Women Physicians and Lifestyle: What Are All Those Doctors Doing?
A generation has passed since I graduated from Medical School. Much has changed over this time, not the least of which has been a distinctive “feminization” of medicine. Over the past twenty years, the percentage of U.S. Medical School graduates who were women increased from 27% to approximately 45%. That increase continued without plateau in the last decade (1996-2002), and, in fact, the last few years have witnessed another 4% increase. In this regard, medicine is no different from other professions, such as law and business, where the same demographic trends related to gender are apparent.1 What are the perceived advantages and disadvantages of a medical workforce comprised by a greater number of women physicians?
Research has demonstrated that women doctors possess better communication skills than men and are more likely to engage in discussions that are patient-friendly.2 As a result, outcomes may be improving, and malpractice suits may be declining. A contrasting perspective gives voice to concern that part-time doctoring by women—the result of their full menu as physicians, wives, mothers, and caretakers of aging parents—will create a critical shortage of physicians. Is there a bona-fide crisis looming here? Is the feminization of medicine responsible?
There is an evolving crisis, but I would like to re-frame the discussion. For example, with the aging of America, who will provide medical care for the expanding geriatric population of the next generation? Primary care physicians, of course. But the proportion of positions in Family Practice filled by US medical school seniors has decreased from 73% in 1996 to 47% in 2002. Although Internal Medicine has had a much less dramatic decline, it is headed in the same disconcerting direction.
What are these future Primary Care doctors doing? They are gravitating toward what has come to be known among students as the “EROAD” specialties—Emergency Medicine, Radiology, Ophthalmology, Anesthesiology, and Dermatology. The reason these specialties are popular is clear; they are all characterized by what is called a “controllable lifestyle,” a practice style that permits substantial time free from professional responsibilities. That time is available for family, hobbies, and other leisure pursuits.3 It is essentially a clearly defined beeper-free respite. Uncontrollable lifestyles seem to be the rule rather than exception for primary care and many surgical specialties. Thus, these specialties are struggling unsuccessfully to entice the future generations’ practitioners.
One might then surmise that since women physicians wear so many hats and make up a steadily increasing percentage of medicine’s labor force, they must be the ones opting primarily for lifestyle control when they choose careers. Well, data in this regard may surprise many. Both women and men equally are choosing controllable lifestyle medical careers.4 A portion of the predicted physician shortage may be due to an increasing percentage of women doctors working fewer hours, but a profound generational and cultural shift is taking place simultaneously. Today’s medical students, both men and women, value lifestyle highly enough that it is the determinant of their eventual specialty choice. They would prefer the structured day of a dermatologist in contrast to the unpredictability of primary care.
Is the desire for a controllable lifestyle in medicine wrong? Since it places a premium on family time, seeks to alleviate burnout, and is not motivated primarily by income, the answer is no. However, for physicians, a healthy balance must be maintained between patient care responsibilities and lifestyle. Hippocratic principles require an unwavering commitment to patient needs anytime, day or night. At the same time, lifestyle concerns are important since physicians are also spouses, parents, and contributors to their community. Does balancing these two goods—Hippocratic ideals and lifestyle—require a career in Dermatology or Radiology? EROAD specialists will not be able to assume the primary care requirements necessitated by an increasing population of aging adults. There have to be ways to render optimum care in uncontrollable lifestyle fields without completely sacrificing family, personal health, and other commitments.
Trends in career choice contingent on the increasing number of women in medicine, as well as those contingent on controllable lifestyle, have to be addressed soon. Primary Care and surgical practice have to find an acceptable way to alleviate lifestyle tension without adversely affecting the quality of patient care. To paraphrase H. L. Mencken, for every complicated problem there is a simple answer that is always wrong. The emerging workforce crisis in medicine simply cannot be placed at the doorstep of women who have chosen both medicine and motherhood as intersected careers.
1 MA Milkie, SM Bianchi, MJ Mattingly, and JP Robinson, “Gendered Division of Childrearing: Ideals, Realities, and the Relationship to Parental Well-Being. Sex Roles: A Journal of Research 2002: 21-38.
2 R Kotulak, “Increase in Women Doctors Changing the Face of Medicine,” Chicago Tribune, January 12, 2005, www.chicagotribune.com/features/health/chi-0501120279jan12,1,4042416.story (accessed February 03, 2005).
3 ER Dorsey, D Jarjoura, GW Rutecki, “Influence of Controllable Lifestyle on Recent Trends in Specialty Choice by US Medical Students,” JAMA 2003; 290: 1173-1178.
4 ER Dorsey, D Jarjoura, GW Rutecki, “Controllable Lifestyle and Specialty Choice: How Much Does Gender Contribute?” AMA International Symposium on Physician Health, October 14, 2004, Oakbrook, IL.