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“Patropoly” in Practice: Clustering in Family Friendly Specialties

This is the final post in a guest series on the exclusionary practices of American medicine.  I think if you read through from the first post, you can see that each aspect of the problem contributes to a total system in which the females, though they are admitted into medical school in the same numbers as the males, are bullied and discouraged, especially by sexual harassment and anti-family pressure, until many resolve the problem by going into specialities that have better hours, but also are friendlier to women and families.  So, you find women clustered in obstetrics, pediatrics, family practice, and so on.  Lower working hours and pay are, therefore, merely the measured symptoms of much larger and pervasive exclusionary forces.

As is so often the case in other fields, pay is less in the subspecialties where women are over-represented.  You can argue the chicken-and-egg question til the cows come home. What I wanted to illustrate here, by doing a deep dive into a single highly remunerative field, is that we should not be satisfied to describe women’s career paths as a matter of “choice.”  These career paths are the outcome of a concerted effort to terrorize and exclude females in medicine.  Having made the investment in medical education, which is extremely expensive, these young women would be crazy to change careers entirely, so they gravitate to those areas of medicine where they would be least uncomfortable. We see this same phenomenon across the board in women’s employment and even in their choices for starting businesses.  

Programs designed to help women do better economically often focus on teaching them skills, coaching them to be leaders, and trying to interest them in math and science or finance (in general, to draw them to better paying fields dominated by men).  Such efforts implicitly blame women for their disadvantaged position in the economy.  The judgement is that women simply make bad choices or have too little confidence or are risk averse, or whatever.  These “fix the women” strategies allow companies and schools and governments to feel good that they are doing something to help, but do not put them in the difficult position of facing the real problem:  the norms and behaviors within the system that conspire to hold women back. 

This is the last in a five part series on young women trying to enter one of the most protected and lucrative fields in the world: American medicine.

According to Medical Economics, the average male doctor in private practice in the United States makes $273,690 a year; his female counterpart makes $155,590. Further, 50% of female doctors surveyed by the Commonwealth Fund reported incomes of $100,000 or less, compared with only 22% of men. Unfortunately, debt knows no gender. The median debt of medical school graduates in 2012 was $170,000 with 36% of graduates indebted more than $200,000.  So, women making significantly less than their male colleagues are also struggling more to pay for their training.

The average age of female medical school applicants in 2012 was 24 years old, making the average graduate from medical school 28 and likely thinking about how her career will intersect with her plans for a family. It’s no surprise then that female medical school graduates tend to select less prestigious specialties in the hope of having less demanding hours.

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Many female doctors elect to work part-time, join multi-physician practices, or join practices run by managed-care companies that give them a 9 to 5 office life. This kind of arrangement has become a welcome option for doctors looking for more balanced lives in a field that has on average a 56-hour work week. But it is mostly female doctors finding ways to cut back on their hours: the Commonwealth Fund found that 25% of the female doctors surveyed worked fewer than 40 hours a week, compared with 12% of male doctors. And 17% of female doctors work 30 hours a week or fewer, compared with only 8% of males.

It would be great if it were simply a case of women forging careers in medicine to shape their needs and priorities. And hey–a lot of those less glamorous specialties are where we have shortages in this country. I’m not saying there aren’t silver linings, but the combination of women tending to select the less prestigious specialties, the lowest-paying specialties, and then working fewer hours has instead created a ”pink-collar” level of medicine. It has long been demonstrated that women in all careers who cut back on their hours or take time off, do so to the detriment of professional advancement.

Additionally, there are those in the medical community who feel that the limited resources, residency spots, and doctor shortage should not be wasted on physicians who are going to work part time. This issue will continue to plague medical school and residency applicants who are seen as potential wastes of training just because they have uteruses. Further, the absence of women in the prestigious and high paying specialties allows the “Boy’s Club Culture” to thrive and drive away would-be-great doctors–chasing away women who may just have too much self-respect to put up with the bad behavior.

Patients have spoken: female physicians are in high demand. Studies have shown that women tend to spend more time with patients and to focus on them as people, rather than as procedures.  Patients express their preference by consistently choosing women for their care. ”The minute we put a female physician in a practice,” said Dr. Myron L. Weisfeldt, chairman of medicine at New York Presbyterian Hospital, ”the appointment book becomes fully booked.”

Unfortunately, this demand has not thus far been reflected in the paychecks of female physicians. This “pink-ghetto” of medicine still combines low-paying specialties with reduced hours to produce a significant wage gap. Part-time contracts also pay less per diem than full-time contracts.

The AAMC can boast about having achieved gender parity in medical schools, but that statistic obscures the very real gender bias still alive and well in medicine. Young women embarking on their medical careers can plainly see that they will have to lead a life of compromise, and these compromises begin as early as medical school when one chooses her specialty. Until the male-dominated fields make room for doctors to have lives outside of the hospital, those fields will continue to miss out on the contributions of our smartest women.

Other posts in this series:  on medical school admissions, on sexual harassment, on hiring and evaluation.  The introductory post is here.


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