Women MDs are changing medicine's culture

Medical Post
Helping Hand Column, July 21, 2009

As our medical schools are opening their door to more women than ever before, they are also opening the door to change.  In the past few decades, increasing numbers of women have been entering medical school.  In recent years, there are actually more women than men in Canadian medical school classes. I have heard colleagues from medical schools and organizations say that there is no longer a need for gender-focused committees, as there are no longer any issues about women in medicine.  I disagree, and believe that the issues are not resolved but have changed, from supporting more women getting into medicine, to addressing how they can succeed and be supported in how they practice medicine.  There is no doubt that women practice medicine differently than their male colleagues, and that this will impact on health care. 

There are a few key studies that have investigated the impact of increased numbers of women in medicine.  This increase was already being noted over 30 years ago, by Dr. Naomi Bluestone, in her 1978 AJPH paper on the impact of women physicians on American medicine.  She described how women physicians had been known in the past to favour the 3 P’s – pediatrics, public health, and psychiatry; often did not marry; made less money than their male colleagues; and had not risen in the medical academic ranks.  She wrote about significant changes occurring which showed more women choosing to enter medicine, working longer hours, being more insistent upon recompense, and moving into more varied disciplines including surgery.  She commented on how women practiced medicine differently - tending to work better with other women health professionals, more empathic and intuitive, more vocal in protecting themselves from prejudices, and establishing more mutually supportive networks.  Yet, while they were not ready to sacrifice family and outside interests for their career, they were also not ready to accept a second-class career.  In doing so, they caused male colleagues to question their own attitudes, and lifestyle choices, and seek similar flexibility.

In 1990, a CMAJ article by Williams et al, described how female physicians bring distinctive values that are reflected in how they conduct their professional practices.  Women tended to prefer group over solo practice, only one third were in medical specialties, were working fewer hours than men, and even after adjusting for differences in workloads, their incomes were significantly lower than those of the men.

‘The Changing Face of Medicine”, by Boulis and Jacobs, 2008, looks at why more women are entering medicine, how they are faring personally and professionally, and how they are transforming medicine.  The material draws on multiple sources, including interviews with women physicians.  They describe how women’s roles in contemporary society, not just in medicine, have changed.  Women physicians’ families are becoming more and more like those of other working women,  Yet, there are still gender disparities in terms of specialty, practice ownership, academic rank, leadership roles, and limits to opportunity.

The Royal College of Physicians in the UK just released a study last month, on the increasing number of women in medical schools, and how they are set to overtake men in many areas of medicine within a decade.  However, women seem to be more likely to opt for specialties with ‘plannable’ working hours, work part-time, and are less represented among top medical leaders.  This may mean that these specific specialties could face shortages.  The report highlights the need to adapt to this situation to maintain high standards in medicine, summarizes the organizational implications of this trend, and offers recommendations for policymakers to address future issues of medical workforce and its design.

I have personally witnessed the same change in colleagues through my practice over the past twenty years. There are more women in medicine, and nearly half of medical students are now female.  Women are making patient care friendlier, spend more time in patient care, form stronger bonds with their patients, and are less likely to be sued.  Women are more likely to go into primary care, and serve minority and needier populations.  Women are more likely to shoulder the bulk of family and home responsibilities, want to balance work and home life, and so work fewer hours than male colleagues and focus less on achieving leadership roles.  The reality is that career building and family building occur during the same years. 

This does have implications for the medical workforce, along with other factors such as aging and retirement of the current medical workforce, and an aging population.  This will lead to a shortfall and require health human resource planning to account for this.  There will need to be increased numbers of doctors to be trained, encouragement of physicians to go into specialties currently less likely to be chosen by women, and looking at how these specialities can be more compatible with better work/life balance.

Yet, an increase in the number of women in medicine has lead to improvements in medicine too.  Women physicians have helped to make it more acceptable for both men and women to choose to achieve a healthy balance between work and home lives.  They serve as agents for primary prevention and personal health promotion.  A colleague told me about how he was denied permission to leave to attend the delivery of his first child, 25 years ago.  Men now have the opportunity for paternity leave, to leave the OR to pick up their children from daycare, and to refuse extra work if personal and family plans have already been made.  As a result, perhaps we may see more doctors avoiding burnout, and enjoying their work. Patients like seeing a doctor who is energetic, enjoying their work, and happy to be there, thereby more likely to sustain a long term practice.  Healthy doctors are good role models for patients.  We know that a healthy doctor leads to a healthier community.