a physician, there is no real prescribed path, and you need to figure this out on your own. You have to get yourself involved with the right mentors to teach you how to do research well. I thought that of all the places in the country, that I would 100% know what research would be like if I worked at the National Institutes of Health. There are resources and researchers everywhere.”


Dr. Smith’s fight is still not over. There are many people out there like her, who have the intellect and drive to be where they are and who they are. It is unclear what the future has in store for female doctors, but for now it seems that each individual has their own story and how they get to where they are defines who they are and who they become.


Photo Courtesy of Katy Callicott

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