Women have entered medical school in nearly equal numbers to men for the last 20 years, with women under the age of 35 accounting for 60 percent of physicians in this country. These numbers sound promising for the future of gender equality in medicine as well as for female patients who often prefer female physicians.
But the numbers do not tell the whole story.
A recent study published in the Journal of the American Medical Association found that female doctors are more likely than their male peers to shift to part-time work or stop working a few years after completing their medical training. “Within six years,” the researchers found, “almost three-quarters of women physicians reported reducing work hours to part-time or considering part-time work.” All of the male physicians in this study were working full-time six years out of training.
Many medical students sacrifice personally and financially for school and training. The median medical school debt in 2018 was $200,000. Many also delay starting a family, while devoting their lives to the practice of medicine. Many physicians want, and need, to work full-time. The disconnect between intention and reality for many appears to arrive sometime after medical school.
As a future physician in medical school, my intention was always to take care of patients full time, while also having a family. As I start my sixth year as a full-time attending physician, with a toddler at home and a second child on the way, I wonder why at least three-quarters of my colleagues are struggling to make this work.
In an ongoing study that I am co-authoring of over 400 medical students in the millennial generation—born between 1981 and 1996—the vast majority, or more than 90 percent, of both males and females plan to work full-time. When the students respond on factors driving their specialty choice, the top three factors are the same for students of both genders: alignment with medical interests, job security and work-life balance.
But the often-invisible life burdens that women, and not just those in medicine, face at home render female physicians the “designated worriers” and caretakers for children and other family members, complicating their plans.
The vast majority of medical students enrolled in our study across genders expect to do 50 percent of the household work, but a 2018 study in Mayo Clinic Proceedings showed that female physicians with children spend 100 more minutes per day of household work than their male counterparts. Female physicians also experience more depression than their male counterparts, and women in general carry more student loan debt.
A 2018 study published in the Journal of General Internal Medicine demonstrated the different expectations patients have for female physicians. “Female patients tend to seek more empathic listening and longer visits, especially with female physicians; however, female doctors are not provided more time for this,” the study found. “Female doctors have more female patients than male doctors, and more patients with psychosocial complexity.”
Because of this, female doctors may have lower “patient satisfaction” scores and more emotional exhaustion, even though patients of female physicians have been shown to have better outcomes than male physicians in some instances, and many female patients express that they prefer female physicians. A diverse healthcare workforce is important for female patient advocacy and research, yet this attrition of a large proportion of physicians will surely contribute to the U.S. physician shortage. Replacing a physician costs between $500,000 and $1 million, adding to rising healthcare costs in the U.S.
The recent trend toward physician employment by large medical centers and groups and away from privately-owned practices may be no coincidence. This shift has greatly reduced autonomy and flexibility, and has added demands from hospital administrators, worry over patient satisfaction ratings, productivity and documentation. Added to family obligations, these factors contribute to burnout.
To be sure, female physicians have made great strides in the last several decades in terms of advancement and inclusion. Having the option to work part time could be considered a luxury, as many women and men do not have the option financially to work part time. But neglecting the advancement of female physicians is sure to have rippling effects for patients if not addressed. The future of medicine, and the futures of female physicians, relies on taking steps to change the trend.
One of the obvious first steps is a federal paid family and medical leave policy, which has been shown to improve health outcomes for women and children. For female physicians, who are most often employees, change must come from employers. Despite the huge monetary costs to health care systems when physicians leave or reduce their hours, most institutions have not been quick to make changes that are likely to help retain female physicians. Coordinating this in conjunction with the power of online ratings, in place now for everything from restaurants to babysitters, could help market forces drive change.
Melinda Gates proposed, in the September Harvard Business Review, strategies to “amplify external pressures” to attain gender equality in the workplace. She suggests that consumers—patients, in our case—can use their power to “reward companies that are part of the solution and punish those that aren’t.” The hope is that with concerted effort, the next generation of female physicians—who envision their full time careers and families with shared domestic responsibilities—will see equity as a reality. Fair is fair, and everyone deserves to see their intentions fulfilled.