Wednesday, January 12, 2005

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What happens when women become doctors?

Ronald Kotulak has an interesting front-pager in the Chicago Tribune on the effect of an increased number of female doctors on the health care system. The article is interesting in how it skirts the line between stereotyping and just saying what's true:

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 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.

Read the whole thing. What's particularly interesting is the "colonization" of women into the subspecialties that permit flexible work hours.

I'm sure there's a labor economist somewhere writing about this... which would be ironic, as women who get doctorates in economics disproportionately become labor economists (the joke when I was in grad school was, "all women go into labor").

posted by Dan on 01.12.05 at 10:49 AM


All those specialties also have shorter residency times. Women can then marry and start families sooner. Also, in the 3rd year of med school students start doing rotations in the hospital. When faced with real human patients - gross, loud, stupid, and stubborn - most students drop all pretense of "doing good" and choose specialties for more practical reasons. Radiology is boring, but $1M/yr for 26 weeks work (in a second tier market after 3yrs experience) makes it very popular.

posted by: borat on 01.12.05 at 10:49 AM [permalink]

Didn't read the rest of the article, but I wrote one myself in Newsweek a few months ago about the looming surgeon shortage. To some degree this can be blamed on the influx of women, who dislike both the long hours/residencies and the macho culture.

On the other hand, women are only one piece of the puzzle. There's also an increasing number of female chief executives, but no one thinks of CEOs as cuddly-sweet. Medicine is becoming more patient-friendly, yes, but that's also because docs are trying to avoid increasingly common lawsuits. Students don't want to go into "malignant" specialties anymore, but that's partially because medical schools started recruiting more laidback students a few years back -- precisely to counter the fact that everyone at that point wanted to go into malignant specialties (like surgery). I'm sure the fact that half of all med students are women is hugely significant, but it's definitely not the whole story.

posted by: Mary on 01.12.05 at 10:49 AM [permalink]

My mother, a certified nurse midwife nearing retirement, has actually complained about how it's a waste of these younger women's medical education when they only want to work part time, which seems like an attitude straight out of 1950, but there you have it ...

A question, though: Generally the entry of women into the labor force has expanded the labor force. On the other hand, doctoring is a obviously a high-education specialty. Is there a limit to the number of doctors, and does more women going into med school perforce mean fewer men?

And if the trend holds through other professions, when are we going to see kinder, gentler, more holistic lawyers?

posted by: trotsky on 01.12.05 at 10:49 AM [permalink]

OK -- everyone jump on this.

Woman Lib is a capitalist plot to exploit the last segment of quality labor and keep labor costs low. Great negative correlation between female participation rate and real wage growth.

posted by: spencer on 01.12.05 at 10:49 AM [permalink]

> On the other hand, doctoring is a obviously
> a high-education specialty. Is there a limit to
> the number of doctors, and does more women going
> into med school perforce mean fewer men?

What kind of doctoring? The Soviet Union cranked out about 4x the number of GPs per capita that we did and used them to provide basic health care for everyone [too bad about the lack of drugs and equipment though :-( ]. I believe that is still true in Russia to a certain extent.

It may well be true that certain specialties require very smart and/or highly experienced people, but you have to seperate out the guild aspect and the "because we have always done it that way" aspect of modern US medicine before deciding where the limits are.


posted by: Cranky Observer on 01.12.05 at 10:49 AM [permalink]

Could be the maleinization (maleification?) of dentistry? IIRC, I've never had a male dental hygeinist, nor have I ever had a female dentist, hmmmm...

On average, general dentists in 2000, the most recent year for which comparative data are available, earned $166,460 -- compared with $164,100 for general internal-medicine doctors, $145,700 for psychiatrists, $144,700 for family-practice physicians, and $137,800 for pediatricians. All indications are that dentists have at least kept pace with physicians since then.

Those figures are a sharp contrast to 1988, when the average general dentist made $78,000, two-thirds the level of the average internal-medicine doctor, and behind every other type of physician. From 1988 to 2000, dentists' incomes more than doubled, while the average physician's income grew 42%. The rate of inflation during that same period was 46%.
Factor in hours worked -- dentists tend to put in 40-hour weeks, the ADA says, while the AMA says physicians generally work 50 to 55 hours -- and the discrepancy is even greater.
Dentists have grown richer even as cavities, once the main cause for visiting them, have declined, largely because of fluoridation of drinking water and improved preventive care. According to a study published in the Journal of the American Dental Association in 1999, cavities in 6-to-18-year-olds dropped by three-fifths from the early 1970s to the early 1990s -- even though many children in lower socioeconomic groups still lack adequate dental care.
As people born in the 1960s and later have grown into adulthood, they tend to need fewer fillings than their parents did and are keeping their teeth longer. Painful disease-related procedures such as root canals are declining, too.
So why are dentists so handily outpacing doctors? In part, it's because dentists have avoided being flattened by the managed-care steamroller, and instead many have turned into upscale marketers. Dental care makes up less than 5% of the overall U.S. health bill, and hasn't been a major focus of cost-cutting.
Although some dental insurers have tightened up on reimbursements, most private dental insurance is still paid on a fee-for-service basis. Many optional procedures aren't covered by insurance, leaving dentists free to charge whatever the market will bear. About 44% of all dental care is paid by patients out of their own pockets, according to federal statistics for 2002, compared with just 10% for all physician and clinical costs.
While dentists may be able to focus more on marketing costly optional treatments, many physicians can't make the same kind of switch in their practices.
"This is a man's world thank you very much / But it wouldn't be a damn thing without a woman's touch." - Ice Cube f/ Yo-Yo, AmeriKKKa's Most Wanted
posted by: Gary on 01.12.05 at 10:49 AM [permalink]

I recently had lunch with nine female medical practice administrators at a practice management seminar (pleasant company, to be sure).

The hottest topic was not too surprising, "female doctors are a pain in the fanny." Most want part-time hours at full time pay, disrupt office schedule, and etc. was the general theme of the conversation.

So should 50% of our medical school seats be given to females? What will this do to supply and demand? Time will tell, but preliminary indications are not good.

I have some empathy for women juggling all of their committments, but when my wife (an RN) worked part-time and raised the kids, she sure as heck did not expect full-time pay, or to have the entire office reorganized to fit her moods.

Tough questions, no easy answers.

posted by: Tom E on 01.12.05 at 10:49 AM [permalink]

Well, in an academic practice with 5.60 female and 6 male salaried docs, scheduling is not an issue. The 0.60 female doc is a national expert who has chosen to cut back later in her career. It might be noted that the number of coverage options (large number of docs) and the general easygoing nature of the docs makes schedule juggling non-traumatic and non-whiny.

posted by: NP on 01.12.05 at 10:49 AM [permalink]

Could be the maleinization (maleification?) of dentistry? IIRC, I've never had a male dental hygeinist, nor have I ever had a female dentist, hmmmm...


That's funny, because two of the last three dentists I've had were female. The first one, an American, was wonderful, while the current one, a Pakistani, is brutal. I lost the first one, because my wife's union stopped providing a dental office. And I'm not dumping the current one just yet, because I found myself with some terrible tooth aches (it's root canal time, again -- the fourth time's the charm), and always have trouble finding dentists on the union program within spitting distance.

posted by: Nicholas Stix on 01.12.05 at 10:49 AM [permalink]

Puzzling article. They contrast medicine becoming 'more patient friendly' against lower physician salaries and encouraging part-time doctoring, in a way that implies that the second group of issues are downsides. If more physicians are getting lower salaries because they want to work less hours, that is not necessarily a bad thing. And, assuming that these women are voluntarily taking on fewer hours for less pay, then it is most likely a good thing. Higher salaries is not everywhere and always, regardless of what else is happening, a Good Thing - people maximise utility, not income.

Anyway, a looming shortage of physicians should correct the lower salaries 'problem'.

posted by: Tracy on 01.12.05 at 10:49 AM [permalink]

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