Women in medicine

[mcater2006]

Dear Premed101'ers:

 

While doing final preparations I stumbled across this question:

 

"Given the increasing presence of women in medicine (i.e. female physicians) today, how do you think that impacts on the workforce in general?"

 

I would like to know what they are after for this question. I had answered that it's good to see women entering trad male dominated, Canada has come a long way, close the gender salary gap -- no more sexism, bringing issues like maternity leave to the table, liberate women from home-bound nurture secondary roles into roles wielding great authority and command and intellect.

 

But I'm not sure if that's what they want for the answer to this question. Please advise.

 

Thanks.

 

mcater2006

[mistah_g]

Not only that.. it talked about the lack of women in surgery, especially fields like orthopedics. It was a good article for seeing both sides.

[Madz25]

another issue that comes up aside from women taking time off for maternity leave, is that women, in general, dont work as many hours as men (although, nowadays men are working fewer hours as well). with the doctor shortage, some may argue that this wont help our healthcare situation with the increasing percentage of women being admitted to medicine.

 

on the flip side, more women go into family medicine, which will help the doctor shortage.

 

there are many issues, some which have already been mentioned above. i just thought i'd add some other things i had heard. feel free to correct me if i've stated something incorrectly!

 

hope this helps.

[cluelesswonder]

are you kidding me? that Maclean's article was definitely NOT balanced, nor did it provide any intelligent contribution to the debate. dean carol herbert from western has a good response to the article in the CMAJ if you're interested.

 

the author of that article was the same woman who wrote the scare article on the HPV vaccine. i've lost all respect for maclean's for publishing irresponsible things like that.

[Devari]

Which issue can I find that article in? It sounds like it might be worth reading, even if just for entertainment value.

 

One thing to keep in mind with Maclean's is that it's written for consumption by the average Canadian, similar to how Time magazine in the U.S. is written for consumption by the average American. So unfortunately it involves quite a bit of politics and bias that often obscures the actual issues being discussed. I've come across some good articles in Maclean's but I've also read a fair bit of crap as well, so I personally don't expect particularly high standards from the magazine.

[Devari]

It's on the front cover of the magazine. You can't miss it.

 

I think it was Feb/March one... not too sure. Maybe early March?

 

Thanks for the info, I'll take a look at the newsstands and see if they still have that issue. I don't read Maclean's often because I don't have a subscription but if there is an issue that has a particularly relevant or interesting article I'll often try to track it down. I'm not usually particularly interested in Canadian politics (since our government/politics are exceptionally boring) but I try to keep informed about major health care issues.

 

100th post! SPARTA!/3

[Ollie]

The Macleans story is in the January 14 issue. The response in the CMAJ is in the the March 11 issue.

[Smurfette]

I didn't read the CMAJ article. But the MacLeans one basically argued that women in medicine is compounding the problem with the shortage of doctors because (a) women work less hours or not at all (due to family commitments, childbirth, etc.), and ( women spend more time with each patient. They did mention that women spend more quality time with patients which can reduce the number of times that patients come in for the same thing. But as a whole, I found the article rather offensive (I'm a woman in med, so I'm biased, but some of my male classmates were offended too).

 

Besides the obvious issues of equality, the article de-emphasized a number of important points. In my opinion, one of the most important points that they didn't really discuss very much (they casually mentioned it) is that it's not just women in medicine that are choosing lifestyle/family over career. It's men too. It's really a generational thing more than a gender thing. Both men and women doctors graduating now want to spend time with their families and have a life outside of their careers. It's the old doctors (men because at that time there were few women doctors) that choose to work 100-hour weeks until the day they die.

[Devari]

That's pretty funny actually. That type of argument is rather ridiculous because it could be applied to pretty much any career that a woman might choose to pursue. Since women would need to take at least some time off during pregnancy they will therefore always have less time to pursue a career than men would. Based on that type of reasoning you could make an entire series of equally idiotic suggestions. Did the author also consider that if women stopped driving cars there would be fewer cars on the road and therefore fewer accidents, pollution, and infrastructure costs? Or that women who work are contributing to a sandwich shortage because if they're out working they obviously aren't in the kitchen making someone a sandwich?

 

It sounds like if we just get women to stop working and stop driving cars this would fix most of our problems. More healthcare, less traffic problems and a steady supply of sandwiches! Don't they have a place like that where I can visit to see how well it works? Oh, wait, I think it's called Saudi Arabia. From what I’ve heard it’s a great place to live, as long as you happen to have a Y chromosome.

 

It sounds like the Macleans and CMAJ articles will be very entertaining to read, hopefully it won't be too difficult finding those issues.

[gogopogo]

That's pretty funny actually. That type of argument is rather ridiculous because it could be applied to pretty much any career that a woman might choose to pursue.

Agree to disagree, perhaps. A woman holding a position like a company CEO, or a Bay Street lawyer (both comparably paying jobs) will have her career options limited by choosing a family. It may not be right, but it happens every day. Men and women have the choice to be with their families whenever they want, and in both situations a career can be jeopardized by not seeming "committed" enough to the employer. Biggest difference? A doctor is always a doctor, qualifications and the "perceived value" of that employee to the employer do not really diminish over time. This contrasts lawyers and businesspeople which must not only do competently, they are expected to consistently outperform every day. Those that don't (or can't, due to personal choices) get fired or bumped down, it is that simple.

This just can't happen with doctors, you cannot devalue a doctor that practices safely, even though they may only practice once a week. Other professions provide (in my opinion) a much worse scenario than medicine for women wishing to have a family, and are not comparable, imo.

[Devari]

Agree to disagree, perhaps. A woman holding a position like a company CEO, or a Bay Street lawyer (both comparably paying jobs) will have her career options limited by choosing a family. It may not be right, but it happens every day. Men and women have the choice to be with their families whenever they want, and in both situations a career can be jeopardized by not seeming "committed" enough to the employer. Biggest difference? A doctor is always a doctor, qualifications and the "perceived value" of that employee to the employer do not really diminish over time. This contrasts lawyers and businesspeople which must not only do competently, they are expected to consistently outperform every day. Those that don't (or can't, due to personal choices) get fired or bumped down, it is that simple.

This just can't happen with doctors, you cannot devalue a doctor that practices safely, even though they may only practice once a week. Other professions provide (in my opinion) a much worse scenario than medicine for women wishing to have a family, and are not comparable, imo.

 

I do realize that the demands of medicine are somewhat unique compared to other careers, but the exact same arguments have been applied in both cases, i.e., women don't make as good CEOs/lawyers/doctors/etc. as men do because they need to devote too much time to raising children. My biggest issue with the idea that women physicians don't contribute as much to the health care system as male physicians is that it isn't actually supported by any clear statistics or evidence, it's just one of those arguments that's based on general ideas like "women spend more time raising children than men". Which technically is true, but that's primarily because men still don't share proportionally in child-rearing duties. However, as stated by others this is rapidly changing, particularly with issues such as paternity leave becoming far more common and with men becoming more directly involved in raising children compared to previous generations. I would also argue that even if women contributed slightly less time than men to their chosen career because of the demands of child care the benefit of having women proportionally represented in medicine (or any other career) greatly outweighs any small loss of time from pregnancy/childbirth. Not to mention the fact that a woman who is dedicating time to raising her children is making a very valuable contribution to society that is arguably even more important than simply providing more healthcare to the general public. So it's one of those situations where the issues that are brought up may be true in a technical sense but are due to social/gender roles in society rather than to any inherent differences between male and female physicians.

[threadster]

First off - there are clear statistics demonstrating that women work fewer hours per year on average, and work fewer years on average, when compared to men, so lets stop saying there isn't evidence. Secondly, the argument that a new generation of physicians is working less across the board is valid but this doesn't invalidate the former statistics (one could argue that it actually makes them more relevant). And thirdly, comparisons to other professions are misleading because the inquiry stems from the amount of public funding required to train physicians, along with the discrepancy between physician hours required for the health care system and physician hours available. These issues are not present with CEOs, lawyers, and investment bankers.

 

People who are offended with these articles should stop trying to argue the premise and switch to arguing the solutions. Nothing in these articles should lead any reasonable thinker to believe we need fewer women in medicine. There's lots of evidence that women enhance our pool of physicians in many ways, including the ways they interact with patients and the specific fields they choose. As the physician gender gap closes we need to find ways to support physicians who choose to work part time (to prevent losing them entirely) and we need to expand our system's ability to train doctors in a way that meets current needs under a modern framework.

[Devari]

Having not read either article yet some of these issues may have already been addressed (someone can point out if the articles have already addressed these topics) but I'll respond to some of these comments anyways.

 

First off - there are clear statistics demonstrating that women work fewer hours per year on average, and work fewer years on average, when compared to men, so lets stop saying there isn't evidence.

 

If "clear statistics" are available then I'd like some kind of reference for this so I can take a look at the numbers myself. Assuming for the moment that this is true and that it is a significant difference (i.e., at least a 10% difference or greater), then the reasons for this also need to be explained. If this is a result of women bearing a disproportionate amount of child-care duties, for example, then this is really a social issue that affects women in general, it's not necessarily a specific "women in medicine" issue.

 

Secondly, the argument that a new generation of physicians is working less across the board is valid but this doesn't invalidate the former statistics (one could argue that it actually makes them more relevant).

 

Again, the real question is why this is the case. If women are spending more time raising children than men, then this reflects a deeper underlying social issue. If men and women shared equally in raising children (which is what should happen, at least in an ideal situation) then you would expect to see very little difference in terms of the time dedicated to their careers, other than the difference in time that a woman would need to take off work during pregnancy.

 

And thirdly, comparisons to other professions are misleading because the inquiry stems from the amount of public funding required to train physicians, along with the discrepancy between physician hours required for the health care system and physician hours available.

 

This is really a much larger issue that has far more significant problems than whether male and female physicians work the same number of hours on average. For example, there is nothing that requires Canadian medical graduates to stay in Canada after they complete their training. So the way the system currently works there is really no way to ensure that the public funding spent on training a Canadian medical student will even result in producing a doctor that stays in Canada. Of course, the majority of Canadian medical graduates do choose to stay in Canada, but the point is that the system is not currently designed to maximize the effectiveness or value that is derived from Canadian-trained physicians. So to really get the best value for the training dollars spent there needs to be a considerable overhaul across the entire system, not just by addressing minor differences between the hours worked by male and female physicians.

[xone]

I'm reading some interesting stuff here. I can see some knee-jerk responses towards the ideas posed in this article.

 

I feel we're almost conditioned to think of issues like this from a gender-equality perspective that is deeply instilled into many of us (and in my opinion rightly so). However, while we refuse to apply the time-money argument to women, many of us do so readily against other population, such as the elderly generation. I was in Ottawa and a lady was explaining to me how there was a fairly old applicant (maybe 45-50yrs old) to UofM med school, and how she'd uncomfortable letting him in because he'd have fewer practicing days compared to his younger individuals. She didn't have a great retort when I mentioned the application of this logic to women. Just something I've noticed and something to maybe keep in mind. I think quality is more important than quantity. Moreover, even quantity may be misleading, as I've met many physicians and students who want to retire before they are 40 or 50. It really does make the economic argument a little questionable on all populations. 'tis a slippery slope.

[threadster]

Hi Devari,

 

I assumed that if I divided things into firstly, secondly, thirdly, I'd get three distinct points from you. Glad to see you follow through. You'll notice in my first point that I didn't refer to medicine at all. That was on purpose, so I'm glad to see you figured out that this point wasn't medicine specific. I'm also quite happy to see that you've created your own rules for significance (10% difference versus standardly accepted statistical practices). Furthermore, I was thrilled to see that you've decided the differences in hours worked by male and female physicians were "minor" before even reading the articles or doing any research. Considering you haven't even read the articles we're discussing, you'll excuse me if I don't waste my time digging up even more references for you.

 

Your first two points highlight the same principle that women spend more time caring for children. Great. No-one here ever thought of that. Your emphasis on explaining the causes of this discrepancy seems counterproductive to me, unless you have suggestions to change the causes. We all know societal issues are at play here. It would be great if men and women shared family responsibilities equally but they often don't and I doubt you can regulate this in any reasonable way. Your third point shows that you understand my third point but adds nothing beyond what everyone here can infer on their own.

 

I wonder if I put the second paragraph of my initial post in point form - would you have been more interested in discussing a plan to deal with these issues?

[cluelesswonder]

Secondly, the argument that a new generation of physicians is working less across the board is valid but this doesn't invalidate the former statistics (one could argue that it actually makes them more relevant).

 

How does it make them more relevant?

 

 

People who are offended with these articles should stop trying to argue the premise and switch to arguing the solutions. Nothing in these articles should lead any reasonable thinker to believe we need fewer women in medicine. There's lots of evidence that women enhance our pool of physicians in many ways, including the ways they interact with patients and the specific fields they choose. As the physician gender gap closes we need to find ways to support physicians who choose to work part time (to prevent losing them entirely) and we need to expand our system's ability to train doctors in a way that meets current needs under a modern framework.

 

I agree, but that Maclean's article was offensive because it didn't even bother to consider solutions to the problem. While no "reasonable" thinker might believe that we need fewer women in medicine, that WAS the article's implicit suggestion - and a frustrated, doctor-less "average reader" might not make the "reasonable" conclusion.

 

As previous posters have mentioned, the article barely touched on the fact that the entire younger generation of physicians--women and men--is moving toward fewer work hours and a better work-life balance. Particularly offensive, to me, was that it also tossed out random statements that weren't even connected to the doctor shortage, such as blaming women for turning medicine into a "pink ghetto" because policymakers won't respect a profession dominated by women, or arguing that women "don't take on leadership roles in medicine." (AND then it had the audacity to quote Danielle Martin and refer to her only as "a family physician" without mentioning that she is the founder of an influential organization of physicians! Argh).

 

I would have loved to hear the authors talk about some of the REAL reasons for the physician crisis (i.e. the governments ****ting the bed on class size in the '90s) or about how we should improve things, but it chose to go for controversy over substance.

[threadster]

How does it make them more relevant?

 

As you and others have pointed out, women working fewer hours or fewer years is just one of many compoundnig issues that contribute to doctor shortages (brain drain, generational trends). I just meant that this is one angle pointing towards a broader issue and that the compounding effects enhance each angles relevance.

 

I completely agree that parts of the article are offensive, but I also know you're not surprised the media chose controversy over substance, so someone has to take the higher ground and I think the medical profession itself would be a great place to start.

 

An effective strategy when dealing with a poor thesis is to reject the conclusions firmly and quickly direct the course of further discussion. If we get caught up picking at the details we may miss a real leadership opportunity here.

[Devari]

Hi Devari,

 

I assumed that if I divided things into firstly, secondly, thirdly, I'd get three distinct points from you. Glad to see you follow through. You'll notice in my first point that I didn't refer to medicine at all. That was on purpose, so I'm glad to see you figured out that this point wasn't medicine specific.

 

Actually, It wasn't clear whether your first point was supposed to be medicine-specific or not, which is why I specifically addressed this issue.

 

I'm also quite happy to see that you've created your own rules for significance (10% difference versus standardly accepted statistical practices).

 

The issue I was referring to is that in many cases a "difference" can exist that is neither statistically or practically significant. This is why I asked for the source of your information so I can take a look at the numbers myself.

 

Furthermore, I was thrilled to see that you've decided the differences in hours worked by male and female physicians were "minor" before even reading the articles or doing any research. Considering you haven't even read the articles we're discussing, you'll excuse me if I don't waste my time digging up even more references for you.

 

Sorry, but you specifically made a statement that "clear statistics" are available to support your argument. I've clearly asked you to provide the source or reference so I can take a look at them myself. If you're unable to tell me where I can find these "clear statistics" that support your statements then I'm not going to simply take your word for it.

 

Your first two points highlight the same principle that women spend more time caring for children. Great. No-one here ever thought of that. Your emphasis on explaining the causes of this discrepancy seems counterproductive to me, unless you have suggestions to change the causes. We all know societal issues are at play here. It would be great if men and women shared family responsibilities equally but they often don't and I doubt you can regulate this in any reasonable way. Your third point shows that you understand my third point but adds nothing beyond what everyone here can infer on their own.

 

I wonder if I put the second paragraph of my initial post in point form - would you have been more interested in discussing a plan to deal with these issues?

 

I've been trying to discuss some of the underlying issues involved here rather than focus only on the differences between the number of hours worked by male and female physicians. I'm not necessarily concerned about "solutions" because this isn't necessarily a "problem" that needs to be fixed. As I mentioned above, if the reduced amount of time that women spend in their careers is spent raising children then this will probably benefit society overall. The effort that goes into raising a child properly is arguably more important than simply spending more time in one's career. So I'm looking at this from a general societal perspective. I'm not just concerned about seeing men and women spend equal times in their chosen careers, because if this comes at the expense of raising a child properly then it really won't improve society overall. There are more important things to consider than ensuring that physicians work the highest possible number of hours. So we’re clearly approaching this issue from two different perspectives.

[vip_138]

The effort that goes into raising a child properly is arguably more important than simply spending more time in one's career. So I'm looking at this from a general societal perspective. I'm not just concerned about seeing men and women spend equal times in their chosen careers, because if this comes at the expense of raising a child properly then it really won't improve society overall.

 

i'm not disagreeing with you, but more to play devil's advocate on the part i quoted:

 

if raising children is more beneficial to society than being a doctor, and that women have more responsibility in this (not saying they should, but its obviously the case in a majority of households) then isn't this an argument for women not to be doctors. if you want to be completely utilitarian, then the best benefit for society would be for medschools to take 100% men, and those men to work as much as possible (ie. something like 80 hours a week). Technically the school could take women and they could work the same hours while their SO spent all their time being the caregiver but as you said earlier,

childcare is usually disproportionate (there are exceptions of course).

 

btw, i have seen statistics, somewhere altho i can't remember, i'm sure theadster will find them, but if i remember correctly they were roughly a little over 10% difference (altho i'm not sure if this was in a specific age group since it could be argued that older docs are more likely to be male and work more than younger docs).

 

I personally agree that there are underlying issues that need to be solved about our healthcare, but i think its important to understand why our healthcare service might be different than say 20 years ago.

 

I actually think there should be a complete overhaul of our system to try to provide service while allowing HCP to have an actual lifestyle

[NLengr]

I hoped to avoid this thread all together, since it's too much of a powder keg. We had a class discussion on the article last term, and it was far from calm and reasonable.

 

I just wanted to point out, the numbers we learned in our community health course the past term were:

 

1. Female physicians work 80% of the time that male physicians do, even when controlling for age.

 

2. Female physicians spend more time per patient (9 vs. 13 minutes or something. Can be seen as a good thing, or a bad thing, depending on the situation).

 

3. Females are more likely to become family physicians (again good or bad, depending on the situation).

 

I'm not making any judgments of either sex based on the numbers. They are merely numbers.

[gogopogo]

Yeah wow, powder keg, indeed.

 

So rather than arguing something that already can be decisively proven (I'm a Maclean's subscriber and still have the issue plus I read a multitude of journals and papers weekly, so yeah, there's clear evidence, now put it to rest) I'd love to actually debate a solution. If we all consider ourselves to be relatively bright individuals (and I suspect that we do) then what would work, other than a "complete system overhaul" as is so often the answer. If the system could be fixed, how would you fix it?

 

I would establish a maximum 40 hour workweek and immediately double the amount of doctors being trained. A recent article in the Winnipeg Free Press (Mar. 18/08) discussed the pains of Manitoba's doctor shortage and highlighted the loss of our resident candidates to other provinces or countries. This loss of local talent compounds with the several hundred premedical students who, despite their best efforts, are only able to secure acceptance to an international school, typically in Australia or Europe. Clearly, we are not allowing enough money to be utilized for training if we must lose so much talent every year during selection processes. Let's face it, most of us (me too probably) would accept an offer from abroad if it was our only shot. You constantly hear griping about "ooh it costs a hundred-seventy thousand a YEAR to train a doctor" here, but what is not teaching more doctors really costing us? There's a pretty darn overworked Health Care field out there and it seems like they could use more help, not a tighter budget.

 

Looong story short, more doctors and shorter workweeks lead to less overall stress, more productivity and personal satisfaction, and, yes, more time for family raising. Downside is less money for those people into that sort of thing:P, not to mention about ten years of absolute catastrophic scramble while the first new docs are trained (did I mention this'll cost a fortune?).

 

Whaddaya think?

[Devari]

I hoped to avoid this thread all together, since it's too much of a powder keg. We had a class discussion on the article last term, and it was far from calm and reasonable.

 

I just wanted to point out, the numbers we learned in our community health course the past term were:

 

1. Female physicians work 80% of the time that male physicians do, even when controlling for age.

 

2. Female physicians spend more time per patient (9 vs. 13 minutes or something. Can be seen as a good thing, or a bad thing, depending on the situation).

 

3. Females are more likely to become family physicians (again good or bad, depending on the situation).

 

I'm not making any judgments of either sex based on the numbers. They are merely numbers.

 

Thanks for the information, that's exactly what I was looking for. It would seem that based on the information you've provided that there is no clear difference in terms of "quality of care" between male and female physicians. Although female physicians work fewer hours on average since they apparently spend more time with patients and are more likely to become family physicians this may even out in terms of overall benefit to the healthcare system. Definitely provides some interesting information to consider.

[Devari]

i'm not disagreeing with you, but more to play devil's advocate on the part i quoted:

 

if raising children is more beneficial to society than being a doctor, and that women have more responsibility in this (not saying they should, but its obviously the case in a majority of households) then isn't this an argument for women not to be doctors. if you want to be completely utilitarian, then the best benefit for society would be for medschools to take 100% men, and those men to work as much as possible (ie. something like 80 hours a week). Technically the school could take women and they could work the same hours while their SO spent all their time being the caregiver but as you said earlier,

childcare is usually disproportionate (there are exceptions of course).

 

Well, if you want to use a strictly utilitarian argument then you could argue that the government should be given the authority to rework the healthcare system to provide the most effective healthcare possible with the physicians that are trained using public funding. For example, from a strictly practical perspective it would be most efficient for all Canadian doctors to be directly employed by the government and sent throughout the country as needed to provide the maximum benefit to the healthcare system. Sort of like how the RCMP would send police officers to where they're needed most, with little or no considerations for "personal preference". That way you could ensure coverage of underserviced or remote areas and even out access to healthcare across the country. On the other hand, most physicians would not be particularly happy to be told where to practice medicine by the government. So it's one of those issues where the only way to ensure that we get the most value for our healthcare dollars really requires a very authoritarian government that makes decisions for the "greater good" to override physicians personal preferences. That's obviously never going to happen, but ultimately some of the main reasons for the healthcare shortage in Canada have a lot to do with physicians choosing specialties other than family medicine, preferring to work fewer hours and preferring not to work in remote areas. Each of these are ultimately personal choices that collectively have a large effect on how efficiently the healthcare system can provide services in Canada.

[JewelLeigh]

MacLean's article:

 

http://www.macleans.ca/article.jsp?content=20080102_122329_6200&source=srch

 

 

CMAJ response:

 

http://www.cmaj.ca/cgi/content/full/178/6/659

[threadster]

I'm not necessarily concerned about "solutions" because this isn't necessarily a "problem" that needs to be fixed.

 

I'm not just concerned about seeing men and women spend equal times in their chosen careers, because if this comes at the expense of raising a child properly then it really won't improve society overall. There are more important things to consider than ensuring that physicians work the highest possible number of hours. So we’re clearly approaching this issue from two different perspectives.

 

Critical reading needs to go way up. I never said men and women should spend equal time in their careers and I never said that we should ensure physicians work the highest possible number of hours.

 

"there isn't necessarily a problem" Well reporters wouldn't be doing stories about this issue if there wasn't a doctor shortage. It's very nice that people are helping you out with spoon fed links, and it's great to look at issues from different perspectives, but if you really want to contribute to a discussion about an issue then you need to do your own reseacrh and actively read other posts.