I have always liked the word “dynamics .” According to my dictionary, it means”change producing forces.” That is certainly true of women in medicine. These days, about 50% of medical students are women. According to Richard “Buz” Cooper, MD, a former medical school dean, and now a professor pf medicne at Penn, by 2010, 62.5% of physicians completing medical school will be women. For various legitimate reasons, maternity leave, desire to spend more time with family, a tendency to retire in their 40s and 50s after their children are grown, husbands who are physicians with comfortable incomes, women are a force for change and will aggravate the physician shortage.
On average, woman physicians work 20% - 25% fewer hours over their careers than male counterparts. In addition, women physicians are more likely to work as salaried physicians, with 45 to 50 hour workweeks with flexible hours, and health and retirement benefits. Most hospitals and medical groups prefer their new physicians to be young, and women physicians tend to be younger. In the 1970s, only 10% of U.S. doctors were women. Today women account for one-third of the physician workforce. In U.S. medical schools, they make up half the class.
Women doctors in the U.S. work less—47 hours per week on average, versus 53 for men. They also see about 10% fewer patients and tend to take more time off early in their careers. "It's pretty much an even bet that within a year or two of entering practice they will go on maternity leave," says Phillip Miller, a vice-president of the medical recruiting firm Merritt, Hawkins & Associates. "Then they are going to want more flexible hours."
Women tend to gravitate to certain specialties.
Percent of Medical Residents in Certain Specialties
• OB/GYN, 68%
• Pediatrics, 65%
• Dermatology, 54%
• Psychiatry, 49%
• Family medicine, 47%
• Pathology, 47%
• Internal medicine, 40%
I am not suggesting any of this is bad. It just differs from the past. In many ways, it is more sensible. In my experience, women doctors are smart, emphatic , hardworking, and excellent physicians with good bedside manners.
But the omnipresence of women physicians changes the dynamics of practice and contributes to a relative physician shortage. If women doctors comprise more than 50% of the work force and practice 20% fewer hours, more doctors will be required to make up the difference.
Let me conclude with the summary of an interview I conducted with Elizabeth Chase, MD, a 46 obstetrician and gynecologist in Dover, New Hampshire. I ran this interview summary previous on April 20 , and it received a record number of hits. It may therefore be worth reprinting.
Women in Medicine: When Gatherers Become Hunters
Summary of interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire
Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The purpose of this interview is to give insight into trials, tribulations, and joys of being a woman physician in a transformed health care system.
"Q: Dr. Chase, when did you graduate from medical school, and how old are you?"
“A: I graduated from Tufts University School of Medicine in 1992. I am 46 years old, and I have practiced for 12 years.”
“Q: Has your career lived up to your expectations? Has anything surprised you?”
“A: From the standpoint of the joys of being part of patients’ lives, listening to their stories, and the pleasure of doing surgery, it has lived up to my expectations.”
“Q: And what have been your disappointments?”
“A: The hardest part in my early years of practice in Pennsylvania was a combination of things – the shock of low reimbursements paying me half of what I expected to make, the negative malpractice environment, and inadequate amount of time I had to spend with patients to make up the difference. I just could not justify spending so little time with patients.”
“I left Pennsylvania for partly personal and partly professional. I was part of an exodus of doctors from Pennsylvania. I recall a full-page ad in the Philadelphia Inquirer, listing all the doctors who had fled Pennsylvania. I moved to Dover, New Hampshire.”
“Q: Give us some context of the community you’re in, the hospital you use, and your practice setting.”
“A: I practice in a community hospital with a level 2 nursery. We have about 900 births per year. Dover has 50,000 people, and its primary industries include the headquarters of Liberty Mutual insurance company and we have some high tech firms. The hospital employs a lot of people. We have a private practice, five doctors, and all women.”
“Q; You’re part of the gender revolution. “
“A: Yes, but Tufts was one of the first medical schools to accept women, and my class had 50% women. And OB/GYN at this point is something like 80/20 women/men entering the profession.”
“Q: That changes medical practice dynamics. Women require pregnancy leaves, spend more time with family, are more likely to be employees, retire earlier, and sometimes women doctors are working and the husbands are not. How many women in your practice have “house husbands?”
“A: All four of us, including myself, have a “house husband.” It gets a little hectic, but we manage very well. We’re on call every fourth night, but we make our call easier by working with midwives. About half of our on call time is back up call, with the midwives taking primary call.”
“Q: Describe to me the hospital –physician practice environment. As you know, hospitals are hiring more and more primary care doctors these days and even specialists. How large is your hospital?”
“A: We have 155 beds and 10 Operating room suites.”
“All primary care practices are ‘owned.’ There are no independent generalists working out of our hospital. We have a fully staffed hospitalist program. And all primary care practices participate in the hospitalist program. We have 13 hospitalists on staff at this point. We have 24 hour ICU coverage by hospital-employed doctors. None of the surgical practices or sub-specialty practices is owned. There appear to be some collaborative agreements with plastic surgeons. “
“Hospitals like to own the physicians because they can control them. We are not owned, but the hospital has often suggested to us the only solution to any financial problem we might have is to be owned.”
“We feel much more comfortable with owning ourselves. We prefer the independence we have. We’re making it financially. We’re 5 women, and 4 of us have kids. All our midwives have children.”
“We call ourselves a ‘lifestyle practice,’ and we try to blend being mothers with a sustainable way of being a doctor. We give ourselves 6 weeks of vacation a year and we give ourselves 2 weeks of CME. We do not believe in working 24 hours a day, 365 days a year. Our salaries are not as high as the national average, but we are happy this way. We look after each other and we collaborate and cooperate with the town’s other OB/GYN practice.”
“I’ve learned how to deal with adversity, and not make it kill me. I like medicine too much to stop. We truly love our patients, and try to develop positive relationships with them