Starting medical school in 1978, I could not have anticipated the changes I would see in our profession during my career. HMOs, RVUs, EHRs, corporate medicine structures, patient satisfaction/experience scores and productivity metrics did not exist or did not dominate the landscape, as they do now. Evidence-based medicine and physician burnout were not overriding concerns. These seismic shifts have redefined what it means to practice medicine and are prompting an increasing number of physicians to question whether they want to remain in the clinical arena. I also could not have suspected that we, as a profession of educated, thoughtful individuals, would be so resistent to change in many important ways as the fabric of our profession shifted.
One of the major transformations in medicine is the increasing number of women who have entered the field: the AMA claims that “Medicine is increasingly a female profession, with the number of women physicians growing 43 percent in the last decade to more than 376,000 nationwide.” Women now constitute nearly 50% of medical students in the US and it’s expected that this number will continue to rise. A recent New York Times article, “How Medicine Became the Stealth Family-Friendly Profession,” (New York Times 8/21/19) explains that the ability to work part time or choose specialities that offer more control over their time is one reason why women are entering the profession in greater numbers. They state that “Female doctors are more likely than other professionals to have children and keep working.”
That sounds great, doesn’t it?
As with any situation, there is more complexity than this rosy picture portrays. Although women predominate in some specialties (OB-GYN, Pediatrics, etc.) and comprise increasing numbers in many others, the culture in which we practice has not adapted in ways that would make women feel welcome, included, or valued. As Caroline Criado Perez explains in Invisible Women, men are the default in our culture. Since the profession of medicine was created and practiced exclusively by men for many years, it is, understandably, not always supportive of the unique needs and challenges of women. For this and other reasons, women experience burnout at higher rates than men (relative risk 1.6), have greater rates of suicide than women in non-medical professions, and find that their choice of profession compromises their chance of marriage and opportunities to have children. Women are still vastly under-represented in leadership roles than men. Implicit bias pervades our culture, such that women physicians are often seen as less competent and less worthy of investment than their male colleagues.
As I routinely tell the medical students I’ve taught (and anyone who cares to listen), being a physician is one of the best things I can imagine to do with one’s life. There are few other professions where we can make a difference in the lives of almost everyone we encounter – treating or curing the diseases our patients come to us with is a thrilling and gratifying experience. And even if we cannot improve our patients’ disease, we can listen and show kindness as they find ways to live their lives with it. The conversations we have with our patients are often deep and meaningful and the relationships feel intimate and sacred. The continuous intellectual stimulation and challenge of medicine offer opportunities for life-long learning and growth. Yet, I am not of the mindset that we must “love it or leave it” when it comes to considering whether our profession is the best it can be.
As more women enter our profession, we have an opportunity to truly transform the culture of medicine – in ways that will improve patient care and enhance the career and life satisfaction of all physicians, both men and women. Women can lead the way in redefining the ways in which we work, how we interact with each other, and what we prioritize. We all have both masculine and feminine traits, although these traits are more common in the gender they are associated with. Since medicine was created by and for men, it is heavy in masculine traits. By balancing the masculine traits of domination, competition, reliance on logic, productivity, intellect, will and commitment with the feminine traits of receptivity, collaboration, empathy and intuition, creativity, curiosity, imagination, and courage, we will expand our abilities, tools and options. This will allow us to better meet the challenges of the future and provide a more welcoming environment for all those in our field.
In celebration of Women in Medicine month, please join me in examining the important ways in which women contribute, as well as the continuing obstacles they encounter as they attempt to do so. Our goal will always be to find solutions and new perspectives, so that all physicians – men, women, and those under-represented in medicine – can feel welcome and valued, provide the best care to their patients and the most healthy and loving environments for their families, and appreciate themselves for who they are and what they contribute to our profession and the world we live in.