More than a third of all U.S. doctors today are women. The days of referring to a female physician as a “woman doctor” are (mostly) behind us. If you looked in a medical history textbook, you might think this is something new – that women did not practice medicine before modern times. And it’s true that many barriers held women back professionally throughout the centuries, from lack of reproductive and marital control to official bans keeping women from the ranks of medical practitioners and midwives.

But some women did beat the odds and practice medicine, paving the road for today’s female physician. Let’s take a look.

The Female Physician in Ancient Times

Records from Ancient Egypt note women physicians such as Meit Ptah who lived around 2700 BCE and was a contemporary of Imhotep; Peseshet lived in the Fourth Dynasty and was called “Lady Overseer of the Female Physicians.” But it was ancient Greece who had the most famous female physicians.

Agnodice, who lived in Athens around 300 BC, was the first female gynecologist, according to Latin scholar Hyginus. Legally prohibited from practicing medicine, Agnodice cut her hair, dressed as a man, and studied under the famous Alexandrian physician, Herophilus. When she stole the business of her male colleagues, they took her to court where she revealed she was a woman. Agnodice was not only acquitted, but successfully had a law passed allowing freeborn female citizens to practice medicine.

Greece was also the home of a doctor named Metrodora (200-400 CE) who may have written the oldest medical book known to have a female author: On the Diseases and Cures of Women. 

A Ban on Witches and Midwives: The Middle Ages

Education and progress slowed to a near standstill in the Middle Ages. The Church banned female physicians, as did universities and professional guilds. Nuns were permitted a limited role as healers; Hildegard of Bingen wrote Subtililates Diversarum Naturarum Creaturarum in the 11^th century, in which she suggested medical remedies for common ailments. But it became almost impossible to practice medicine in Europe without a diploma from the University of Paris. In 1325, Pope John XXII ordered a ban on midwifery and female practitioners, warning that these women were practicing witchcraft.

As the late Middle Ages gave way to the Renaissance, more women earned medical degrees. The Schola Salernitana in Italy accepted female students, while historical records of two 13th century female doctors survived in Hertfordshire, England; other women are recorded as treating Bubonic Plague victims and working in pharmacies. Slowly but inevitably, women were claiming their place in the medical profession.

The 19th Century: the Rise of Women’s Medical Colleges

When a young United States admitted only male students to its medical schools, American women launched their own institutions. In 1849, Elizabeth Blackwell became the first woman in the United States to earn a medical degree. Women of color faced steeper barriers but Rebecca Lee Crumpler became the first African American woman to earn a medical degree, graduating from New England Female Medical College in 1864. She eventually cared for freed slaves who would otherwise have been denied access to medical care and penned the 1883 work Book of Medical Discourses.

By the 1860s, women could earn medical degrees from at least three schools for women and a few coed medical schools. Most of these schools didn’t last long, being absorbed into other universities or turning coed. But they provided a launching pad for women to enter the medical profession.

After graduating, many women found they were banned from internships, residencies, and medical societies – and once again, they began opening their own hospitals and clinics. The number of female doctors boomed from approximately 500 in 1870 to about 7,000 in 1900.

For an idea of men’s opposition to female colleagues, consider Harriot Hunt’s application to Harvard Medical School. Dean Oliver Wendell Holmes supported her but the students put forth a formal rejection: Resolved, that we object to having the company of any female forced upon us, who is disposed to unsex herself, and to sacrifice her modesty by appearing with men in the lecture room.

Hunt ultimately earned a medical degree in Syracuse as a homeopathic physician; Harvard Medical School refused to accept female medical students until 1945.

A Drop and a Resurgence: The Female Physician in the 20^th Century

The future looked bright for female physicians at the dawn of the 20th century. But clinical doors began to close in their faces. Many previously coeducational schools reversed their decision and banned women again; at Johns Hopkins, the percentage of women students dropped from 33% in 1896 to 10% in 1916. In 1905, women constituted 4% of all medical graduates, but that number dropped to 2.6% in 1915. Progress slowed once again over two world wars and the Great Depression dominated the first half of the century.

In 1951, Mildred Jefferson became the first Black woman to graduate from Harvard Medical School. “I am at once a physician, a citizen and a woman,” she said, “and I am not willing to stand aside and allow this concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged and the planned have the right to live.” Jefferson served as a surgeon at Boston University Medical Center and a professor of surgery at the university’s medical school. But she was an outlier; by 1955, less than 5% of medical graduates were women.

Second-wave feminism swept to power in the 1970s and changed everything. The demand for educational and professional reforms challenged and toppled brazenly discriminatory policies. Title IX of the Higher Education Act prohibited federally funded educational institutions from discriminating on the basis of sex.

The impact was immediate: the number of women in medical schools tripled between 1970 and 1975. Nearly half of new medical school students were women as the 21^st century began.

The Female Physician Today

2021 marked the first year that a majority of medical students were female. But women still face specific challenges. Some female physicians say their patients and families often assume they are nurses. One study found that male doctors introduce their male colleagues as “Dr.” around 70 percent of the time but introduce their female colleagues as “Dr.” less than half the time. Female physicians are also more likely to report higher levels of depression and burnout than male physicians – possibly because they often shoulder a great burden in terms of childcare and housework at home.

Today, many women in the medical workforce are fighting for schedule flexibility, lactation rooms, better parental and family leave policies, childcare coverage and other changes that can benefit all healthcare professionals. Others have launched coaching, mentorship and development programs for younger women just starting their medical careers. These women are building a healthcare field that more fully represents the patients and communities that depend on them – and creating a future of insight and innovation.

How can the healthcare industry better support female physicians? If you’re a physician, what challenges have you faced? Share your thoughts with us!

Christina is ready to quit. She feels tired, numb, and cynical during every nursing shift; her coworkers and the high patient ratios at her hospital annoy her. At home, she’s overwhelmed by even small tasks on her To Do list, such as taking her car for an oil change or scheduling her dog’s vet appointment. And despite being surrounded by patients and nurses all day, she frequently feels depressed and isolated from others.

There’s a term for what Christina is experiencing: compassion fatigue. It can show up in different ways amongst healthcare workers, but the Merriam-Webster Dictionary defines it as “the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.”

And it’s reaching epidemic levels; one survey found that even before the pandemic, 54% of physicians felt they no longer had any compassion left to give, even after a restful weekend. Since the pandemic? In reviewing a number of studies, MDPI found “that the quality of life of health professionals was significantly affected by the COVID-19 pandemic. Specifically, burnout levels increased from medium–high to high and compassion fatigue went from medium to high.”

The Emotional Burden of Providing Care

Is compassion fatigue the same as burnout? British author and scientist Tim Jarvis draws an important distinction: “Unlike burnout, which is caused by everyday work stresses (dealing with insurance companies, making treatment choices), compassion fatigue results from taking on the emotional burden of a patient’s agony.” For this reason, compassion fatigue is sometimes called “secondary traumatic stress.”

“It’s tiring that we are always expected be a certain way when we show up,” says Jaclyn Tjipto, RN. “During my ICU days, whether you were preparing a patient’s body for the morgue or telling family members a patient isn’t going to make it, you were expected to act ‘straight,’ matter of fact and let it roll off, move on. Then we do not talk about the effects this can have on the medical professional’s mental health and well being. We can feel massive grief that we’re often not given space to express. There isn’t enough emphasis in society on teaching us to care for ourselves – and that’s where compassion fatigue grows.”

The ramifications of compassion fatigue can stretch beyond an individual provider to affect their coworkers, patients, and workplace. Reduced productivity, an increase in sick days, and higher turnover are all common in a workplace where staff feel emotionally detached and cognitively drained.

The Root of Compassion Fatigue

Compassion fatigue is not a character flaw. It’s a natural outcome of our current healthcare environment. Providers are perpetually asked to see more patients, do more documentation, and stay professional when dealing with angry or unappreciative families. They may take on extra shifts, miss out on family time, and live off microwaved burritos in the break room instead of nourishing meals. Staffing shortages can put pressure on them to prioritize hospital needs over their own mental health.

“In nursing, there’s a culture where you’re taught to put others first and I believe that it’s not the healthiest belief to embody,” says Tjipto. “Nurses and doctors are expected to be healers but often these ‘healers’ don’t know how to heal themselves. And there can be a culture in the medical field where burnout is almost ‘glorified’, such as people taking pride in skipping their lunch breaks – it becomes this competition of who can sacrifice the most.”

Signs and Symptoms of Compassion Fatigue

While a tough week can leave any physician or nurse feeling dissatisfied, compassion fatigue persists over time. It can manifest in some subtle ways, such as:

• Feeling drained by even minor demands
• Abusing food, drugs, or alcohol
• Workaholism
• Insomnia and nightmares
• Numbness and lack of joy
• Social isolation
• Digestive troubles and headaches
• A sense of hopelessness and despair
• Taking longer to recover from stressful patient encounters
• Neglecting or delaying life management tasks
• Physical and mental exhaustion

Nicole Streich, RN, shared her experience with compassion fatigue.

“At my facility, the friendlier/newer nurses were expected to always volunteer more and to always say yes – whether it was in the scope of practice or not,” she said of her past job in a NICU. “Doctors and supervisors would resent you if you said no to something, older nurses were resentful of the newer nurses because they were ‘brown-nosers,’ and the newer nurses resented being asked to do extra work.”

The result: “My resentment led to sleeplessness at home, irritability with family, and feeling alone and unsupported during shifts. The focus became trying to make my leadership happy and wasn’t on my patients. I began looking for ways to numb out – to not have to be responsible for anyone or anything for at least 8 hours a day.” 

Minimizing Compassion Fatigue

If despair and exhaustion continue long enough, quitting – or even leaving the healthcare field entirely – can feel like the easiest solution. Before your compassion fatigue gets to that point, try these practices.

#1. Set boundaries.

Think about how much you can give at work – and then practice holding firm to those limits. “Setting boundaries is so important. One incredibly important boundary is to say NO,” says Streich. “I think we are conditioned to believe that we have to just do what we are told – but why? Is it because something needs to be done, and there’s nobody else who can do it? Sometimes that might be it, but sometimes it’s because we are the ones who routinely do what nobody else will do.  Doctors get to say no, supervisors get to say no – and nurses do too.”

#2. Ask for help before you are in desperate need of it.

Whether you talk to a counselor, colleague, or support group, sharing your experiences can help you unload burdensome feelings instead of suffering in silence. Tjipto recommends peer support so you can talk to other frontline workers who understand your frustrations and can offer real-world advice.

#3. Control self-medication.

After working too many shifts with too many draining patient encounters, it can be tempting to try to numb your feelings. That might involve drinking too much, substance abuse, compulsive overeating, running up credit cards, or risky behaviors. Ultimately the relief is short-lived and the original problem is still there, with the addition of new problems.

#4. Learn how to recharge and nourish yourself.

There’s plenty of generic advice on how to recharge: spending quiet time alone, getting more sleep, or going for a walk. But as Tjipto points out, what matters is finding something that works for you. “It’s about understanding what your needs are,” she said. “Find out how to take care of yourself and what kind of things will replenish you. It may be tricky at first – patience is of the essence. Practice self-awareness and compassion instead of self-medication.”

#5. Feel your feelings.

Many frontline staff wind up becoming jaded – or feel they work in a culture that demands they stifle their emotions. “It’s normal to feel sad if our patients don’t make it,” Tjipto says. “It’s okay to cry, to feel your feelings – even if you need to go out in your car and scream. The human in you makes you a better caregiver when it’s allowed to be integrated.”

#6. Don’t take on others’ suffering.

“You can witness what patients are going through without taking it on. That’s a lesson for many nurses,” says Tjipto. “In the OR, when we weren’t allowed to leave, we would take a moment to meditate with a mint or candy, breathe deeply to our pelvic bowls, and refocus on being at home in our own body and experience.”

#7. Support each other as a team.

Providers tend to worry most about supporting patients – but their team members also need a helping hand. Healthcare leaders can build a more supportive culture by offering mentorship and holding debriefing sessions after stressful patient incidents. The idea is to help frontline staff process their feelings in the moment and feel appreciated by their leadership.

The Road to Compassion Satisfaction

As a healthcare professional, you probably gravitated toward your career out of an innate generosity of spirit. Your empathetic nature is a gift when it comes to patient care, but it can also lead down the road of compassion fatigue. Let us know what practices you use to renew your state of compassion satisfaction – and how the industry can do better in supporting its providers on the front line.

Every February, campaigns for American Heart Month remind us that cardiovascular disease (CVD) is the leading cause of death in the U.S. So you probably won’t be surprised to hear that holds true among Native Americans. But as with many healthcare conditions, heart health is worse in Tribal nations – with CVD mortality rates 20% higher among Native Americans.

Death comes earlier too; 36% of CVD deaths occur before age 65 for Native patients, compared to 14.7% for White patients with CVD. Heart disease deaths are 30% higher for Alaska Native people age 25 to 44 – and 40% higher for patients age 45 to 54.

Heart Health Risk Factors

Cardiovascular disease is an umbrella term that covers every type of disease affecting the heart or blood vessels – including coronary heart disease. Factors influencing heart health for Native Americans include:

• Stress. Historical trauma, discrimination, racism, and other stressors can affect heart health. Native American poverty rates are at 26.2 percent, nearly double that of the rest of the United States.
• Sex. Native men have higher ratesof CVD than women, according to the Strong Heart Study, which explored cardiovascular disease in Native Americans.
• Genetics. The Strong study also found that heritability pattern contributes to 20% to 50% of the phenotype of CVD risk factors such as obesity, dyslipidemia, hypertension, and diabetes mellitus.
• Clinical discrimination. 23% of Native patients reported experiencing discrimination in clinical settings; 15% have avoided seeking care for themselves or family members due to anticipated discrimination.
• Environmental poisoning. Nuclear testing, high levels of air pollution, and exposure to toxic metals in Tribal nations is linked to a dramatic increase in cancer, heart disease, and stroke.
• Food Insecurity. 1 in 4 Native Americans is food insecure.  A new study suggests that food insecurity is linked to cardiovascular disease.
• Diabetes. Diabetes mellitus is a strong risk factor, with rates approaching 24% in Native Americans – that’s compared to 8% in White patients. The Strong study found almost all women and more than half the men with diabetes had heart disease.
• Hypertension. High blood pressure is strongly linked to CVD risk, with one study finding Native adults were 10% more likely than White adults to have high blood pressure.
• Smoking. Native Americans cigarette use is nearly double that of White and Black smokers, according to the 2016 National Health Interview Survey from the Centers for Disease Control and Prevention (CDC).
• Obesity. The obesity epidemic is rampant across all U.S. populations, but Native communities are leading the rest – with obesity rates than span 30% to 40%.

The good news is that healthcare teams have the power to radically reduce cardiovascular disease rates.

Telemedicine Access

Underfunded Indian Health Service facilities may not always offer cardiology services beyond echocardiography and treadmill testing. While some services must be done in person, such as coronary bypass, telemedicine can connect patients to a cardiologist’s care and help them avoid traveling hours for a 25-minute appointment.

Smoking Cessation Programs

An estimated 56% of Native smokers report the desire to quit smoking. The problem: Native people can have a harder time accessing a commercial tobacco cessation service. When they do, that program may not differentiate between ceremonial tobacco use and recreational smoking. What’s needed are culturally adapted programs that involve Tribal leadership. Young leaders can be especially effective in stopping smoking in the younger generation.

Diabetes and Hypertension Management

Several programs tailored to Native communities have had great success in addressing risk factors. The Special Diabetes Program for Indians offers a Healthy Heart program and a Diabetes Prevention Program; the Native-CHART project (Native-Controlling Hypertension and Risk Through Technology) works to help Native patients lower their blood pressure and reduce their risk of stroke. The REACH program (Racial and Ethnic Approaches to Community Health), developed by the CDC, blends community empowerment, cultural intelligence, and clinical treatment.

Cultural Approaches

Sweat lodge ceremonies, talking circles, and community-driven programs are effective ways to help Native CVD patients learn more about their condition and make lifestyle changes, such as increasing physical activity. Shared decision making is an old Native tradition, which often use community-talking circles that allow each person to provide uninterrupted perspectives and frame health decisions in a cultural context. 

Smarter Practices, Healthier Hearts

Social determinants of health and historical trauma can’t be eliminated overnight – but building culturally relevant practices for all ages and backgrounds is a great start to reducing health inequities. Cardiovascular disease is a community problem, and it takes community-based interventions to change the roots of cardiac disease.

This month we’re profiling the nurse recruiter you might have known as Brooke Cooper – now Brooke Foster as she recently married our Account Manager Joey Foster!

A fateful star guided Brooke’s journey to Tribal Health. Originally from Virginia, she attended fashion school in New York City and then took a job in fashion in Phoenix. “I hated it,” she says, “so I started waitressing, figuring out my next move.”

One night she waited on a table where Dr. John Shufeldt, Morgan Haynes, Joey Foster, and Brent Cavender were having dinner. It was a fortuitous moment that introduced her to both her future career and her future husband.

That was in 2019. Brooke began working as a recruiting coordinator; a year later, she became a nurse recruiter. Today she is treasured by our other recruiters for her willingness to share her wisdom, and valued by our nurses for her ability to match the right assignment to their goals.

So what is it like to work with Brooke? Luis Saenz, RN, says, “Brooke is an attentive recruiter/advocate that makes you feel extremely well cared for. I would not change agencies/recruiter for any reason. If you’re looking for greener pastures, I assure you, the water bill will be higher.”

We asked Brooke about her career change – and her advice for new recruiters.

Recruiting is a big leap from fashion. What do you like best about recruiting?

I never thought I would be in this field! I’d say my favorite thing is being able to build a connection with everyone who comes on board. When I find that perfect fit, it’s the best thing in the world. They find their new home and new family and that’s my favorite part.

As the most senior recruiter, can you describe your recruiting philosophy? 

I try to get to know them and understand what they’re looking for in a contact – money, mission, location, or another factor. Then I figure out where they’ll fit best. I don’t push anyone. I just direct them.

What are your biggest challenges?

Working with rural facilities, you can encounter challenges like housing or the drive out there – but that’s also our specialty so we know how to figure out solutions.

If you were going out on assignment, what would be your dream location?

I visited Rosebud recently and it was awesome. It was really cool to see the facility and so nice to meet everyone. It was humbling too. My next picks would be Pine Ridge and Sells.

When you’re not at work, you are…

Walking my dog, Chesney, and spending time with Reese, our new puppy! Mostly I spend time with my family and friends.

Your advice to new recruiters is….

Don’t give up on cold calling. All your leads will pay off in the end. And don’t try to be a salesperson! Get to know them first and understand what they’re trying to get out of a contract. It’s about listening to their needs and hearing them out.

Brooke is ready to help you find a new assignment whenever you are – so reach out to her at:

• Email: bcooper@tribalhealth.com
• Phone: 480-240-3211