This post begins the series I promised on exclusive practices in US medicine. Bear in mind, as you read, that the male applicants are not being screened in the same way as the females, though most of them will also want families. Why? The presumption clearly is that the men will have in-house child care in the form of a wife, while the women will be expected to bear the brunt of child-rearing to the detriment of their careers. Note that this assumption is being made even if the couple may be pinning their main financial hopes on the potential to have a doctor in the family–and thus are willing to make a different kind of arrangement for care. This antiquated cultural presumption about the unequal gender distribution of household responsibilities thus levels economic disadvantages at whole families. It is the source of profound inequity across all kinds of employment and is contributing to the growing crisis of fertility in the developed nations.
It is also disturbing, I think, that the medical profession, which is, after all, a field of care, would be knowingly favoring people who don’t want families and righteously excluding people who are normal enough to want affection in their lives. Scary.
The following anonymous blog was written by a top-ranked student who applied to 24 medical schools, was asked to interview at most of them (including several in the top ten), and is now studying at one of the most respected facilities in the United States. Please bear in mind how qualified she was when reading about how she was treated in the admissions process.
Ask any medical school applicant: becoming a doctor is one of the most competitive endeavors anyone can undertake. Even the application process is rigorous and costly. After busting your ass for years getting an outstanding GPA, completing prerequisites, volunteering, cultivating contrived hobbies, and taking on any leadership role that comes available, you are ready to be scrutinized. Then you still have to spend a year taking standardized testing, writing countless essays, and blowing thousands of dollars on traveling to interviews. The average number of schools a would-be medical student applies to is 15. Each application charges a substantial fee, each interview—delivered at a visit to the school–is at your own expense.
At the end of the application process, only about 40% of these super human applicants nationwide will actually be accepted to medical school. Yes, that means fully 60% don’t get into a single one.
At the starting line, male and female candidates who survive this selection process are comparably outstanding and begin in equal numbers. In 2007-08, women accounted for 49% of medical school applicants and 48.3% of those accepted. Medical schools have made great strides in evening out the gender balance in recent decades. Women were 9% of total US medical school enrollment in 1969; this had increased to 20% in 1976. They graduate in equal numbers, as well. According to the American Association of Medical Colleges (AAMC), 48.3% (16,838) of medical degrees awarded in the US in 2009-10 were earned by women, an increase from 26.8% in 1982-3. So, from a numbers standpoint, it would appear that parity has been achieved.
Unfortunately, the career paths of males and females diverge dramatically. The disparity begins to form as early as application season. Numerous blogs and articles suggest the career gap between male and female doctors emerges from a series of compromises female physicians make to balance work and life. The so-called “leaky pipeline” found in the corporate world appears in medicine and is called by the same name.
The pipe starts leaking before you even know you are in it, even before they give you the white coat. Let’s start with the obvious and tired issue of reproduction. Medicine requires time-consuming training. You must plan for the long road. Run down of the numbers: medical school, 4 years; internship, 1 year; residency, 3-7 years; fellowship, 1-3 years. Total years of training: 9-15 years.
The average medical school applicant is 24. It doesn’t take a genius to realize that a 24 year-old applicant will be enduring the rigors of medical training throughout all her prime fertile years. You can bet this applicant can do that math. She thinks about this problem, even if a serious boyfriend is the furthest thing from her mind at the moment. But, for now, let’s pretend our female applicant is at the point of actually planning her family.
Online, you can read many different opinions on “when is the best time” for an aspiring woman doctor to have children. (A site called momMD.com is an invaluable resource for any potential doctor mom.) But the consensus is that having a baby during medical school is easier than during residency. Residency entails 80-100 hours of work a week plus studying for in-service exams. So, the most commonly recommended times to pop one out are: the summer between 1st and 2nd year (coincidentally, your only summer in medical school and the time to conduct research for residency applications) or your fourth year, when your residency applications are done and you are taking all electives with lots of vacation time (coincidentally again, the time when you have to go on a zillion residency interviews … looking like you are about explode? Good luck, kiddo!). Props if you have the fertility to time conception so precisely.
So, hypothetically, our applicant decides to shoot for a medical school pregnancy. Some schools are delightfully accommodating. The best ones give you up to two years of leave, non-consecutively, so that students can start a family. You could maybe even get away with having two kids if you went to one of those schools.
But there is a lot of variation. Some schools will not even reschedule an exam if you go into labor—and make you retake the course the next year it is offered if you miss it.
Obviously, applicants need to know about these differences when applying to schools. But maternity leave policies and childcare options are virtually impossible to find out without asking. Schools do not include these policies in their materials or on their websites.
Most female applicants do not feel comfortable asking these questions of admission offices for fear of compromising their chances. For good reason! While it is illegal to ask an applicant about their marital status or questions about their plans for reproduction, admissions offices at medical schools around the country appear to think they are above the law. I myself interviewed at 15 schools, including several of the most highly ranked programs. More than half of 30 some-odd interviewers who spoke to me asked about my husband and our “plans” in thinly veiled attempts to discern my intention to get pregnant. Every married female applicant I know had the same experience. Even unmarried female applicants as young as 22 were asked the same questions.
This says to me that medical schools are well aware of the reproductive pressures that female medical professionals are under during their training, yet most have no intention of accommodating any woman unwilling to wait till her late thirties to have a kid. In fact, one medical school educator remarked in the New York Times:
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.
The person appears to believe that accepting mothers into medicine robs society of better doctors—defined as people who are either willing to neglect their families or not have families at all? So, does that mean that admissions offices should preemptively filter out women who want to be mothers?
Well then ladies, we’ll have to get stealthier about our intent to use our girly parts! Dodging the mom question is something female applicants actually get coached on. One day long before I started my interviews, I was killing time in a strip mall Barnes & Noble. I picked up one of many how-to-get-into-medical school guidebooks. In one of the books I grabbed off the shelf, there was an entire chapter devoted to interviews for women. That chapter opened by saying that while all of the following questions are illegal, the female applicant should have answers prepared. It then listed pages of questions women applicants should expect — from relationship questions to flat-out being asked when you plan to start a family.
These questions come up even earlier too. The premedical advisor who interviewed my married female friend asked her about her plans to start a family. My friend answered honestly that she planned to do it during medical school. The advisor (who, to be fair, did accept her to the pre-med program) told her quite plainly that she was going to need to keep her family intentions to herself if she wanted to get into medical school.
Another fellow applicant told me over dinner that she was warned against the opposite strategy: you can’t say you don’t want children and risk looking like an unnaturally cold woman; but you also can’t want them too much because that would mean you are too soft
and womanly to be a doctor. So, you have to practice saying something to the effect of wanting children later in life because that is what your parents did and you valued having older parents.
In summary, a woman’s reproductive capacity is a liability to her candidacy for everything from pre-med programs through residency and fellowship applications, and no one seems to think there is anything wrong with that. In fact, it is considered by some to be a perfectly relevant deciding factor.