Sorry for the controversial title but the topic of women in medicine is becoming quite a hot issue in recent years. Especially since over 50% of Canadian and US medical students are now female, one has to wonder about future work force implications, especially when these female docs decide to start their own families and take maternity leave. Before I begin, let me just state my position (so I’m not seen to be a sexist chauvinistic antiqued male medical student): I fully support women in medicine and believe they are equal, if not better than their male counterparts, at providing medical care. However, there may also be a workforce shortage in the foreseeable future because of this “feminization” of medicine and I believe that new ideas and a change in the system will be needed. Now that’s out of the way, let’s start with some controversial articles.
This weekend, Dr. Karen Sibert, a female anesthesiologist and a mother wrote a provoking article in the New York Times titled Don’t Quit Your Day Job. Below is quoted text verbatim
Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.
In summary, Dr. Sibert addresses a sense of entitlement amongst female physicians who believe they can have it all, both a career and a family. In response, Dr. Michelle Au (theunderweardrawer.blogspot.com) wrote a response The Mommy Wars, Medical Education where a good counterpoint is given. Quoted from the article.
Instead of pointing the finger at women doctors for being the reason for the shortfall in physician numbers and productivity, it might first be helpful to examine the circumstances under which parents feel like they need to go part-time or leave medicine altogether–a decision which, after almost a decade of training (and sometimes more), I can’t imagine anyone would take lightly. In medicine, you can treat the symptoms all that you want, but there is no cure until you can identify the underlying cause.
Definitely some strong points made, though I probably side more with Dr. Au’s position. I did a search on this topic and came up with some further reading
- Are there too many female medical graduates? – a scientific article published in the BMJ by Brian Mckinstry
- Women Doctors: Waste of Money? and Are There Too Many Women Doctors? – both in Bloomberg Businessweek
- Should Women be Doctors? – NYTimes Motherlode Blog
- Mothers in Medicine – a group blog by physician-mothers writing about their challenges and joys about caring for two different populations in their life
If you can get through all the comments too, it’s quite a debate. There’s also no clear blueprint or outline on how to address this problem and I don’t think it will be a simple solution. Not being an expert at the topic, I give you medaholic’s overly generalized summary. Please feel free to leave some commentary to correct me of my ignorant ways.
- We are currently training more female doctors than male doctors
- There are still more male doctors overall in the workforce because older generations were almost exclusively male
- Newly trained doctors (both sexes) work less hours than their predecessors from the generation before
- Female doctors work less hours than their male counterparts
- Females are more likely to take time-off work to raise their families
- Females are more likely to go into primary care specialties (family medicine, pediatrics, obsgyn)
- There will be a shortage of physicians
Things I think we can do to improve the situation
- Acknowledge that physicians today are unlikely to make the same sacrifices (family, personal life) as the generation before
- Acknowledge that modern medicine is different from medicine of the past – more complex, team based
- Continue to encourage both genders to pursue medical careers
- Train more doctors, both females and males
- Males should take on equal responsibilities at home – stay at home dad’s? part time male docs?
- Restructure the hours in medicine, less overnight call, more shift work?
- Provide nursery/child care options for working mothers
Things we can do……Maybe, select medical students based solely upon merit rather than race or sex?
Perish the thought.
So… where are medical students selected based on race or sex?
Or even better, end the blockade on medical school admissions. If the AMA hadn’t spent the last 100 years trying to limit the number of medical school graduates, we wouldn’t be having this discussion. Want to deal with the physician shortage? Train more physicians! Expand residency slots!
Where is the mystery in all of this?
easier said than done
you can’t just train more doctors
@Med School Odysssey
I am going to disagree with you. When did medical schools select based on race or sex? I’ve been on the admission commitees and all applicants are blinded (sex, gender, etc) The only instance where there might be a preference is for rural or aboriginal applicants. Or when did they create a blockade? Expanding medical schools and residency spots isn’t decided by just the medical school. Government funding and your tax dollars go into each medical spot, subsidizing the high costs of training doctors. If there’s no funding, how could you possible increase the number of spots?
Then maybe it’s time we let qualified foreign trained doctors to come and work in Canada.
Dentistry has faced the same shortage issue and has now made the process much easier for qualified foreign trained dentists to practice in Canada.
If there truly isn’t a racial bias in medicine, then as long as the medical doctors meet the quality, we should let them in and practice as long as they received the same kind of training as Canadian doctors.
In theory, letting more IMGs practice medicine seems like a simple fix, but there are several factors that complicate it.
1) Not all foreign doctors are trained to the same standards as medical graduates (many are, but many also are far below and practice something entirely different, I know from first hand experience)
2) Language barriers – you do want a doctor who can speak English and communicate properly with nurses, docs and patients
3) In terms of the process, it is becoming a lot easier for foreign docs to work in Canada, compared to 10 years ago, and certainly 20 years ago. Look around in the hospitals, a good portion of docs are already from elsewhere (USA, UK, South Africa, etc). Look in rural areas, tons of foreign trained docs.
4) The immigration of doctors from other countries (often those with less resources) ultimately is an unfair solution because it causes a drainage of resources from other countries. We take their best and brightest, often funded by their country’s tax dollars, and we give back nothing in exchange. It’s a non-sustainable solution and in my opinion almost an unethical type of situation.
5) Dentistry is quite different from medicine since most of it is privately funded.
I’ll address your two points in reverse order. First of all, while taxes and federal funding do support medical training to some extent (more so with residencies), class sizes are almost entirely determined by the state branch of the American Medical Association. The AMA has been preaching about physician surpluses for years and has gone to great lengths to limit increases in medical school class sizes. Individual medical schools can’t unilaterally decide to increase their class sizes, nor can medical schools (public or private) be built without the approval of the state branch of the AMA. When was the blockade created? Around 1910, when the Flexner report was released and basically turned the medical profession into a guild.
Only in the last few years has the AMA admitted that the US actually has a shortage of physicians, but the typical refrain is that the solution is to expand residency funding rather than medical school admissions. Expanding the number of residency slots will only serve to increase the number of FMGs imported into this country. Look at the numbers yourself – there are far more residency slots in the US than there are medical school graduates. This is starting to change, but the damage has already been done. The next 15 years are going to herald an incredible physician shortage, more so due to the latest attempt at health care reform which simply expanded eligibility for Medicaid.
Secondly, on the subject of race and medical school admissions, I would point you to the AAMC’s own statistics (Table 25):
https://www.aamc.org/data/facts/applicantmatriculant/157998/mcat-gpa-grid-by-selected-race-ethnicity.html
In particular, note that statistically, a Hispanic with a GPA of 3.4-3.6 and an MCAT score of 27-29 has a 69.1% chance of being admitted to medical school. For blacks, it’s even higher at 84.8%. Contrast that with a 35.9% chance of admission for whites with the same scores. In fact, in order for a white applicant to have a similar chance at being accepted, he or she would need a 3.6-3.8 GPA and an MCAT score of 36-38.
I should point out that those are well below average marks for applicants, particularly on the MCAT, yet more than twice the probability of being accepted. To stand a similar chance at being accepted into medical school with the same grades, a white applicant needs to score in the top 1% of all MCAT takers! If you think that the admission process is truly color blind, you really should take a second look.
I’d question whether the AMA is involved in determining medical school spaces, though I’d imagine state medical boards would be more likely to influence that. Having said that, your reply is wholly Americentric and I can’t really respond to all of it. However, provincial medical associations are completely distinct from provincial colleges of physicians and surgeons in Canada, and neither controls any aspect of medical school admission or capacity. Provincial governments have effectively exclusive discretion as they control funding and allowable tuition levels for undergraduate and postgraduate medical education.