Conflicted: Women in medicine

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Tuesday, October 3. 2017

Conflicted: Women in medicine

At least 50% of American medical students are women. That has been a dramatic cultural change in the profession, at least in the US. When I was in medical school we were around 20%.

When I was sent this article, Majority of U.S. Physicians Now Support Single-Payer, I thought "That's the women!" Then I felt conflicted.

At the obvious risk of being assaulted for stereotyping and demeaning females in my profession, I will share some of my observations (with countless exceptions, of course):

- Women in medicine are very smart and detail-oriented. Excellent students without much rebellion or cantankerousness. However, they are often too much "by the book" and rule-oriented to adjust to specific situations. I have fought this in myself. The men tend to be willing to take more risks, less rule-bound, more blunt, and willing or eager to work ungodly hours. Definitely more defiant and skeptical of authority.

- Women in medicine tend to view it more as a career than as an identity. Men in medicine have traditionally seen it as their raison d'etre, members of an ancient priestly caste. Men in medicine feel heroic and manly about responding to that 3 AM phone call, women generally not so much.

- As a career rather than as a 24 hr/day identity, women in medicine tend to be more comfortable with a regular paycheck, defined hours of responsibility or even part-time hours of duty, and good job benefits. That often means working for somebody else.

For better or worse, the coming dominance of American medicine by women will be changing the culture of the profession. Other influences, like the emergence of large group practices, and of hospital-owned practices, are changing the character of American medicine too.

Posted by Dr. Joy Bliss in Hot News & Misc. Short Subjects at 13:56 | Comments (30) | Trackbacks (0)

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Send these female idiots to North Korea, Cuba, and Venezuela for a YEAR
(FORGET about Canada, England, etc etc)
and let them EXPERIENCE their glorious utopian "single payer" in action.

Then, revoke their passports for another year.
Let them back ONLY AFTER they've learned their lesson.

#1 Kauf Buch on 2017-10-03 14:58 (Reply)

Dr. Bliss, after 33+ years as a male M.D. always in clinical practice, military, VA and civilian, solo and employed, I have to say that your observations are absolutely correct. Including your caveats. I don't enjoy getting rolled out of bed at 0300 for the GI bleeds etc. but I cannot deny the sense of validation it gives me, and as I approach retirement I find myself wondering what I am, if not a doctor, the guy who rolls out at 0300.

#2 Khornet on 2017-10-03 15:21 (Reply)

I seem to see women doctors more likely to be in family practice, pediatrician, general medicine. But look at the surgeons...all men. Rarely do I see a woman. I think b/c of the reasons you listed above for how men view the profession of doctor and their dedication to work ungodly hours.

My husband is able to work out in our yard all day long doing heavy labor for hours and hours w/o more than a break for a Gatorade. He will even forget to each lunch until 3 pm or work until his muscles have literally given out on him and cramp uncontrollably.

I prefer to do labor in 1-hour to 2-hour chunks with breaks between. Part of that is my stamina. I just don't have the capability to stack wood all day long with no break or what have you. I'm sure part of that is my all over conditioning, but I will bet a lot of it is men vs. women when it comes to work.

#3 MissT on 2017-10-03 16:47 (Reply)

I agree with everything you said. One addition though. There’s a nationwide shortage of docs. Everyone knows this. But what they drastically underestimate is the tendency of female docs to work part time once they decide to start families. Almost all of my peds colleagues who are female go part time once they have babies. We’ve been replacing retiring male physicians with two females because we fully expect them to go part time which inevitably happens. The problem is that there arent two out there to hire. Medical schools haven’t expanded. This means we’re about to hit an unbelievable crisis soon. No matter what national healthcare plan is passed the crisis will worsen. There are no docs to see you.
And in peds what happens is that our first time moms flock to female docs at first because they seem relatable. This only lasts for a couple of months because these moms realize their own female docs just aren’t around to see them. We wind up seeing them and treating them. My workload has drastically increased because the female docs aren’t pulling their weight.

#4 Doc g on 2017-10-03 16:49 (Reply)

Came here to say exactly this - that the majority of female MDs I know cut back on their hours once they have children.

This is NOT a bad thing, but since 50% of graduating MDs are women, common sense indicates that we should be creating more MDs to offset the large numbers of MD moms who will not be working full-time for 10 - 15 years.

#4.1 JM01 on 2017-10-04 12:12 (Reply)

I was just talking to a doctor friend of mine about these same issues.

I live in a small town with a rural hospital. I grew up with GP's who were - by and large - men educated in the US. They owned their own practices, owned their own offices, and employed their own nurses and staff. They were solid members of the community and trusted friends and advisers to many. In an emergency you could call any of them on a Sunday afternoon and they would come to your house and administer to you. They did very well financially - but I don't think that was what motivated most.

Today, almost all of the GP's (and specialists) are in hospital owned practices. My doctor friend says the first three questions he is asked when recruiting are - 1. How often do I have to be on call? 2. What are my hours? 3. How much vacation do I get? He says pay and benefits are 5th or 6th on the list of questions.

My observation of these new doctors is that they are not really committed to their patients or community (again this is a generalization - don't roast me). When you are just an employee - you can move to a new job or new town at will. You are not held by the three or four generations of a family that you have treated over so many years. The babies that you have delivered - and their weddings that you have gone to.

My wife had a internist that she liked - he staid two years and decided that he wanted to be a "hospitalist" in another city. He was gone in an instant.

Maybe I am sentimental - but I think it is a shame. I think patient care suffers - because the new doctor didn't treat my grandfather and know that he had a stroke and my father had plaque removed from his carotid artery. He/she is not watching me for it because he doesn't know me or my family.
He/she works 8 hours and punches out.

I agree that some of it is that women are more family oriented and less willing to work 16 hour days. I think that foreign born doctors are likely to be less committed to a small rural town and consider themselves more mobile. Again I know plenty of both that are committed and do work long hours - but in general this is my observation.

This is not to impugn their intelligence or medical skills. it does, however, change the way medicine is conducted - and in my opinion - not for the better

#5 jg on 2017-10-03 17:03 (Reply)

There’s a nationwide shortage of docs. Everyone knows this. But what they drastically underestimate is the tendency of female docs to work part time once they decide to start families.

I have been teaching medical students in a small group setting for 15 years. It isn't just the female students. They all are in the employee mindset. The last few years before I finally quit, I had groups of engineers doing medical school because I had been an engineer. They are probably a bit more entrepreneurial but few students are like we were 50 years ago.

#6 Mike K (Link) on 2017-10-03 18:05 (Reply)

I’ve got a business partner with two sons in Medicine (one in practice and one in Med School). It was clear that when they were applying that the 50% quota for women was strongly enforced.

#7 DirtyJobsGuy on 2017-10-03 18:24 (Reply)

Women make better students.

#7.1 Bird Dog on 2017-10-03 18:27 (Reply)

I think you mean to say,
"women are SUCH better students,
that they REQUIRE LAWS FORCING SCHOOLS TO ACCEPT THEM."

rolls eyes

#7.1.1 Kauf Buch on 2017-10-04 02:52 (Reply)

Even laws that require taxpayers to pay tuition for female and minority students but not white male students. Even laws that discriminate against white males on campus and favor, probably in an unconstitutional way, female students. Even surreptitious efforts by colleges and politicians to qualify unqualified females and minorities and disqualify white males.

#7.1.1.1 OneGuy on 2017-10-04 10:27 (Reply)

Now that I'm older and have a few chronic health problems I get to have a lot of interaction with doctors and health care professionals. I have few if any negative interactions and for the most part I love my doctors, nurses and other medical care givers without regard to gender. I do find that female nurses seem more committed to their "in hospital" patients where the male nurses seemed less caring or perhaps more accurately only did what was required without much personal interaction. My last surgeon was a female and like all of my surgeons I am extremely gratified with their efforts and success.

One "odd" comment; my Ex did not like female doctors and preferred men. She felt uncomfortable, for example, with the idea of a female doing a breast cancer exam or gynecological exam on her.

#8 GoneWithTheWind on 2017-10-03 18:48 (Reply)

Women have practically taken over the veterinarian business. There are still men in the big animal part of the business where strength is required.

#9 Ray on 2017-10-03 19:20 (Reply)

Been practicing law--the in-the-courtroom variety--40 years. I have seen the radical shift toward female lawyers, and yet, mostly in the support staff, not the lead chair barrister types. The same characteristics that define female doctors also apply to female lawyers. As for me, I'm glad to be looking to retire soon. It's just not as much fun to play with girls.

#10 Law Dog on 2017-10-03 19:21 (Reply)

I very much prefer female doctors and dentists. More compassionate, caring, and helpful. They seem to prefer the tried and true medicines and procedures. I like to go right to the known good fix and not be messing around with newer stuff.

#11 Fred on 2017-10-03 20:54 (Reply)

Might have something to do with young women being more likely to be radical left wingers than young men and the campus culture being extremely hostile towards anyone who is not a radical left winger, especially men?

And yes, of course the radical left wing wants single payer, or at least what they think single payer is (meaning, paid for by magically appearing money from the government while retaining all the quality of care and product that they're used to seeing from their youth, not the factory style minimalist healthcare it really it. And of course the higher wages of the market driven system rather than the starvation wages of slavery).

#12 JTW on 2017-10-03 20:55 (Reply)

I don't think it's necessarily a "woman" thing--it's more likely to be that science/engineering/technology people are easily manipulated by rhetoric. "Single Payer" makes sense to them: lack of wasteful competition, far fewer forms to fill out, a rational healthcare system, no one suffers from lack of care, etc. The reality that "Single Payer" is a slick advertising slogan for "a government bureaucracy with total control over everything from your treatment options to your salary, and one that will be just as efficient, responsive, flexible, and caring as the DMV, IRS, and public school system" is something they cannot grasp.

#13 Joe Y on 2017-10-03 20:56 (Reply)

Yes, "...but the trains ran on time..."
Ever hear that before (PRO TIP: Mussolini)?!

Efficiency...perhaps...WITH A PRICE.

#13.1 Kauf Buch on 2017-10-04 02:49 (Reply)

My wife and I are both physicians in our 60s. While there has been a long tendency for women to prefer certain specialties - pediatrics, radiology, dermatology, etc. - that are more compatible with part-time practice and/or making time for a family, I don't think that the recent acceptance of single payer (let's call it what it really is - socialized medicine or just plain socialism) is as much a man vs woman phenomenon as it is a generational phenomenon.

Each generation since the 50s has been increasingly indoctrinated by our schools into accepting - and indeed embracing - socialism and "social justice." They have been taught that emotions or FEELING GOOD about what you do is better than careful thinking (analyzing the facts) about a course of action and actually DOING GOOD.

In the American Conservative article, one young (and foolish) doctor states that interposing a single payer between the doctor and the patient will restore the doctor patient relationship. He fails to apply common sense and appreciate that when the doctor is solely dependent on "single payer" (i.e. a government bureaucrat) for his paycheck, he will do what pleases the bureaucrat rather than what pleases the patient. The young foolish doctor feels good parroting the left-wing garbage, but he doesn't bother to really think about the situation.

#14 mike m on 2017-10-03 21:32 (Reply)

I'd turn your argument around:
in a single payer system,
there is no longer ANY doctor-patient relationship.

There is the politician/regulator/bureaucrat* (AKA "Death Panels") as
the "Head Doctor," telling the underling Junior Bureaucrat
(formerly known as Your Doctor)
what procedures may or may not be provided to the serf,
who exists merely to
A) justify the government Program and
B) eat up the Government's money (you may "think" you earn it, but - no! - they can take it as a tax, so it's theirs (/s) ).

This is exactly why such nationalized systems fail,
because they strain the budget so greatly,
that services must keep getting reduced and reduced,
with waiting times extended longer and longer.

#14.1 Kauf Buch on 2017-10-04 03:30 (Reply)

"there is no longer ANY doctor-patient relationship"
It's pretty much that way now. I'm on Medicare and quit getting annual exams because my PCP told me, "Unless you have any symptoms, you don't need these exams." What he was really telling me was, "Medicare only reimburses me $16 for this exam, so don't waste my time unless you have something where the reimbursements are higher." I can't really blame him I guess.

#14.1.1 snopercod on 2017-10-04 07:57 (Reply)

How is that different than what I said?

#14.1.2 mike m on 2017-10-04 23:38 (Reply)

Well, then, it seems we're saying the same thing with different words.

#14.1.2.1 Kauf Buch on 2017-10-05 02:23 (Reply)

It makes sense that female doctors would not be much different from women in other fields. Part time work and staying home for a while is a main reason women make less than men (and generally they are in less physical risky jobs). The article http://www.dailymail.co.uk/debate/article-2532461/Why-having-women-doctors-hurting-NHS-A-provovcative-powerful-argument-leading-surgeon.html, points out that high achieving women tend to prefer high achieving men, and when they marry, the women do not have as pressing financial needs. This article points out that it requires more female doctors to provide as many services as male doctors, which means doctor shortages when they are not being produced by med schools.

Teaching was heavily female because it is a family freindly occupation. I know men are going into these, and the intangibles, like time off, is attractive to the new generations.

#15 Ren on 2017-10-04 06:15 (Reply)

Great thoughts in this string - thanks for posting! Here's one more:

Dad (now 82) was an Orthopaedist with a PhD. Mom (75, still working) is an OR nurse with a doctorate in healthcare management. Spent a lot of my growing up time sitting at nurses stations. Heh. They watched managed (socialized, etc) care grow with a commensurate demand to cut costs.

Nurses naturally began shouldering a lot of daily caregiving tasks because they were cheap(er) labor. Some nurses, who also began collecting licenses to deliver this care, realized that medical school wasn't much more demanding than what they were already qualified to do. Even though they knew they weren't going to be compensated the way many specialists were, the difference above their current salary and quality of life was enough to merit going to med school.

Looking at my own parents, my dad's doctorates were purely clinical. He hated the bureaucratic piece. Always said the 20% doing surgery and patient care was just enough to offset the 80% of PITA stuff.

Mom was willing to add bureaucratic skills to her resume. Perhaps women are more willing to do that, which makes them more suitable for today's healthcare models.

#16 Bull on 2017-10-04 07:53 (Reply)

My mom was a nurse and said if she had to do it all over again, she'd have went to be a doctor.

#16.1 Ren on 2017-10-04 07:58 (Reply)

My late Mom, born in 1925, was a nurse but had wished to go to med school instead.

I follow the LCME page on accrediting new med schools, because I am amazed at the qualified young students who get their dreams dashed when the musical chairs stops and they haven't been accepted to the very limited number of seats in med school. http://lcme.org/directory/candidate-applicant-programs/

Always interesting to see where the new med schools are opening.

And when my poor Mom was dying in the St E's hospital in Boston I received such a shock. Her doc ordered a GI consult, and the GI 'doc' came while I was there. That rat, in an indecipherable accent, fired off some questions (maybe, who knows). My polite little Mom, hard of hearing, quietly said what was going on with her. Recall, she was a nurse, so a knowledgeable woman with whom a real doc could discuss symptoms and protocols. So, she was soft spoken, he made no effort to hear her, and he incoherent. As the doc-rat turned to leave, his consult done and billable, I asked him to hold on a moment. I then pointed out the zero information had travelled in either direction and asked him to stay until he could make himself understood.

So this foreign doc works at a Boston med center while Joe all American student gets his shot at med school killed, not because he isn't smart enough or can't do the work, but because med school seats extremely limited in number.

And, my husband is icu doc called in at wee hours and all hours. He has saved so many people and put them back into their lives, it is breathtaking! He's valiantly plugging along as independent business, but it's harder and harder.

#17 Jayne on 2017-10-04 09:04 (Reply)

Also, I meant to add, when my husband was in med school in the early 1980s, half of his class were women. I am trying to imagine the class makeup today!

He did the military program, so military paid his med school, and he did his residency and fellowship with military. Back then the military med corps had an extremely high proportion of women. It was very surprising. Again, I can only imagine the proportions today.

#18 Jayne on 2017-10-04 09:11 (Reply)

I am a retired surgeon and my wife is a retired nurse practitioner. Her new primary care internist graduated from St Georges Medical school in Grenada. Times have changed. The doctor shortage will not be fixed as each new class works less than we did. The numbers will go up but the numbers will never catch up. Also thousands of young doctors are leaving the NHS in Britain and emigrating to Canada and Australia. They are being replaced by foreign graduates with limited English skills like that described above by Jayne.

#19 Mike K (Link) on 2017-10-04 10:10 (Reply)

It's not just their English skills. It's their lack of desire to communicate with people they feel are beneath them. In some countries, only certain classes can get into medicine and they bring their uppity attitudes with them when they come to the US.

#19.1 mike m on 2017-10-04 23:45 (Reply)

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Tuesday, October 3. 2017

Conflicted: Women in medicine