Gender Gaps In Medicine

[kbrolinen]

Two points:

1. Men in general have lower educational attainment than women. They complete less schooling and make up a lower % of students at all stages of postsecondary training. Combined with outsourcing and automation of jobs, a lot more men nowadays find themselves in low-wage, precarious jobs, with the few that do attain education able to enjoy better-paid and secure jobs. It is a big and growing problem in Western societies and is thought to be partly causing lowered marriage rates, and a rise in single-parent households (women typically do not marry down in education or pay). Male children in single-parent households are at an even greater risk of repeating this pattern, so the trends towards lower educational attainment for men are set to continue in the near-term. There is a report about this from MIT that you should all read (or at least look at the figures).

 

2. As a guy in a high-earning, high-prestige field like medicine, why complain? The numbers are working out in your favour. There are 2000 more women than men among medical trainees right now. You literally have your pick of the litter. Women in medicine that want to have children are doubly screwed in this regard, as lengthened training really puts pressure on finding someone suitable quickly. Not to mention that the same trends are true in other professional fields and men typically do not put as much value on women's social status as women do on men's. 

 

I kid about #2 btw. Not the facts - because the facts are what they are, but the tone. Western societies need to figure out ways to deal with the diengagement and educational lag of males. Single, unmarried, frustrated men cause wars and crime. It's the one unmistakable sign of male intrasexual competition.

[1D7]

4) If it helps, I do have an idea or two of how to keep public discussions to students only. In any case, my point is that self-censuring is not the same as being censured by others. In the situation you described, the claim of bias didn't shut people up, they shut themselves up. The original speaker could have used support, but was left in the wind, simply because someone disagreed with them.

 

It's disingenuous to suggest that people can simply "speak up" and defend their views in a public setting. In the best of cases, doing so leads to friction & animosity within a team/group. More likely though someone with non-conforming views would be putting his/her reputation (or even career) in jeopardy by defending their thoughts.

 

With many sensitive societal topics there is an enormous pressure for those with alternate views to either conform or stay silent.

[ralk]

It's disingenuous to suggest that people can simply "speak up" and defend their views in a public setting. In the best of cases, doing so leads to friction & animosity within a team/group. More likely though someone with non-conforming views would be putting his/her reputation (or even career) in jeopardy by defending their thoughts.

 

With many sensitive societal topics there is an enormous pressure for those with alternate views to either conform or stay silent.

 

I don't think it's disingenuous at all. It takes a bit of courage, and a bit of tact, but disagreement is part of a well-functioning team and doesn't necessarily need to lead to animosity. Take uwopremed's example of the person discussing awards. He claims there were several people who agreed with the original speaker. Presumably, because he knows that there are multiple people, they also know (or could know) of each other. Would it really be so hard for these people to collective respond in support of the original speaker?

 

"We recognize that women still face pressures that men do not. However, the situation for women in medicine has changed dramatically since many of the women-only awards were created and we don't think it's unreasonable to reevaluate the appropriateness of those awards, particularly as women are now in the majority at medical schools as a whole. At a minimum, we don't believe calling [original colleague's] suggestion evil helps our group work together productively and regardless of how everyone in our group feels on this issue, we hope that we can continue having our discussions with civil responses to each other's ideas."

 

The above is a statement I'd disagree with in terms of its suggestions regarding awards, but it's one that first de-escalates the situation and then constructively reiterates the view of the original speaker. It invites others with similar viewpoints to speak up as well, and supports the original speaker, who already made the first step to put themselves out there. Disagreement is not persecution and the best way to remove what pressure there is to "conform or stay silent" is to support those willing to respectfully dissent.

 

I'm encouraging uwopremed to speak publicly primarily to challenge his notion that his views are part of the majority. I don't doubt that the majority of the people he talks to are supportive of his viewpoints, but echo-chambers exist precisely because they don't let their views be heard - and criticized - more broadly. It's easy for uwopremed to claim that silent majority when he never puts his views to the test. If he did speak out, and the majority of individuals agreed with him, he might actually see the change he advocates happen. But, if he's not in the majority, than he has to face the uncomfortable possibility that he might be wrong, and so he only provides his viewpoint when he feels perfectly safe when he has anonymity, is surrounded by those he knows agree with him (hence the statement that he would only publish his viewpoints in papers already receptive to his viewpoint, like the National Post), or has a degree of power over those he's speaking to (waiting until he's a resident or staff to speak up).

 

Where I would agree that there can be consequences for speaking up is when viewpoints are expressed in a way that demeans, dismisses, or denigrates those who might disagree with the opinions presented. What I've tried to reinforce throughout this thread is that any viewpoint can be expressed in a respectful manner and, if done so, won't expose the speaker to significant blowback and could encourage those with similar viewpoints to come forward. Medicine has entrenched viewpoints, but respectful disagreement is exceedingly common. I don't believe uwopremed is interested in presenting his views respectfully, and that his unwillingness to change the style of his arguments is the main reason he fears speaking out, not because of anything to do with the substance of those arguments. In short, he wants the right to offend others without consequence, and is resentful that he does not have that right. That's the other reason I encourage him to speak out publicly, so that he has to learn to phrase his ideas more respectfully, while there's still an incentive to do so.

[older]

Well said ralk.

Difference of opinions are not only interesting, they are invaluable in getting a perspective to one's views. Professional discussions lead to betterment and consensus.  If a future doctor cannot listen, respect other views, and express own opinions in respectful manner, it is a serious flaw. Quite a few people on this Forum - presumably doctors or future doctors - show this trait, and can benefit from your advice. They'll have to function as a part of a team in their professional life, so they'd better learn fast.

[uwopremed]

I do want to respond to Ralk.  I don't think my opinions reflect the large majority or even a majority in my class, or even in society.  But A LOT of people do harbour those views - considerably more than would be indicative on a board like this that tends to lean left on issues such as women in medicine.  Speaking out with a centrist or right wing opinion on campus has historically led to concerns about punitive punishment.  Certainly that has happened, even in very recent times, to academics in Ontario universities.  The amazing thing is that it's actually worse on US campuses than in Canada.

 

The Trump election in the US, and the slow steady rise of Leitch (at least in small town Canada) are testament to the fact that many people are angry that some speech is considered more acceptable than others.  This does not mean that the left is wrong.  There are genuine concerns about women's safety on campus.  There are challenges in regards to bias at the uppermost levels of academia for women - at least those that have families.  I don't want to dismiss all concerns that the left has.  But i feel that there has been such a radical lurch in the last few years - such that whenever there are issues that effect men worse, those that bring up the claims are neglected or treated like whiners that have male privilege (or even more damning, white male privilege). 

 

I suppose this forum, where my name is not emblazoned everywhere, does embolden me to speak my mind in a way I would not do face to face.  Not sure if that is good or bad - but it is one of the issues that the internet has created.

 

 You can't read even an innocuous youtube video comments without insanely racist and sexist banter - so this forum is an utopia of enlightened souls compared to much of mass social media.

[amichel]

I do want to respond to Ralk. I don't think my opinions reflect the large majority or even a majority in my class, or even in society. But A LOT of people do harbour those views - considerably more than would be indicative on a board like this that tends to lean left on issues such as women in medicine. Speaking out with a centrist or right wing opinion on campus has historically led to concerns about punitive punishment. Certainly that has happened, even in very recent times, to academics in Ontario universities. The amazing thing is that it's actually worse on US campuses than in Canada.

 

The Trump election in the US, and the slow steady rise of Leitch (at least in small town Canada) are testament to the fact that many people are angry that some speech is considered more acceptable than others. This does not mean that the left is wrong. There are genuine concerns about women's safety on campus. There are challenges in regards to bias at the uppermost levels of academia for women - at least those that have families. I don't want to dismiss all concerns that the left has. But i feel that there has been such a radical lurch in the last few years - such that whenever there are issues that effect men worse, those that bring up the claims are neglected or treated like whiners that have male privilege (or even more damning, white male privilege).

 

I suppose this forum, where my name is not emblazoned everywhere, does embolden me to speak my mind in a way I would not do face to face. Not sure if that is good or bad - but it is one of the issues that the internet has created.

 

You can't read even an innocuous youtube video comments without insanely racist and sexist banter - so this forum is an utopia of enlightened souls compared to much of mass social media.

I don't really feel like arguing with all your ridiculous statements here. However, I'd like to point out that some speech IS more acceptable than others. You can't dismiss all your sexist, racist comments as "everyone is entitled to their opinion".

 

Everyone is entitled to their opinion, that's true. But some opinions are more valid than others, and some opinions don't deserve to be spewed to the rest of the world.

[older]

I generally disagree with uwopremed post but he has a point. Political correctness often stifles honest discussion. It  is not always clear where is the line between "conservative" thinking and sexist, racists, and other unacceptable comments. What is "sexist' to some,  is only "reasonable" and "true" to others.

 

One thing that should guide any discussion is respect for others. If you know your comments are inflammatory and harmful, you may want to withheld your opinion even if you think you are right. But that may lead, in turn, to expressing your views only in echo chambers.

 

Anonymous fora are quite a good for open discussion. If you say something offensive, at least there are enough responses to make you realize that  you crossed the line without negative consequences to you. It's a good learning process.  

 

Members of this forum are educated people, professionals or aspiring to the profession that requires a lot of tact, understanding and sensitivity.  I find it  refreshingly different comparing to other  "free" fora where offensive comments and language is rampart, and removal posts by moderators is a rule rather than exception.  

[ralk]

I do want to respond to Ralk.  I don't think my opinions reflect the large majority or even a majority in my class, or even in society.  But A LOT of people do harbour those views - considerably more than would be indicative on a board like this that tends to lean left on issues such as women in medicine.  Speaking out with a centrist or right wing opinion on campus has historically led to concerns about punitive punishment.  Certainly that has happened, even in very recent times, to academics in Ontario universities.  The amazing thing is that it's actually worse on US campuses than in Canada.

 

The Trump election in the US, and the slow steady rise of Leitch (at least in small town Canada) are testament to the fact that many people are angry that some speech is considered more acceptable than others.  This does not mean that the left is wrong.  There are genuine concerns about women's safety on campus.  There are challenges in regards to bias at the uppermost levels of academia for women - at least those that have families.  I don't want to dismiss all concerns that the left has.  But i feel that there has been such a radical lurch in the last few years - such that whenever there are issues that effect men worse, those that bring up the claims are neglected or treated like whiners that have male privilege (or even more damning, white male privilege). 

 

I suppose this forum, where my name is not emblazoned everywhere, does embolden me to speak my mind in a way I would not do face to face.  Not sure if that is good or bad - but it is one of the issues that the internet has created.

 

 You can't read even an innocuous youtube video comments without insanely racist and sexist banter - so this forum is an utopia of enlightened souls compared to much of mass social media.

 

I've said this a few times through the thread, but I think it captures what I'm trying to convey - disagreement is not oppression.

 

The Trump example is a great one. He said things that a lot of people disagreed with, yet the punishment he got for expressing his views was to get extensive media coverage to broadcast those views and then to be elected president. His voters may feel their voices weren't be represented well enough in public circles, but when someone representing their views - or at times, more extreme views then they held - can be elected leader of their country, that perception that their speech was considered "less acceptable" was just that, a perception. It was acceptable enough to a large enough portion of the population to win the electoral college. Likewise, I have trouble accepting that Leitch's rise is because people feel they can't speak their minds. The entire Conservative caucus is in the middle of a broad-based discussion representing multiple viewpoints across the Conservative spectrum. Leitch is gaining (some) traction because there is a group of people that agree with her, nothing more.

 

I'd also like to emphasize that everyone, of every ideological background, will experience disagreements with their peers or superiors and feel some pressure to keep quiet. That's just a part of life - you'll never fully agree with even the most compatible of supervisors, and there can always conceivably be consequences for disagreeing with someone in charge. Learning how to manage these situations is a skill most people simply have to learn, and it's a useful one to improve. For example, I can think of two situations in just the last few weeks where I had a superior - in one case a resident, in another an attending - express a viewpoint I disagreed with. I couldn't exactly object and start saying my entire viewpoint in these circumstances - not as an elective student in my CaRMS year! Yet, I could still present a countervailing opinion without starting a conflict, which is exactly what I did. No hurt feelings, no punishment coming my way, and I could still represent my opinion to an extent.

 

The internet does provide cover to say things without consequence, but remember that there are actual people reading what you write. If you wouldn't say what you would here to your peers, it's worth taking a minute to think why that might be the case and what effect your words could have on those still-real people you encounter online.

[rmorelan]

I generally disagree with uwopremed post but he has a point. Political correctness often stifles honest discussion. It  is not always clear where is the line between "conservative" thinking and sexist, racists, and other unacceptable comments. What is "sexist' to some,  is only "reasonable" and "true" to others.

 

One thing that should guide any discussion is respect for others. If you know your comments are inflammatory and harmful, you may want to withheld your opinion even if you think you are right. But that may lead, in turn, to expressing your views only in echo chambers.

 

Anonymous fora are quite a good for open discussion. If you say something offensive, at least there are enough responses to make you realize that  you crossed the line without negative consequences to you. It's a good learning process.  

 

Members of this forum are educated people, professionals or aspiring to the profession that requires a lot of tact, understanding and sensitivity.  I find it  refreshingly different comparing to other  "free" fora where offensive comments and language is rampart, and removal posts by moderators is a rule rather than exception.  

 

I have  a problem with political correctness when it drives debate underground - like as a recent example the US election in many ways. It doesn't fix anything and tends to result in backlash in ways eventually. 

 

Also it prevents people from actually debating as you mention things that are "obvious" and results to appeal to the norm as a tactic. Many ideas in the past were politically incorrect that we take for granted as truths today. 

[MountainAmoeba]

I have  a problem with political correctness when it drives debate underground - like as a recent example the US election in many ways. It doesn't fix anything and tends to result in backlash in ways eventually. 

 

Also it prevents people from actually debating as you mention things that are "obvious" and results to appeal to the norm as a tactic. Many ideas in the past were politically incorrect that we take for granted as truths today. 

 

I like what you say here, but something to consider is the way in which we communicate to each other, and the context in which we do so. 

 

A society that has no disparity, no "isms" - sexism, racism, etc, creates a context in which it is safe to speak frankly. We come (hypothetically) as equals. 

 

We don't live in that society. We speak to each other as people that come together with varying levels of "power", or "authority". Various levels of internalized oppression. So we should take care, we should be aware that our word choices matter, because we can elevate people, or degrade people through how we approach communication. 

 

There is no reason we can't debate intelligently, passionately, and freely. We just have to consider the other. What they bring to the table, baggage and all, and how we affect them. 

 

Thats my opinion anyways. 

[rmorelan]

I like what you say here, but something to consider is the way in which we communicate to each other, and the context in which we do so. 

 

A society that has no disparity, no "isms" - sexism, racism, etc, creates a context in which it is safe to speak frankly. We come (hypothetically) as equals. 

 

We don't live in that society. We speak to each other as people that come together with varying levels of "power", or "authority". Various levels of internalized oppression. So we should take care, we should be aware that our word choices matter, because we can elevate people, or degrade people through how we approach communication. 

 

There is no reason we can't debate intelligently, passionately, and freely. We just have to consider the other. What they bring to the table, baggage and all, and how we affect them. 

 

Thats my opinion anyways. 

 

sure not all debate is healthy

 

I fear when we spend so much debating words that we are actually not debating ideas. Banning someone from saying sexist/racist etc things doesn't actually make them change their core believes and no longer be sexist or racist. Sometimes it just makes them worse - they become either smarter about it and still manage to find people that reinforce their beliefs, or simply feel that they have dealt with the problem by not speaking in a particular way and become annoyed when you still keep asking them over and over again to change aspects of things. Either way the problem really hasn't been solved. 

[older]

That's not quite true either. People change their minds and opinions all the time, and yes, they are influenced by opinions of others. Of course there are people who never change their core beliefs or shrug prejudices, but intelligent beings usually have open minds.

[Nietzsche_hammer]

Why insist on gender equality, when men and women are diffferent? How can we implant politics that would not give unfair advantages to one sex? What is a fair selection process? Who are the acting agents? Is there any bias?

 

The framework for creating a fair selection process needs to be tested scientifically and not based on random empiric experiences as discussed here. The desire to accomplish this action is faculty based and not nation wide.

 

What is the best course of action?

[SunAndMoon]

Why insist on gender equality, when men and women are diffferent? 

 

 

Agreed. Perhaps we should favour those who would be more likely to succeed at something? 

 

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 

[uwopremed]

Agreed. Perhaps we should favour those who would be more likely to succeed at something? 

 

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 

 

This JAMA article is all over The Atlantic, MD forums, and even discussed in my class.  Despite claims to the contrary, there are major issues with the article, as one would expect.  It only deals with senior patients getting government medical coverage.  It of course does not address all areas of medical expertise - like surgical skills or dealing with violent traumas (which tend to occur with younger patients).  We are talking SPECIFICALLY about general internists/hospitalists - which are among the poorest paid of all US physicians, and where the weakest medical students end up.  For the medicare grouping, physicians are disproportionately filled with IMGs (who are mostly male), and DOs.  We are not talking the top people in medicine.  We are not talking surgeons, anesthetists, radiologists, oncologists, or cardiologists.  The areas where the best males in medicine gravitate towards in high number.  For domestic reasons, many top female medical students still choose hospitalist or GP work. - suggesting that among GPs and psychiatry and general internal medicine, women may in fact on average be better than men anyways.

 

When comparing these relatively poorly paid doctors, often working in poorer environments - we probably have big differences in care between IMGs (that tend to be more poorly trained in issues like communication, and are of course disproportionately male), and american trained physicians (where close to 50% of american trained hospitalists and GPS are female, if not higher).  That alone creates the 'women are better' statistic - without having to touch the hot button issue of male IMGs with poor skills.

 

Like a lot of such 'social' research - only one result would have been allowed to be published by JAMA - and the IMG issue, which ANYONE working among hospitalists in public hospitals in the USA would note in an instant, not being brought up as a confounder is shameful.

 

Feel free to read the study in full detail if you doubt my statements.  Of note - all SIX authors were indeed males, and they do public health research at Harvard. Many of their previous published work tends to have a 'leftward' shift if you will.  I don't doubt the results.  I doubt the broad based meaning because of the significant confounding effects not explored, plus the very narrow focus of the physician work.   IT would be like saying women are better engineers than men because in some small sub specialty of mechanical engineering, there were slightly less errors in the end product with female leads as opposed to male leads.  

[ralk]

This JAMA article is all over The Atlantic, MD forums, and even discussed in my class.  Despite claims to the contrary, there are major issues with the article, as one would expect.  It only deals with senior patients getting government medical coverage.  It of course does not address all areas of medical expertise - like surgical skills or dealing with violent traumas (which tend to occur with younger patients).  We are talking SPECIFICALLY about general internists/hospitalists - which are among the poorest paid of all US physicians, and where the weakest medical students end up.  For the medicare grouping, physicians are disproportionately filled with IMGs (who are mostly male), and DOs.  We are not talking the top people in medicine.  We are not talking surgeons, anesthetists, radiologists, oncologists, or cardiologists.  The areas where the best males in medicine gravitate towards in high number.  For domestic reasons, many top female medical students still choose hospitalist or GP work. - suggesting that among GPs and psychiatry and general internal medicine, women may in fact on average be better than men anyways.

 

When comparing these relatively poorly paid doctors, often working in poorer environments - we probably have big differences in care between IMGs (that tend to be more poorly trained in issues like communication, and are of course disproportionately male), and american trained physicians (where close to 50% of american trained hospitalists and GPS are female, if not higher).  That alone creates the 'women are better' statistic - without having to touch the hot button issue of male IMGs with poor skills.

 

Like a lot of such 'social' research - only one result would have been allowed to be published by JAMA - and the IMG issue, which ANYONE working among hospitalists in public hospitals in the USA would note in an instant, not being brought up as a confounder is shameful.

 

Feel free to read the study in full detail if you doubt my statements.  Of note - all SIX authors were indeed males, and they do public health research at Harvard. Many of their previous published work tends to have a 'leftward' shift if you will.  I don't doubt the results.  I doubt the broad based meaning because of the significant confounding effects not explored, plus the very narrow focus of the physician work.   IT would be like saying women are better engineers than men because in some small sub specialty of mechanical engineering, there were slightly less errors in the end product with female leads as opposed to male leads.  

 

Have you read the article? They clearly state that they account for medical school of graduation and allopathic vs DO in their final model. They don't state IMG vs USMG explicitly, but school of graduation encompasses that in addition to considering the stratification of medical school quality in the US. I agree that this isn't, on its own, generalizable, but the authors also agree with that and say as much in their listing of limitations. It's also worth noting that other research has found differences in male and female practice patterns, with much of it indicating higher quality for female physicians. Much of this work has been done in primary care, so there is certainly room for these results to be field-specific (what research I could find on the effect of the gender of surgeons was mostly limited to the effect on gender-specific surgeries). Still, considering that primary care is the largest area of medicine, and hospitalist care is a very large field as well, even these field-specific results are fairly meaningful.

[uwopremed]

Have you read the article? They clearly state that they account for medical school of graduation and allopathic vs DO in their final model. They don't state IMG vs USMG explicitly, but school of graduation encompasses that in addition to considering the stratification of medical school quality in the US. I agree that this isn't, on its own, generalizable, but the authors also agree with that and say as much in their listing of limitations. It's also worth noting that other research has found differences in male and female practice patterns, with much of it indicating higher quality for female physicians. Much of this work has been done in primary care, so there is certainly room for these results to be field-specific (what research I could find on the effect of the gender of surgeons was mostly limited to the effect on gender-specific surgeries). Still, considering that primary care is the largest area of medicine, and hospitalist care is a very large field as well, even these field-specific results are fairly meaningful.

The MDs are heavily mixed with both IMG and local.  I also said I did not doubt the specific result - but to look at primary care and hospitalist work - and state that male physicians have worse outcomes is a bit ingenious.  While the individuals seen by women may have slightly better outcomes - there is also the issue of the systemic result.  If women spend more time seeing patients - those seen may have better outcomes - but there might be stresses on the system with increased wait times.  I should note that in the big dangerous inner city hospitals - the physicians are by and large men - probably self selected.  And to compare male physcians to female physicians among IMGs and medical schools would have such a small N for females as to be almost useless. 

 

Irrespective, looking at the results of gendered MDs in a single area where the physicians tend to the weakest in medical school is a bit shady.  (http://www.doctorsintraining.com/blog/usmle-step-1-average-match-scores-by-specialty/)

 

There have been multiple studies suggesting that men at the high end are better in most fields of achievement.  Those same studies also suggest that the bottom is also full of men as well.  This is particularly true in mathematics and the physical sciences - i remember when the president of Harvard, Summers, from admonished for having suggested that a few years back while citing evidence.  From what I have witnessed - men seem to be in much better control in the OR than women.  By  a lot.  I'd love to see studies evaluating male conducted surgeries vs female conducted surgeries with complication and survival outcomes.  But such a study might not have the happy outcome that left leaning publications would want. 

 

But I do believe that when female primary care physicians actually see patients, they on average listen more and spend more time with them.  Which for general internal medicine work and primary care work is better. It is not better for acute trauma, or surgeries requiring excellent 3 dimensional visualization (which men tend to be better at), or long term continuity of care (where men are less likely to take career breaks for whatever reason).

[MountainAmoeba]

Can you point out where the literature suggests the diffference is due to women listening more or spending more time with patients.

 

The article states that women follow evidence based practice more.

[uwopremed]

Compared with the male physicians included in the analysis, female physicians were younger (mean, 42.8 vs 47.8 years), were also more likely to have undergone osteopathic training (8.4% vs 7.0%), and treated fewer patients annually (131.9 vs 180.5 hospitalized patients)

 

The average male physician saw 50 more patients a year.  And the difference between men and women ended up being something like 0.4%.  More volume does somewhat compromise quality - but in a realistic world - we can't all spend an hour a day with each inpatient on the ward.  I suppose it does we should spend more time with patients - but every action comes with a cost.

 

Irrespective - the play this study has had is pretty remarkable.  I wonder when the next study outlining criminal behavior likelihood based on country of immigrant origin will be published.  This data exists - it's just rather offensive when the differences outlined, while statistically significant, are not necessarily practically significant (and I don't want it coming out either - as the vast majority of all immigrants are not criminal - even if small statistically significant differences do exist between different groups).

 

And there are many studies suggesting women physicians spend more time with patients.  Journal of the American Medical Association 2002;288:756-764.  Same journal - JAMA.

[amichel]

The MDs are heavily mixed with both IMG and local. I also said I did not doubt the specific result - but to look at primary care and hospitalist work - and state that male physicians have worse outcomes is a bit ingenious. While the individuals seen by women may have slightly better outcomes - there is also the issue of the systemic result. If women spend more time seeing patients - those seen may have better outcomes - but there might be stresses on the system with increased wait times. I should note that in the big dangerous inner city hospitals - the physicians are by and large men - probably self selected. And to compare male physcians to female physicians among IMGs and medical schools would have such a small N for females as to be almost useless.

 

Irrespective, looking at the results of gendered MDs in a single area where the physicians tend to the weakest in medical school is a bit shady. (http://www.doctorsintraining.com/blog/usmle-step-1-average-match-scores-by-specialty/)

 

There have been multiple studies suggesting that men at the high end are better in most fields of achievement. Those same studies also suggest that the bottom is also full of men as well. This is particularly true in mathematics and the physical sciences - i remember when the president of Harvard, Summers, from admonished for having suggested that a few years back while citing evidence. From what I have witnessed - men seem to be in much better control in the OR than women. By a lot. I'd love to see studies evaluating male conducted surgeries vs female conducted surgeries with complication and survival outcomes. But such a study might not have the happy outcome that left leaning publications would want.

 

But I do believe that when female primary care physicians actually see patients, they on average listen more and spend more time with them. Which for general internal medicine work and primary care work is better. It is not better for acute trauma, or surgeries requiring excellent 3 dimensional visualization (which men tend to be better at), or long term continuity of care (where men are less likely to take career breaks for whatever reason).

Actually, the literature suggests that the difference in achievement in math and physics is largely (pretty much all) societal - not genetic.

 

You're following your same old pattern. You start being more and more inflammatory if nobody is biting.

[ralk]

The MDs are heavily mixed with both IMG and local.  I also said I did not doubt the specific result - but to look at primary care and hospitalist work - and state that male physicians have worse outcomes is a bit ingenious.  While the individuals seen by women may have slightly better outcomes - there is also the issue of the systemic result.  If women spend more time seeing patients - those seen may have better outcomes - but there might be stresses on the system with increased wait times.  I should note that in the big dangerous inner city hospitals - the physicians are by and large men - probably self selected.  And to compare male physcians to female physicians among IMGs and medical schools would have such a small N for females as to be almost useless. 

 

Irrespective, looking at the results of gendered MDs in a single area where the physicians tend to the weakest in medical school is a bit shady.  (http://www.doctorsintraining.com/blog/usmle-step-1-average-match-scores-by-specialty/)

 

There have been multiple studies suggesting that men at the high end are better in most fields of achievement.  Those same studies also suggest that the bottom is also full of men as well.  This is particularly true in mathematics and the physical sciences - i remember when the president of Harvard, Summers, from admonished for having suggested that a few years back while citing evidence.  From what I have witnessed - men seem to be in much better control in the OR than women.  By  a lot.  I'd love to see studies evaluating male conducted surgeries vs female conducted surgeries with complication and survival outcomes.  But such a study might not have the happy outcome that left leaning publications would want. 

 

But I do believe that when female primary care physicians actually see patients, they on average listen more and spend more time with them.  Which for general internal medicine work and primary care work is better. It is not better for acute trauma, or surgeries requiring excellent 3 dimensional visualization (which men tend to be better at), or long term continuity of care (where men are less likely to take career breaks for whatever reason).

 

Again, the article is very clear about its own limitations. It does not claim that, as a general rule, female physicians outperform male physicians. That's arguing against a strawman, or at a minimum criticizing the study for the interpretation others have made about the data, not what the authors themselves have said.

 

Furthermore, part your counter-argument to potential bias in a peer-reviewed study in a high-impact journal is... anecdotal interpretations from your time in the OR... as a second year medical student?! Gosh, good thing personal experience from a single non-expert can't possibly be biased, unlike a peer-reviewed study by a group expert researchers...

 

I'd love to see actual research on the subject of gender-based outcomes in surgery. It may support your position that men perform better in those circumstances, but it could just as easily indicate the opposite. Lack of data is just that - lack of data.

 

Lastly, it's important to note that the JAMA study doesn't indicate why there is a disparity in outcomes between men and women in hospitalist care. As amichel points out, research on gender differences in performance in math and science indicates that societal components are extremely important, if not explanatory of the entire gap. Saying women are worse than men in math is a self-fulfilling prophecy. Likewise, as a male hoping to enter primary care, I don't assume I am going to be intrinsically worse with patients than my female counterparts, despite this study and similar work. There may be tendencies women have towards their practice that improves patient outcomes, but nothing stops me from adopting those tendencies. The same would apply to surgical outcomes. Men have been the predominate gender in surgical specialties for longer than they have other specialties in medicine, and there continues to be surgeons who do not believe women can be as capable, in spite of a lack of real evidence in either direction. Even if further research shows that there is a disparity in outcomes between genders in surgery, societal factors may play a role and could be corrected.

[uwopremed]

Actually, the literature suggests that the difference in achievement in math and physics is largely (pretty much all) societal - not genetic.

 

You're following your same old pattern. You start being more and more inflammatory if nobody is biting.

Ahh...no..not at all.  I honestly think that the far left is just as delusional about basic core science as the far right.  The right is delusional about issues surrounding = religion and the environment.  The left, about gender and crime.  

 

For the record - the differences between men and women are the same irrespective of culture.  Iran and Saudi Arabia have proprotionately as many top performing females in math/physics in their population as do larger western countries like Germany, France, the USA and Sweden.  Doubt that?  Take a look at the top performing people at the international math and physics contests.  The disparity at the top has remained the same for 30 years.  No changes at all.

 

Last year, for example, in the WHOLE world, only 1 female got a silver medal.  Interestingly a Canadian.  She was the only female in the top 100 in the world, and ranked 63rd.  . The 2nd best was 146th.  That is unusually bad  year for women - there have been a few women that have even been number 1 in the past.  But it's the incredible rarity of women excellling (but the fact that a few do) - despite whole programs designed just for top women, that suggests that it isn't just some social constraint.  If everythign was equalized, there would be a few more women in the top.  But not many more.   https://www.imo-official.org/year_individual_r.aspx?year=2016&column=total&order=desc&gender=filter&nameform=western

[ralk]

Ahh...no..not at all.  I honestly think that the far left is just as delusional about basic core science as the far right.  The right is delusional about issues surrounding = religion and the environment.  The left, about gender and crime.  

 

For the record - the differences between men and women are the same irrespective of culture.  Iran and Saudi Arabia have proprotionately as many top performing females in math/physics in their population as do larger western countries like Germany, France, the USA and Sweden.  Doubt that?  Take a look at the top performing people at the international math and physics contests.  The disparity at the top has remained the same for 30 years.  No changes at all.

 

Last year, for example, in the WHOLE world, only 1 female got a silver medal.  Interestingly a Canadian.  She was the only female in the top 100 in the world, and ranked 63rd.  . The 2nd best was 146th.  That is unusually bad  year for women - there have been a few women that have even been number 1 in the past.  But it's the incredible rarity of women excellling (but the fact that a few do) - despite whole programs designed just for top women, that suggests that it isn't just some social constraint.  If everythign was equalized, there would be a few more women in the top.  But not many more.   https://www.imo-official.org/year_individual_r.aspx?year=2016&column=total&order=desc&gender=filter&nameform=western

 

How does performance on an international competition provide evidence against societal impacts on female performance in math? The top mathematicians of the 1930's were predominantly men too, as they were for decades beforehand, yet it would be hard to cite that as evidence that there were no barriers to women in math back then (there clearly were).

[uwopremed]

How does performance on an international competition provide evidence against societal impacts on female performance in math? The top mathematicians of the 1930's were predominantly men too, as they were for decades beforehand, yet it would be hard to cite that as evidence that there were no barriers to women in math back then (there clearly were).

 

Just to be clear.  You think there are more societal impacts against OBJECTIVE mathematics competition results for women, then there are societal impacts on the more SUBJECTIVE success of getting into medical school or performance as a doctor for women?  Sure...sure...

 

For the record, a few women have been the number 1 in the world in the past in that competition.  From countries like Russia, Iran, and Germany.  But very few - and the top 100 is never more than 5% women.  Can't imagine why those few managed to break through with few if any major issues.   Heck, the only woman to ever win the Putnam prize, a prize harder to win than a nobel prize, was born and raised in Iran.  With Iran being proud of it.  I would suspect the societal pressures in radical islamist Iran would inhibit such success - but she says it didn't impact her at all.  She simple did well in math tests, and kept getting promoted in their system of competitions.

 

Maybe...just maybe...at the upper echelons of the bell curve...there is an advantage for men.  The worst at math are also disportionately men too...

[ralk]

Just to be clear.  You think there are more societal impacts against OBJECTIVE mathematics competition results for women, then there are societal impacts on the more SUBJECTIVE success of getting into medical school or performance as a doctor for women?  Sure...sure...

 

For the record, a few women have been the number 1 in the world in the past in that competition.  From countries like Russia, Iran, and Germany.  But very few - and the top 100 is never more than 5% women.  Can't imagine why those few managed to break through with few if any major issues.   Heck, the only woman to ever win the Putnam prize, a prize harder to win than a nobel prize, was born and raised in Iran.  With Iran being proud of it.  I would suspect the societal pressures in radical islamist Iran would inhibit such success - but she says it didn't impact her at all.  She simple did well in math tests, and kept getting promoted in their system of competitions.

 

Maybe...just maybe...at the upper echelons of the bell curve...there is an advantage for men.  The worst at math are also disportionately men too...

 

You didn't answer my question. How does performance on a single test say anything about social factors in mathematics ability? On math tests - objective evaluations - several prior studies have indicated that women do worse when told that males are inherently better at math. That stereotype is a self-fulfilling prophecy, one you're perpetuating here.

 

Additionally, while places like Iran have significant barriers for women, gender gaps in mathematics performance are not universal and, interestingly, might be lessened or even reversed in some lower SES countries typically thought of as being less favourable for women. For example, while Iran itself is not listed in this study, countries like UAE and Qatar - hardly bastions of female empowerment - have a gender gap in mathematics performance favourable for women, not men. We shouldn't assume places like Canada and Europe are doing better on measures of gender equality in all respects, nor that evidence of reasonably equal opportunity by a single woman in Iran is indicative of equality of opportunities in general - in Iran or otherwise.

 

I never said that there aren't societal factors that cause more women to enter medicine than men. I believe there are significant social factors causing that disparity which are worth addressing. I mentioned previously my concerns about primary school education and the influences boys get with regards to prioritizing school performance or in being caring, all of which can contribute to a lack of interest in higher education and medicine in particular. Where I objected was to the notion that the disparity is due to biases at the admissions level, particularly deliberate or intentional biases, which I've already explained at length why the data doesn't support that conclusion.

 

The idea of a wider bell curve for men has been postulated many times and I'm sympathetic to that notion, but have yet to see strong data to support or refute it. If you have any good-quality studies, I'd be interested in reading them.