DR. STARLING: It wasn't until I became a resident, and more so when I became an attending physician, that I started noticing that it's actually very difficult to be a female physician.

NARRATOR: In this episode, Dr. Aamal Starling, a female neurologist, and Tyler Bahr, a male nurse, discuss their experiences with gender stereotypes.

DR. STARLING: Tyler, tell me a little bit about your journey to becoming a nurse.

BAHR: I talked to my guidance counselor in high school. I didn't really have a direction where I wanted to go. He was helpful in suggesting the CNA (certified nursing assistant) class for me and one of my other colleagues to take. We were the only two people in the class who were male out of about 15 other females. At the time, I didn't really know the differences in the female-dominated field of CNAs. We ended up taking the class, and I worked as a CNA for about eight months. I ended up wanting to move on.

As you can imagine, going through school — not a lot of male nurses. I didn't really notice a whole lot of differences being a male to female minus the study groups. I had to squeeze myself in just because I felt that I was out of place. As time went on, I saw more and more guys come into the field. This was probably like seven years ago when I graduated. But once I got to my bachelor's degree, I noticed there were probably 10–15 men in my class. It got to be more and more male-dominated. Working here in the clinic and hospital, I've noticed that there have been times where I'm the only guy there. Sometimes there are five or 10 of us, but it's becoming more and more apparent that men are becoming more interested in being registered nurses.

DR. STARLING: For me to become a physician, it was a very, very young age. Interestingly, my family is from Bangladesh, which is a country right next to India. Many of the females in my family are physicians, so I never really thought it was odd that I wanted to become a physician. My parents always really encouraged that, and I never really doubted that it's something I'd be able to do. Going through undergrad and grad school, and even in medical school — my medical school class was 60 women and 40 men. It still never really hit me that it was going to be a big deal to be a female physician because in medical school, it was not a big deal.

When I was on my clinical rotations in medical school, I was the medical student, and I was already the lowest person on the totem pole. Anything that implied I wasn't important or anything invalidating, I just assumed it's because I was the medical student.

It wasn't until I became a resident, and more so when I became an attending physician, that I started noticing that it's very difficult to be a female physician. Someone recently asked me, "How often is it that people think that you're not a physician?" I said, "Every day." At least once or twice a day, I'm assumed to be a nurse or someone else on the health care team but not the physician.

Even after I've talked to the patient, the question often is, "When is the doctor going to come in?" I've introduced myself as Dr. Starling. "I'm Dr. Starling. I'm your attending physician." This happens on a daily basis when I'm on the inpatient service. There was shock around the room from all the male physicians, and all the male and female administrators and support staff, that it happens that frequently.

The female physicians were like, "You guys don't know it happens all the time, like every day?" It wasn't until then that I realized that it makes a big difference. For a while, I didn't know how to address it. I remember a situation in which I was with a group of female residents. I was the attending physician, and the only male on the medical team was the medical student. The whole time, the patient was looking at the medical student. Finally, the medical student goes: "I'm the medical student. She's the boss. She's the one you need to be talking to."

I'm curious from your perspective, Tyler, being a male nurse in a field where you may have been assumed to be the doctor, how has it felt? Have you felt the need to set the story straight in situations or say something like, "You know males can be nurses, too?"

BAHR: It's funny that you mention that because that's happened daily, even in the clinic here. They always think that I'm the doctor calling with the test results when in fact, I'm reading off a script. Even being in the hospital seeing patients, I'm wearing the same scrubs as all the other nurses, but they still think that I'm wearing the white coat underneath. I've gotten to the point now where I do correct them. But if it's somebody in their 80s or 90s that still thinks that way, I just have to go with it.

DR. STARLING: When is it that you correct things? When is it that you don't correct things? That's a thing I struggle with all the time, and you kind of get exhausted. I've learned and accepted to embrace that it's a part of my responsibility, especially as an educator. Making a safer, more equitable learning environment for my trainees and a work environment for the trainees who will become future physicians — I have to do it for them. It's so important that we do that to try to change things for the future.

BAHR: With interactions in the clinic, patients know who the doctor is. Whereas if you're in the hospital and it's one particular person you don't see all the time, it ends up causing some confusion.

DR. STARLING: I agree. In the outpatient setting, it's easier because they are only seeing one person.

BAHR: What brings you joy in your career? What keeps you getting up every day to keep seeing your patients and not call it quits?

DR. STARLING: There are so many things that detract from our joy, so what are the things that do fill our cup? For me, I love my patient population. My primary patients are people who live with migraines. It's a hugely underserved, underdiagnosed, underidentified, undertreated population. They often are very desperate by the time they get to us as a tertiary and quaternary center here at Mayo.

I love diving in with those patients and making sure they know that I believe them. I see them, and I hear them. We have options, and I'm dedicated to trying to get them to a point where they have a better quality of life.

I call all my patients "migraine warriors." I say: "You're not a sufferer. You're not a victim of your disease. You are someone who's going to be empowered against your chronic disease."

I think that's a big thing for me. What fills me with joy is walking together down that path to recovery, and improvement and a better quality of life with my patients. It's a partnership whenever it's chronic diseases. The other thing that fills my cup is working with my interns, with my trainees — being a small part of their journey to whatever field of medicine they're going into. Being their introduction to Mayo Clinic and the professionalism, and the community and collegiality that we have here at Mayo Clinic. Being able to introduce them to the Mayo family during their intern year. It's such a cool thing to be in this position as the program director for the transitional year.

BAHR: In the clinic, you become friends with everybody here. You work so closely with residents, compared to working in the hospital. You feel like you have to be in the know to be hanging out with co-workers, especially if you're kind of stuck on the sidelines as a male. A lot of the other female co-workers are always hanging out. I always make the joke that I was a bookworm in college, mostly because I was underage. They were all females. They're all hanging out together. I'm like, "OK, I'll hang out and just do my papers and such."

Being in the clinic, you get to know the same people every day — male or female. It doesn't really matter. If you're in the inpatient (setting), if you're working every three or four days, it's really hard to get into a groove with staying out of that whole stigma of being a minority in your group.

DR. STARLING: Right. I have a question for you, Tyler. On Facebook, we have a group called the Women's Neurologist Group. Do you have male nurses where you guys get together and you have this bond because you are male nurses? Or is that something that women are doing on the other end in fields where there are fewer women perhaps in leadership roles?

BAHR: I think that really comes down to organization. I mean, how many men do you really see organizing a huge event or a Facebook group? You don't see men doing it. There is a "Men In Nursing" group put on for mainly college-age and new grads to get their feet wet and get to know people in the community. But once you get in and you're in the trenches for five years, there's really nothing. It's not because we don't want to get to know each other. It's because we don't organize. We don't put up the whole Facebook thing. We just talk to each other and converse. Other people could have a different story. But for me, that's the way it's been.

DR. STARLING: That's so funny you say that, Tyler. That's really interesting. What advice would you give to other men who want to enter nursing with it still somewhat dominated by females?

BAHR: I would tell them to be a chameleon. Once you get into it, you start studying with them. It doesn't matter if it's men or women, you have to be able to blend in. You have to be able to just say, "We're future nurses." We all ask each other for help. We all work together.

DR. STARLING: For me and my colleagues who are other female attending physicians, we've really looked at it as an equality versus equity thing. Perhaps 50-50 is not even enough right because there has been such limited female leadership, female sponsorship and academic promotion.

It's not always a conscious decision for one of our male mentors or colleagues to not think about us for that next opportunity. It happens unconsciously. Because we're so acutely aware of that, we've really had to band together, uplift each other, and we have to promote each other. We have to support each other, write recommendations for each other and encourage each other. If a male leader says, "I don't know if you're ready for that," it might be a good idea to speak with a female leader to make sure she also feels the same way because there might be a little bit of unconscious bias going on. And then really empowering each other, as well — male and female — empowering everyone to be able to be not just a bystander, but an upstander in situations in which there are microaggressions. Mayo Women's Health did a study where they were looking at Grand Rounds introductions, and 95% of the time, when a male is introducing a male speaker, he uses "Dr. So-and-So," their professional title. Only 49% of the time does he use the professional title for a female speaker rather than her first name.

BAHR: That's an amazing stat to me. I feel like once you get up to the full-fledged M.D., once in your own practice, those biases come out. All the residents here in the professional setting — we address them as "Dr. So-and-So." But in the bullpen, we are addressing by their first name — it doesn't matter if it's male or female. But obviously, in a professional setting, in front of the patients, we still address them by their professional letters. I don't understand how that gets lost in translation later on, or if it's happening subconsciously or unconsciously.

DR. STARLING: It's normal for males to be "Dr. So-and-So," and they just command more potential respect. It's good, though, for all of us to be that upstander, even if it means that it's a slightly uncomfortable conversation initially. I think it's worth it so we get to a point where there is change.

BAHR: I feel the days of males or females dominating a specific area are becoming more and more split. It's something that's positive, but at the same time, people need to understand that it's going to happen. You were talking about males presenting themselves as "doctor" and introducing you by your first name. It needs to start changing now if it's ever going to change.

DR. STARLING: I want to tell you a story of hope about change. I have a little boy. When he was 4 or 5 years old, we had gone to a work event. There were many physicians, male and female. Many of my friends are female physicians. I introduced one of my male physician colleagues to him and said, "This is Dr. So-and-so." He looked at me and said, "Boys can be doctors, too?" I was like: "What? Of course, they can be doctors, too." But I realized that he only knew his world was all female physicians. So in his little world, he didn't realize that boys could be doctors, too.

Obviously, we can make change happen. I was like: "Yes, honey. You can be a doctor, too, if that's what you want to do. You can be anything you want." By being an upstander, having these conversations, making sure that our kids and our trainees, and our young people, see that we're making these active, conscious decisions to bring more equity to society and the workplace, it's going to change.

NARRATOR: What has your experience been? Consider discussing with colleagues ways to reduce gender stereotypes — whether in your career or personal life.