Increase in Women Doctors Changing the Face of Medicine
March–April 2005
Physicians are more patient friendly, but salaries are dropping and the MD shortage is getting worse.
With women becoming doctors in ever-increasing numbers, medicine is generally becoming more patient friendly, treatment is improving and malpractice suits may become less common, experts say.
But, they add, the feminization of medicine is helping to lower physician salaries, encourage part-time doctoring, and exacerbate a looming shortage of physicians.
The change in the medical field has been swift and dramatic. Since 1975 the percentage of female doctors has nearly tripled, from 9 percent to 25 percent. And the wave is far from cresting: 38 percent of doctors under age 44 are women, and half the students in U.S. medical schools are women, a change that is expected to intensify.
Already, women have taken over some specialties, such as pediatrics, and they are swarming into internal medicine, primary care, psychiatry, dermatology, and obstetrics and gynecology.
The changes are setting in motion dramatic new trends that already are affecting both patient care and the profession of doctoring.
One result is a patient-doctor relationship that is more empathetic, compassionate, and nurturing. Many women go into medicine because they feel rewarded helping people, said Jorge Girotti, associate dean for admissions at the University of Illinois at Chicago Medical School, where 54 percent of the 300 entering students are female.
“If you bring that attitude in, you’re more likely to see the overall patient as a whole rather than just a disease,” he said. “Knowing what may be going on with a particular patient may require a broader interest rather than just the one symptom they tell you about.”
But the sweeping changes also are affecting how doctors spend their time. Female physicians are more likely to work in teams, provide care for the poor, take institutional jobs with shorter hours, and take lower-paying positions, all of which have lower salaries overall, according to experts. They also are pioneering a trend toward part-time work and rebelling against the extremely long hours often associated with the profession.
A recent survey of graduating pediatric residents found 58 percent of the females — and 15 percent of the males — said they had a strong interest in part-time work. Now, just 15 percent of pediatricians work part time.
“Both men and women are coming into medicine with an interest in being able to combine career and family, and they are not willing to sacrifice completely toward their profession,” said Dr. Wendy Levinson, chief of medicine at the University of Toronto.
Many women like to work for hospitals and other major medical facilities where part-time work is an option and group malpractice insurance is provided, said Debra Roter of Johns Hopkins University. They also are more likely to favor national health insurance.
“Female physicians, just like female workers in many other professions, tend to go in and out of the workforce during childbearing years when they’re raising their children,” she said. “Working for some rationalized medical insurance plan would allow them to have more reasonable work hours.”
Dr. Rebecca Turk, a pediatrician at Loyola University Medical Center, Maywood, started off working full time, but as the first of her four children came she decreased her office hours. Now she works three days a week and one Saturday a month.
“I really love being a doctor and I also love being a mother and having time with my children. It’s nice to be able to do both,” said Turk.
Many of the female pediatricians she knows are doing the same. “As I talk to them we just find a nice balance in our lives,” Turk said. “Many of the experiences I’ve had as a mother, spending time with my children, enable me to be helpful to the families I care for because I can relate to what they’re going through.”
It used to be that the longer hours a doctor worked, the better doctor he or she was, said Dr. Amy Halverson, a colorectal surgeon at Northwestern Memorial Hospital, who was usually so engrossed in her work that she often spent 14-hour days at the hospital.
Since she got married a year ago, Halvorsen has cut at least two hours off her workday and she doesn’t go in on weekends.
“I’ve committed to playing golf with my husband once a weekend so that we have that quality time together,” she said. “But the pre-married Amy Halverson would often work on the weekend.”
But the trend of physicians spending less time at work and more time with their families is contributing to a looming doctor shortage, experts warn.
Doctors’ desires for a better life clash with people’s growing expectation of around-the-clock access to health care. That is exacerbating a shortage in some specialties — radiology, anesthesiology, orthopedic surgery, cardiology, and dermatology — and it’s creeping up in others, said Dr. Richard A. Cooper, director of the Medical College of Wisconsin’s Health Policy Institute.
The problem is that the U.S. has not built more medical schools despite an increasing demand for more services from a growing population, he explained. Meanwhile, as physicians in practice work fewer hours, they are not producing as much care as the same number did 10 years ago.
“The real global shortage of physicians, where people will really be upset, is probably at least five years away,” Cooper said.
According to experts, the influx of women into medicine has two main causes: the larger movement of women into the professional workforce and the shrinking pool of male college students. A generation ago male students were in the majority on college campuses; now they make up just 40 percent of enrollment, giving women a numerical advantage for medical school openings.
Meanwhile, doctors’ income has declined because of restrictions put in place by health maintenance organizations and cutbacks in Medicare and Medicaid payments. As a result, many male college students are pursuing more financially rewarding careers, such as in business.
“Medicine is not as lucrative anymore,” Roter said. “When professions are like that, they tend to open up to women.”
As that happens, observers say, women are bringing greater communication skills and empathy to doctoring, possibly resulting in better outcomes and fewer malpractice suits.
“Our research says that women doctors spend more time with their patients in communication, and they tend to be more likely to engage in discussions of the emotional aspects and psychosocial elements associated with people’s health behaviors and the consequences of that for health,” Roter said.
Data show that demonstrating an ability to listen, to be empathetic, and to show concern cut down on spurious malpractice claims that eat up time and are painful to families and the medical profession, said Dr. Gerald Hickson, director of Vanderbilt University’s Center for Patient and Professional Advocacy.
“Families tell us repeatedly that the factors that promote malpractice suits are their perceptions that we don’t listen to them, that we don’t care about them as human beings, and that we don’t provide access to them when the patient or their family believe they need access,” Hickson said.
Dr. Monica E. Peek, an internist at Rush University Medical Center, said it’s important to get patients involved in making the decisions that affect their care.
“The first thing I always say is, ‘OK, what’s on your mind?’ ” she said. “ ‘What do you have to tell me since I’ve seen you last?’ If people think you have their best interest at heart, if they know that they can trust you, they can tell you whatever, even if it means, ‘No, I actually didn’t take that medication.’ ”
With the help of new medical school courses, students are being taught to adapt this knack for listening to and communicating better with patients.
“Male doctors are doing more of that and they’re trained to do it,” Roter said. “Medicine is changing in a lot of ways, including having men be better communicators than they were in the past.”
Dr. Raymond Curry, executive associate dean for education at Northwestern University Feinberg School of Medicine, said medical education is undergoing its biggest changes since the Flexner report in 1910, which took the curriculum out of the hands of quacks and put it on a sound scientific footing.
“There are very dramatic differences in the whole orientation of medicine and medical education,” Curry said. “I think you would find a fair amount of sentiment among medical educators that having so many women in the student body, and increasingly as faculty, has helped to humanize medicine.”
The changes in attitude require that doctors shed the authoritarian “god complex” that has been a defining characteristic of medicine in the past.
“Part of that has been a bad aspect of previous training,” said Hickson. “We take some of those good human beings who walk into medical school training and by example we teach them to be what we call the ‘medical narcissist.’ ”
The student who entered medical school two decades ago was still thinking that medicine was going to continue in the same golden era where doctors were independent, worked on their own and got paid for whatever they billed, said Girotti of UIC.
“I’m amazed at today’s students, at how conscious they are of what it is they’re facing,” he said. “They’re not coming in with any illusions that things are going to be like they were 20 or 30 years ago. They realize the fundamental role that a doctor has in helping individual people.”
Source: Ronald Kotulak, Tribune science reporter, Published January 12, 2005. Copyright © 2005, Chicago Tribune.
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