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“Patropoly” in Practice: Medicine in America


Doctors are powerful people in the United States–perhaps this leads the men in charge to think they are above the law.  So I have invited anonymous blogs about these experiences.  I have edited posts slightly to protect identities, but have tried to leave the urgent “first person” tone, so that readers can get a sense of the intensity of the circumstances.

There will be at least four posts, each outlining a different issue:  admissions, evaluations, on-the-job harassment, and selection of specialty.

From an economic perspective, these practices are maintaining male dominance of a lucrative industry.  Building on terms for similar phenomena– “monopoly” or “oligopoly”–I have coined the term “patropoly” to describe a system of exclusionary practices aimed specifically at the pressure points of gender (reproduction, sexual harassment, etc.) that work to keep an entire economic sector in the hands of men.

It is important to acknowledge that the overall numbers for women in medicine make it appear that substantial change has occurred. But, as so often happens, the constraints of gender push women into subspecialties where hours are more predictable and pay lower. So, the more men are in an area of specialization, the greater the demands on time and the higher the pay.


My dad, while still in Yale Medical School, about 1952. I think you can tell from the pose: "macho" doesn't begin to describe it. I was--and am still--desperately proud of my father, who became a brilliant surgeon and world renowned medical researcher before his death in 1991. But I have to tell you that growing up in the gender environment of Texas medicine was like being born on the set of Mad Men.


I myself come from a medical family.  I grew up in the very highly respected (and testosterone-intense) environment of the Texas Medical Center in Houston (during the era of rock star heart surgeons).  I remember being very proud of my father and my stepfather–both top surgeons–when they had to drop everything, even in the middle of the night, to see to a patient.  However, though I still have great respect for the practice of medicine, I do not feel that the huge disparities in income or hours are a natural outgrowth of these demands for emergency care.  If that were the case, all kinds of emergency personnel from nurses to paramedics to firemen and police would be equally well paid as surgeons.  But they are not.  And it is certainly not the case that the greater hours are a desirable outcome of the high level of expertise needed to make life-and-death decisions.  Quite the opposite: Nobody wants a strung-out, sleep-deprived doctor making decisions about their health.  And I see no reason why it should be part of medical training and practice that excruciating hours are required. Instead, it seems pretty clear to me that, in this circumstance as in other male-dominated fields (law, management consulting), the long hours increase as part of an economic intention to keep women out.  The result is a tragedy for everyone:  women are excluded, patients get frazzled care, and young men are also pushed to work stupidly unnecessary hours.  All in the name of keeping the girls out.  It’s appalling.

I welcome comments on the coming posts, which will begin tomorrow. In addition, I think it is likely that other very lucrative sectors–finance comes immediately to mind–would follow the same pattern and I would welcome other series.

For other posts in this series: post on medical school admissions is here, post on hiring and evaluation is here, post on sexual harassment in hospitals is here.

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