One of Us: How Women’s Inclusion Hurts Women

Have you heard stories or seen TV shows about how surgeons are the bossiest of doctors, ruling operating theatres like emperors, except that everything they do is more urgent than any imperial demands? That’s an exaggerated stereotype, but some surgeons fit it, and some forms of surgery are so exacting in process and speed that surgeons cannot tolerate slack. Many surgeons get away with bossiness because their work requires it—and because doctors are at the peak of the hospital pecking order and surgeons at the peak of the doctor pecking order. Everyone looks up to them.

Except that surgeons who are women are a little less looked up to than surgeons who are men. The usual mechanisms are at work, such as men (and some women) thinking of surgery as an activity that fits manly men better (so much cutting and bleeding...) and women generally having difficulty getting accepted in the top tiers of any occupation that has traditionally been held by men. But research by M. TeresaCardador, Patrick L. Hill, and Arghavan Salles published in Administrative Science Quarterly has found another source of difficulty: nurses.

Why are interactions with nurses problematic for female surgeons? Ironically, the source of the problem is that most nurses are women, and they interact differently with other women than with men. Nurses tend to act according to the script when the surgeon is a man: he orders, they obey. He does not need to chat or be friendly to get precise and timely work done, so the only benefit of being a friendly male surgeon is that he is seen as a nice guy. The same tends to be true when male nurses interact with female surgeons: they act according to the script.

But female nurses want – even demand – to include a female surgeon in the club of womanhood, where friendly chatting is required, members must know each other’s children’s names and ages, and work is rarely done exactly according to script. “After all,” they may think, “the female surgeon is one of us. That means she should also share some of the burden of the nursing tasks in addition to her work as a surgeon. That’s only fair. If she does not accept our requirements for inclusion and instead acts bossy, we can slow down our responses to her needs and make her job more difficult.” This is what precisely happened in the hospital the authors studied.

The result is extra work for the female surgeon and the loss of some of the special position that a surgeon has in the hospital pecking order. Maybe that’s OK because hospitals are too status conscious and hierarchical to begin with. But the problem is that only women surgeons face these demands for inclusion and the extra work accompanying it. It is discrimination against women, by women.

Is this something that women who are not surgeons should worry about? It probably is. What happens in the hospital is that different occupations interact to produce a result, and the higher-status occupation depends on the lower-status occupation for its success. That should sound familiar to many workplaces: higher-status workers are expensive, so organizations become effective by leveraging them through having lower-status workers do supportive tasks. If the supportive tasks are done differently depending on the sex of the lower-status and higher-status workers, this is an important source of workplace discrimination we need to better understand.

Cardador, M. Teresa, Patrick L. Hill, and Arghavan Salles. 2021. Unpacking the Status-Leveling Burden for Women in Male-Dominated Occupations. Administrative Science Quarterly, forthcoming.