Unpacking Toxic Masculinity in The Medical Field

Growing up, I watched my dad, a surgeon, work himself into the ground. He saw up to 90 patients a day at the clinic in which he worked and performed hundreds of surgeries a month. He often had to wake up in the middle of the night, sometimes multiple times in one night, to rush to the hospital. He never wanted to watch dramas or horror movies because of the emotional burden he absorbed from treating his patients each day. He still practices today even though he lives with early-onset arthritis in his shoulder, which has been exacerbated by performing thousands of surgeries.

Now, as I’m beginning my own journey into medicine, I have tried to talk more substantively with my dad about his experiences and have looked at the research on physician burnout from prolonged occupational stress. Compared to other professions, doctors have the highest rates of work dissatisfaction and suicide rates — in fact, 400 physicians die by suicide each year, a rate that is even higher than that of U.S. combat veterans.

Through this research and these conversations, I’ve begun to understand that what I originally thought were “authoritarian” workplace norms driven by the types of “physician personalities” attracted to this job may actually be attributed to a deep-seated culture of toxic masculinity in medicine.

This is perhaps unsurprising given that the cultures of institutions are almost always a product of not just their founders, but those who carry on their legacies. In the United States, the medical profession was founded by white men, and today, most physicians are privileged white men. Although non-male representation is improving in medicine, parity is far from a reality, especially in medical leadership. In 2019, merely 16% of all chairs of medical departments across the U.S. were female (the AAMC did not gather data on the representation of nonbinary physicians). This male dominance has undoubtedly contributed to sexual harassment, wage gaps, and leadership inequities in the field.

Senior physicians and administrators set a precedent for work climate. It is hard to separate the countless complaints of superiors belittling and bullying residents from toxic masculinity when those superiors are overwhelmingly male. Even if male physicians in positions of power aren’t the perpetrators, as leaders, they should be the ones making it clear that these behaviors have no place in their team or hospital. Yet, these incidences are still commonplace.

Toxic masculinity also plays a role in residents’ grueling work demands, including 80-hour work weeks and 28-hour shifts. Many former and current residents will attest that their superiors champion mental and emotional “toughness” instead of advocating for an increase in staffing, support networks, and mental health resources for them. In an interview for The Guardian, a female resident confessed, “At my lowest, I cried every day at work because I was so snowed under,” and said her superiors laughed at her concerns and denied her request for leave. Some may also argue that these problems stem from the U.S.’s doctor shortage. Still, it is ludicrous to ask individuals to combat that systemic problem with more strict schedules and steelier nerves. And, to be clear, these types of environments harm all residents, no matter their gender identity, as well as their patients.

However, the good news is that as a medical student, I’m seeing my peers push for change. One experience at my medical school shortly after the murder of George Floyd illuminated this for me.

“I know this platform is mostly for med school-related things and is best kept non-political. But I think this issue goes beyond politics, and I feel like it is too important not to discuss. What happened with George Floyd, while not surprising, is absolutely disgusting,” a classmate wrote on our medical school’s Slack channel. “And I’m sure most of you agree. But in case anyone here needs to hear this or be reminded of this: do NOT ever call the cops on a black person unless you are willing to take part in ending their life. And we should remind all our friends and family of this.”

My classmate’s words reminded us that the recent experiences of some Black students was very different from non-Black students’, and so, therefore, their ability to study. In response, a group of non-Black students sent an email to our administrators in solidarity, asking for exams to be postponed to a later date for students who found relief in doing so. Our deans agreed.

In addition to recognizing students’ experiences with racism and the medical profession’s perpetration of it, our medical administrators’ decision represented a shift away from the patriarchy in medical education. Historically, senior doctors have demanded that residents and students work themselves into the ground — mentally, emotionally, physically — regardless of what they had going on in their personal lives because that is what their forebears had always endured. Instead, our educators chose to more positively define our medical institution’s values, ensuring we would treat our future patients and each other with those same values of emotional empathy, cultural humility, and contextual personhood.

In June, my optimism in the medical profession grew further when our administrators assembled our medical school’s Racial Justice Committee for Change. This is a powerful group of students, residents, educators, and clinicians, many of whom are women of color, who will focus on the well-being of students; their safety and experiences with campus policing; recruitment, retention, and success of underrepresented medical students, staff, and faculty; and racial justice curriculum reform.

Of course, this just occurred at one medical school. Much more needs to be done to build a future in which doctors don’t only fulfill the oath to do good for their patients but also recognize that doing good for themselves will allow them to do the most good for their patients. Further, addressing oppressive structures within the medical profession can demonstrate to patients and society that there is no place for these systems in America.

It is possible to preserve physicians’ intense work ethic and calm, clinical objectivity while improving workplace equity and well-being. Changes counteracting toxic masculinity in medicine could allow physicians to hold other physicians accountable for unacceptable behavior, safely communicate and learn from emotional work experiences, access mental health resources, and set healthy boundaries to maximize their ability to heal patients. It is also important to note that, in 2019, there may have been only 24 female department chairs of surgery, but only one was a Black woman. By nature, the inequities people face are intersectional. In this light, diversity and racial equity need to be prioritized when creating task forces to address these issues. I think many physicians like my dad are dedicated to using medicine as a force for good. Initiatives like these could help them gain an invaluable perspective and create positive change.

By the time I become a medical resident, I hope that revolutionary clinicians become the norm, not the exception, and that the institutions in which they work and teach reflect their values.