This transcript has been edited for clarity.

Hello and welcome. I'm Dr George Lundberg and this is At Large at Medscape.

Ladies, there is always room at the top. Ha! I wish that were true. Certainly, that has not been true historically for American women in medicine. For centuries, there was not even room at the bottom.

Elizabeth Blackwell is recognized as the first white American female graduate of Geneva Medical College in New York, in 1849. Rebecca Lee Crumpler is recognized as the first black female graduate of New England Female Medical College, in 1864. These women and their many successors have had a hard time.

Men and women are different; so are boys and girls. That is just the way it is. It begins with chromosome 46—females with XX and males with XY. It is further actuated by hormones. Androgens and estrogens are different and have very different effects.

On average, men are taller, heavier, more muscular, and they can run faster and jump higher. Also, men are, of course, unable to conceive, bear, and nurse children. These profound biological differences are further enforced by tradition, culture, and sometimes even religion.

So where did the notion of gender equality arise? I'm not sure, but I do favor it. I have always supported equal opportunity by gender (my mother taught first grade for 43 years). I have practiced affirmative action in job hiring since the 1960s. I have supported equal pay for equal work since the 1950s, and not only for women, but also for African Americans in Alabama and Mexican Americans in El Paso. During my employment there, that was not always the case.

It was slow-going for women in medicine in America. My medical school class of 1957 included three women in an entering class of 80. All three women graduated. When I was a professor of pathology at USC, my second department chair, beginning in 1972, was Nancy Warner, who was (and still is) terrific.

Nancy was the first female chair of a department of pathology at an American coeducational medical school. The second was Diane Crocker, who left USC to become chair at the University of Tennessee that same decade. That glass ceiling was showing some cracks.

By the time I became chair of pathology at the University of California, Davis in 1977, our entering medical school class was almost 50% female. That was huge progress.

The highest level of career recognition in the field of medicine in the USA is election to the Institute of Medicine (IOM), which is now called the National Academy of Medicine (NAM). There are about 1.1 million physicians in the US and 2150 living members of the IOM/NAM, so the odds of election are < 0.2%. Some NAM members are not physicians, so the odds are even lower.

Consider these numbers: IOM/NAM began in 1970. Female members comprised 3% of total membership in 1970, 13% in 1980, 13% in 1990, 18% in 2000, 23% in 2010, and 27% in 2019. For the entering classes of new members elected, women comprised 29% in 2015, 39% in 2016, 41% in 2017, and 42% in 2018. And the 2019 pre-election female candidate proportion was 38%. This is a giant improvement toward equality at the very top.

I had the privilege of appointing Dr James Dalen as the editor-in-chief of the Archives of Internal Medicine in 1986; he served with honor until 2004. Jim was also dean of the University of Arizona School of Medicine from 1988 to 2001. He told me then that one of their methods of evaluating medical student behavior was to videotape student-patient interactions and then study these tapes with the students as learning experiences.

He said that both men and women were quite capable of empathetic, effective interactions, but there was one real difference: When having to convey bad news, the women medical students would sometimes hold the hand of their patients. I like that.

That's my opinion. I'm Dr George Lundberg and this is At Large at Medscape.

George Lundberg, MD, is editor-at-large at Medscape, editor-in-chief at Cancer Commons, president and chair of the board of directors of The Lundberg Institute, and a clinical professor of pathology at Northwestern University. Previously, Dr Lundberg served as editor-in-chief of JAMA (including 10 specialty journals), AMA News, and Medscape.

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