This piece was originally published on Good Notes. 

The inconsistent use of professional titles for men and women is a common occurrence in health sciences. Titles are one of many facets of our professional identity and stature. However, my experiences as a female doctor, educator, and health care leader reveal the use or non-use of our titles has deeper implications than most of us realize.

Recognizing biases

I never assume ill intent when, in a professional setting or meeting, someone refers to me by my first name while simultaneously referring to a male colleague by his “Dr.” title. Admittedly, I sometimes catch myself doing the same thing to others. In our everyday verbal and written communications, this inconsistency has become a behavioral norm stemming from cultural, implicit, unconscious bias.

According to Project Implicit researchers, most people in our culture have a moderate association or bias toward men in a career and women at home. When I took the implicit bias test, I had that same bias. Knowing that I have this assumption helps me recognize when I am being unconsciously inconsistent in how I refer to male and female colleagues. And when I catch myself doing this, I make a point of correcting it publicly. Knowing our individual and cultural assumptions helps us make better decisions.

(Note: The inconsistent use of titles occurs among all doctorate degrees [MD, PhD, DNP, PharmD, DDS, etc.]. Some of my female nursing colleagues thought this might be happening to them because they are PhDs or DNPs, not MDs. I assured them it happens to me on a regular basis. Let’s not forget to treat all our colleagues with an equal level of respect for their credentials and expertise.)

Diminishing effect

In an invited commentary for the Journal of the Association of American Medical Colleges (AAMC), the authors express concern about the COVID-19 pandemic exacerbating disparities not only in public health outcomes among vulnerable populations but also within the profession of medicine. The authors argue that it is time to investigate the frequency of behaviors that limit both the recognition and the very exercise of women’s leadership.

It may seem like a subtle thing, but consistently failing to use professional titles (unconsciously or consciously) for men, women, and others who are underrepresented in medicine results in deferential treatment. When this becomes a frequent behavior, the AAMC commentary goes on to say, it frames the conversations that follow and affects the level of respect afforded to each person’s views. Ultimately, using formal titles for some and not for others has a diminishing effect for those who no longer have the same authority or respect as someone with equal credentials. It can lead to gendered communication dynamics where women and minorities are dismissed or talked over, where ideas first articulated by a woman are ultimately attributed to a man who repeats them, and where men are charged with (or proceed with) leading initiatives proposed by their female colleagues.

Perpetuating these undermining behaviors robs us all of the increased collective intelligence that exists when diverse perspectives are embraced. Starting today, we can individually and collectively take some simple but impactful steps to promote greater equity, diversity, and inclusion at U of U Health.

Be intentional and consistent 

It’s incumbent on all of us to be intentional and consistent in how we address one another. Here are some simple steps all of us can take to eliminate bias in our verbal and written communications:

1. Take the implicit bias test to understand your own biases.
2. Acknowledge there are inconsistencies in how we treat and refer to one another and identify them when they crop up in everyday interactions.
3. Consistently use professional titles or first names for everyone—choose one or the other; avoid mixing the two.
4. When you see/hear inconsistencies, call it out and correct it even if that means catching/correcting yourself! We must foster a culture where everyone feels safe to call it out.

Role model and champion for equity

It takes all of us to ensure our female colleagues, and others who are underrepresented in health sciences, are on equal footing with their male colleagues. U of U Health is fortunate to have champions like Rory Hume, DDS, PhD, dean of the School of Dentistry and Associate Vice President for Academic Affairs. Hume recognizes there are inequities, and he intentionally takes steps to sponsor and support women. He is very supportive of me in my leadership roles.

The dentistry profession has historically not been welcoming to women; in Utah, the field is more than 90 percent male. Hume recognizes that existing barriers deny opportunities to people who could excel in the field. The School of Dentistry is working hard to encourage more women to pursue the profession and create an environment where they feel welcome.

“As long as these barriers exist, we are denying the benefits of true diversity in patient care,” Hume explains. “In many cases, women will make a different set of decisions that benefit the well-being of patients. We should not deny patients the opportunity to be well cared for, and we should not deny women the opportunity to care for people and have a career in dentistry.”

Hume became conscious of gender inequities as he observed his wife’s struggle to get into law school in Australia. She was emphatically told, “There is no place in the law for women.” She did not let that keep her from pursuing her passion, and she subsequently became part of a new generation of women who thrived in their careers as lawyers.

Hume models behaviors that promote equity and non-discrimination. He calls it out when he sees/hears it and takes steps to correct it. If needed, this includes being prepared to end the service of individuals if they refuse to treat professional colleagues with respect. “When people’s attitudes are irreconcilably sexist or racist, you must address it,” Hume says. Our faculty code of conduct requires us to treat one another with respect. Discriminatory behavior is a violation of professional ethics.

Avoiding an “equity faux pas”

Our interactions with each other over email are just as important as our face-to-face (and virtual) interactions. Believe it or not, email is probably where many subconscious “equity faux pas” occur. But they are easy to correct as well. With Dr. Hume’s permission, I share the following email exchange (actual names removed) in an effort to help others avoid this common pitfall while advocating for the equitable treatment of all of our colleagues.

In this case, the sender addresses the email to two equally qualified, equally ranked male and female faculty members. Dr. Hume is on copy.

Sender (female): Thank you, Nancy and Dr. Jones for your willingness to help us.

Dr. Hume’s Response: A gentle comment—either “Dr. Smith and Dr. Jones,” or “Nancy and Joe”… Dr. Smith is quite equal in qualifications and rank to Dr. Jones. Both are doctors and deans.

Sender’s Response: Dear Dr. Smith and Dr. Jones, Please forgive my lack of decorum while rapidly firing off of my previous email. I apologize for neglecting your title, Dr. Smith, which was entirely inappropriate on my part. I did not mean to diminish you or your excellent work for the university. Looking forward to working with you both.

Even after assuming my role as Associate Vice President for Health Sciences Education two years ago, people continue to refer to me by my first name in professional settings and communications. This is the “stock” call-to-action message I have been using in my own emails:

I’d like your help with a gender issue that I am working on with other leaders. Please be consistent with how you refer to men and women in your emails. I would suggest either referring to all individuals by their first name or all individuals by their titles (Dr., Mr., Ms.). It diminishes a women’s stature and credibility when a female doctor is called by her first name (XX) and the male doctor is called by his title. (Dr. XX – who the writer knows). Thank you for your help in this endeavor.

Let’s flatten the curve

The above examples demonstrate how simple proactive steps can lead to greater awareness and reverse the damaging gender bias curve. I invite everyone in our U of U Health community—faculty, administrators, staff, students, and patients—to join in this effort. The actions we take now can have a profound effect on the future of the medical profession and patient care.