Published Aug 26, 2003
Flooding the Field
When Lynn C. Epstein, M.D., graduated from Johns Hopkins Medical School in 1968, she was a rarity: Only about 7 percent of doctors at that time were women. Thirty-five years later, Epstein, clinical professor emerita for psychiatry and community health at Brown University, has lived through a world of change. Today, about one-quarter of physicians are women, and they make up close to half of all medical students, according to the American Medical Association. By 2010, women are expected to make up one-third of the profession.
In her view, the influx of women in medicine has changed not only the appearance of the profession, but also patient care itself. "As physicians, women have made an enormous contribution in understanding that there are diseases that affect women disproportionately, and differently," says Epstein, who is also president of the American Medical Women's Association. "And they've begun to get the message out that female patients have different needs that are legitimate and should be met."
Two of the best examples of women changing the healthcare agenda are creation of the National Institutes of Health's Office of Research on Women's Health and the launch of the Women's Health Initiative. Under the auspices of the WHI, the largest clinical trial ever undertaken in the United States has strongly questioned beliefs about the benefits of hormone replacement therapy. It's a far cry from the way women were left out of studies when Epstein first entered practice, when women were excluded from trials, because of concerns about the potential risk to those with undiagnosed pregnancies and their unborn children, among other things. "At that time, we weren't doing research on women of reproductive age because we thought we were protecting them," she recalls.
Women physicians also have made a difference for patients-male and female-in other ways. Studies have found that women tend to spend more time with patients and focus more on preventive care. For many female patients, they're also the doctors of choice. "I started the Women's GI Clinic because women wanted to come to a female gastroenterologist," says Cynthia M. Yoshida, M.D., associate professor and director of the Women's GI Clinic at the University of Virginia Health System in Charlottesville, Va. "They're half the population who receive colonoscopies, and I recognized that many preferred to have a woman do the procedure."
The cachet of having women in practice is not lost on those recruiting and hiring. "Hospitals and medical groups feel a definite market advantage to having female physicians," says Carol D. Westfall, president of the search firm Cejka & Company. "There's a whole patient population that has a preference for female physicians. The people hiring follow the preference of patients."
So has this increased interest translated into salary premiums for female physicians? According to the AMA Center for Health Policy Research in Chicago, women physicians had a median income of $120,000 in 2000-$75,000 less than male physicians. That doesn't reflect the fact that women gravitate toward primary care, work fewer hours on average and are less likely to own their practices: Studies and surveys adjusting for those factors still have found that female doctors earn less than their male counterparts.
The glass ceiling is most evident in academic medicine. A recent study by the Association of American Medical Colleges found that in 15 years, the proportion of female faculty who were full professors had risen just 1 percent, to ; ; nearly 11 percent. Women are equally scarce in the administrative ranks: Of 126 medical schools in the country, only nine have female deans, and there are only 241 female department chairs out of nearly 2,700 nationwide.
The scarcity of women on the academic side has a lot to do with family considerations trumping other factors in their career choices, according to Hedvig Hricak, M.D., Ph.D., chairman of radiology at Memorial Sloan-Kettering Cancer Center in New York. "I've seen candidates who could have had superb jobs, but their husbands wouldn't pick up and move across the country," she contends.
Administrative positions aside, the need to accommodate family concerns has made a clear mark on the healthcare workplace. Flexible and part-time work schedules unthinkable a decade ago are now commonplace. Holly Novak, M.D., at one point gave up an interventional cardiology practice because the call schedule conflicted with her responsibilities as a single adoptive mother. Now director of the Cardiac Rehabilitation & Prevention Center and the Women's Health Program at St. John's Hospital's Prairie Heart Institute in Springfield, Ill., Novak sees practices much more willing to find solutions for female physicians.
Although women in medicine spurred the move toward more flexible schedules, male physicians appreciate the change just as much. "Both male and female doctors under the age of 40 place more emphasis on work-life balance and are not necessarily willing to put in the hours their older colleagues did in years past," says Westfall.
Some specialties are more amenable to flexible schedules than others, which probably explains why more women are in primary care, experts say. "Internal medicine gives women a lot of flexibility because there are so many different types of job and work situations. But if you're a surgeon, you're glued to a hospital because you've got to have an OR," explains Sandra Adamson Fryhofer, M.D., an internist in private practice in Atlanta and past president of the American College of Physicians.
As women flood the field, observers predict they'll make further inroads in improving women's health. "Women are very concerned about preventive care and I think we'll see more emphasis on preventive care and lifestyle management," says cardiologist Cheryl Pegus, M.D., M.P.H., Blue Bell, Pa.-based national medical director for Women's Health at Aetna Inc. "My hope is that the trend in increased cardiac disease among women will also be impacted by female doctors in the field."
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