There's a fascinating OpEd piece in the The New York Times that analyzes how women differ from men as doctors and how our increasing percentage of women med school students impacts our supply of doctors long term. I encourage you to read it since the author is much more articulate than I will be in summarizing and it frames the discussion and problem quite well that I'm mentally digging through here.
Essentially, there is a limited amount of funds for residencies, creating a bottle neck and limiting the number of doctors we can field. Women are applying for these in record numbers since they're attending medical school in record numbers. Women now compose 48% of medical school graduates, but the American Medical Association has survey data indicating they work, on average, 4.5 hours less per week and see fewer patients than their male peers. So as we move towards a more gender balanced field of doctors we are likely seeing doctors work less. The OpEd rightly points out that this is a big problem since we face major doctor shortages in key areas. This problem is compounded since women disproportionately enter many of the areas of shortage and in addition to working fewer hours they are also more likely to work part time and take a leave of absence.
So assuming we can't significantly change the number of doctors created each year, which the OpEd suggests is a fair assumption since residencies are federally funded and we all know about the budget deficit, and we need more patient services than we have, we have to ask if doctors can be used more efficiently or if they can be more productive. And since we're facing this shortage it begs a question around if training women doctors is the most efficient usage of our limited training resources since the productivity of women doctors is significantly lower than male doctors.
Please note that I am not advocating any changes to how professional schools or medical schools select their students. I think the more voices and diversity across all metrics we can get in these professions, representing different points of view, the more productive and effective the profession will be. However, I do think this area is deserving of examination and discussion since it's the only way we can work to develop ideas to improve the situation.
I've heard similar sentiments before. I have a friend that attended Princeton who in private confided that he wished the school would go back to being all male and thought the institution would have more impact that way - the female students were not nearly as professional minded as the male students and their career services office found that a large percentage of them did not work full time more than a few years out from graduation. I have a female friend from Texas who resented her female classmates to some extent because, as she put it, they were in college to get their MRS (Mrs.) not a degree for real career or profession.
We have, as a society, have come a long way in the inclusion of women and we still have a long way to go when it comes to some areas (glass ceiling anyone?). Certainly bringing women into the workforce has created a major increase in economic productivity and has brought new ideas and methodologies to market. However, these sentiments above are less than three years old and have some basis in fact as the survey data from the American Medical Association shows. So here's the question: if women are making up a larger and larger percentage (though still not 50% in many cases) of students at our professional schools but aren't as productive as men are we losing out economically as a society?
The number of spots in residency programs is limited by the federal government and the number of students who can attend top programs in business and law is limited as well. I would guess that business and law school graduates have similar trends to medical school graduates with women leaving the work force at a higher rate or contributing at a lower rate (time-wise) than men. In this context what is the best way to allocate our limited educational resources? How do we account for the wide standard deviation in productivity within a gender? There are plenty of women who are more productive than the average man in their profession and there are plenty of men who are less productive than the average woman, eliminating hard and fast rules. How can we encourage women to be more economically productive and meet their needs for work life balance in a cost-effective way? We also need to note that commitment to family and work life balance isn't limited to women. We're also seeing more stay at home dads or fathers adapting their work schedules to spend more time with their children just not in nearly the same numbers or to the same degree as women.
I think this will be constant and growing issue over the next decade. Baby boomers with more traditional demographics are retiring or will be soon and so the new demographic with more women will become a larger force and more prominent. We're also, as previously mentioned, seeing more women attending top professional programs. This Wall Street Journal article puts the Harvard Business School class of 2013 at 39% women and Wharton's at 45% which is an enormous gain from ten, much less twenty, years ago though still not the 50% that would be truly representative. I, personally, am a little worried that women's continued interest in work life balance and significant deviation from men in the number of hours and years they are willing to work might reverse some of these gains. Why would Wharton, Princeton, or any other school or company continue to select women if they spend less time in the workplace? There is public sentiment to support inclusion of women, but I don't know if it's enough to overcome either women's own preferences in how they work or other societal pressures on them to be the primary caregiver to their children. Do you think that the workplace values the contribution of women enough to adapt to their needs?
Okay, wow, that's a lot isn't it? I certainly can't wrap my head around all the implications, but I would love to hear your thoughts.
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I started to type up a slightly mocking response to this op-ed, but then I went back and reread your post. Your final paragraphs covered most of my points.
ReplyDeleteI think that given that we cannot say that there are inherent sex-based differences between the intellectual faculties of men and women, these 4.5 hours can be relegated to the twin pressures professional women still battle more sharply than their male peers of success in both professional lives and personal lives.
As for the original op-ed in the NYT you mentioned, the author makes a convincing case backed from her own experience living life as a doctor. I'm afraid, however, that she is certainly projecting the "If I did it, so must you" fallacy. What works for one person doesn't work for everybody. Should individual hospitals be able to have their young doctors sign contracts stipulating hours/performance requirements? I wouldn't be opposed to that, but I don't think that medical school admission is the appropriate place for this screening to take place.
If anybody wants to be a doctor enough such that they are willing to incur the educational debt that goes along with it, one must trust they will do what they feel needs be done, whether they are refused a place at Mayo's Medical School due to somebody who will later decide to leave the profession or not.
1. What metrics are we using and why? Is productivity measured only in workplace HOURS, and is "productivity" the only thing we should measure? Perhaps the strengths of female doctors are qualitatively different in ways that counter the quantitative loss of hours.
ReplyDelete2. Perhaps all MDs should work less hours, to improve their health (and therefore performance) and professional development--and what we need are more doctors spread broadly.
3. These gender workplace problems and questions will probably persist as long as we place different demands on female professionals' time and resources, and refuse to acknowledge the personal needs of all professionals (e.g. people do need sleep, time with their families, etc).
I have a couple of thoughts here. I work for a Japanese company and I see many of my Japanese counterparts never getting ahead or promoted though they are just as educated and certainly work hard. The difference they tell me is that managers are weary of hiring and promoting women because eventually they leave to have babies or get married and reduce their work hours. Because of this stupidity this company has a vast untapped resource in a lot of women that are not considered equal.
ReplyDeleteQuite honestly the women here that get ahead ARE the ones that sacrifice having families and it's a very hard decision to make. Men have less of that burden because they are not physically attached to the aspect of carrying babies. Granted, not every woman wants kids but when the choice comes down to family or career it's not an easy decision.
With that said should women be given less opportunity? No. These days I see more MEN choosing to staying home and raise children. In my small office we have 3 such spouses to the women working here.
The problem with the doctors is the artificial supply constraint. Without that, the decreased hours could actually be made up for with increased employment opportunities for others. I would think that many of the other professions would find this to be true. Job sharing and part-time work is feasible and could be used to help foster family and work balance.
ReplyDeletecashflowmantra - The supply constraint is absolutely what makes all of this a more pressing issue. There's also a supply constraint for top-tier professional schools in general. Harvard, Stanford and Yale will not expand class size and thus supply quickly enough to meet demand or to balance falling worked hours. Personal choices would be far less of an issue without the supply constraint.
ReplyDelete1. I've read that Op-ed and it's going the rounds on medical blogs. Regarding the idea of "debt to society", while it's true the federal government pays for residencies, it's also true residents repay their "debt" or obligation to society by being high-trained professionals who work 80-hour weeks for $50K a year. I think with any occupation that requires 10 years of training and so much sacrifice, there is an inherent constraint / lead time required in building the pipeline. You can make a career switch into medicine, but it's a long and difficult process.
ReplyDelete2. How to achieve a satisfying career with a good home life is a question for both men and women, as you've correctly observed. And your friend from Princeton.. I just.. have no words.